Welcome back to the Healthy Muse!
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Also, I just posted the top 53 healthcare stories from the third quarter of 2019. Take a peek here.
This week’s must-read healthcare stories:
Telemedicine and the $2.1 billion fraud case
The FBI gets a big win.
Under the guise of Operation Brace Yourself (nice name, FBI), the FBI made a major bust in one of the biggest Medicare fraud schemes to date – 24 people were charged in the $2.1 billion heist.
This isn’t GTA.
The ring of 24 decided that they were going to inappropriately bill Medicare for medical equipment that patients didn’t need. As a part of the scheme, the equipment companies told patients to use virtual care to expedite the process and have it billed by Medicare. After scamming Medicare for $20 million a week, the government finally caught on and brought down the hammer.
Two peas in a pod – healthcare and fraud. (I seriously did not mean to rhyme that).
Healthcare and fraud go hand-in-hand, especially with Medicare (search ‘Medicare Fraud’ on Google and let me know how many hits you come back with). Unfortunately, elderly folk are easy targets for scammers. This type of fraud might be a bad side effect of telehealth, since the physicians unknowingly involved in the scam could not physically examine the patients.
Read the NPR Feature story on the increasing number of Medicare Fraud cases here.
Novartis and Microsoft Partner on Artificial Intelligence in Drug Development
An A.I. Innovation Lab.
It doesn’t get more buzz-wordy than that. This week, Novartis (a huge pharma company) and Microsoft (you know what Microsoft is) announced a strategic collaboration to advance artificial intelligence’s role in drug design and creation.
The Deets.
The multi-year partnership will build joint research activities and “A.I. innovation labs” with the hopes of developing personalized therapies specifically focused on macular degeneration (ophthalmology is big $$$), cell and gene therapy (often thought of as the next frontier in drug development), and overall drug design. This alliance is just the latest example of the transforming life sciences industry.
Nobilis Health gets delisted, loses 3 executives, and closes 5 facilities
Bad day?
You could say that. This week, the NASDAQ notified Nobilis Health, an operator of hospitals, outpatient clinics, and ambulatory surgery centers, that the company is getting delisted from the stock exchange after failing to comply with public financial disclosures – the company hasn’t disclosed one since the end of 2018, actually.
When it rains, it pours.
That’s not all Nobilis is facing, either. Over the last couple of months, the firm lost its CEO, CFO, and CLO. Over that same time period, Nobilis closed 5 facilities. Finally, not to be outdone, the company’s lender, BBVA Compass, is demanding back a smooth $130 million in loans.
2020: The Evolution and Explosion of Medicare Advantage
Wi(Medicare Advantage Supplemental Coverage)nter is Coming.
Brace yourself for Medicare Advantage explosion in 2020. All of the major payors are gearing up for the year. Cigna is planning its biggest ever MA expansion. UnitedHealth is expanding into 100 more U.S. counties (and you thought they ALREADY were everywhere, didn’t you?).
Supplemental Coverage
Anthem, Aetna, and Humana are in the mix too of course. What’s interesting about the plans going into 2020, though, are the supplemental coverage options that CMS is phasing into Medicare Advantage plans. For instance, Anthem is getting creative with these alternative options, including such services like…pest control. Other offerings might include odd benefits like acupuncture, transportation assistance (shout out Uber and Lyft), and other similar services that could be beneficial to seniors.
Policy Corner, week of October 7, 2019 – Protecting Medicare from Socialist Destruction
Trump has a vision for Medicare
This week at a rally in Florida, Trump gave insight into the healthcare executive order he had signed earlier that day. Originally titled “Protecting Medicare from Socialist Destruction,” the order, now called the more-official-sounding “Protecting and Improving Medicare for our Nation’s Seniors,” is somewhat lacking in policy, but does give a positive nudge toward Medicare Advantage as the future of Medicare.
The rest of the order includes generic language surrounding lowering healthcare costs, eliminating inefficiencies, promoting innovation, and more.
DSH cuts get pushed back by Senate
The ever-looming DSH cuts were pushed back once again by the Senate this week. Remember that the DSH, or Disproportionate Share Hospital, program, is designed to reimburse hospitals with a larger population of uninsured or charity cases. Efforts are being made to reform and revamp the DSH program. In other legislative news, lawmakers are looking to repeal and/or extend the delay of the medical device tax.
The FDA might have a new head soon.
Finally, Trump is expected to nominate Stephen Hahn as the next FDA commissioner.
Quick Hits
Biz Hits
- Google Cloud and Meditech are collaborating to build an electronic health records platform to be held exclusively in the cloud. Read about the partnership here.
- Amid a push for growth, for-profit hospital operator Steward Health reported a $592 million operating loss.
- The Pennant Group, a home health and hospice operator, just spun off from its parent company, the Ensign Group. Read about the announcement and its plans here.
- UPS is expanding its previously announced medical drone delivery service nationwide.
- SmileDirectClub is getting shorted. Big-time.
State Hits
- In Philadelphia, a judge ruled that supervised injection sites does not violate federal law
Other Hits
- Doctors Limit What To Tell Patients About Their DNA Test. Should They?
- When Masculinity Turns ‘Toxic’: A Gender Profile Of Mass Shootings
- Walmart pulls Zantac from shelves, joining CVS, Walgreens
- Other drugmakers are looking to participate in Purdue Pharma’s bankruptcy in an attempt to settle opioid lawsuits.
- Speaking of opioids, a doctor was sentenced to 40 years in prison for illegally prescribing them in Virginia.
My favorite reads this week
The 10-year sentence for Amber Guyger triggers chants of protest — and a hug of forgiveness
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