"Jaws dropped at news this summer that the federal government was seeking as much as $3.3 billion from drugmaker Novartis for allegedly paying kickbacks to pharmacies.
But the feds aren't the only ones trying to make Novartis pay up on false claims allegations, and it's not just Medicare dollars at stake. Eleven states are also parties to the lawsuit under the authority of their own false claims laws. They're seeking to recover money paid out by their state Medicaid programs.
The Novartis case is the latest example of states using their own false claims laws to pursue questionable Medicaid billings by drugmakers, healthcare providers and suppliers. Lured by the potential for big paydays, several states, including Maryland and Vermont, passed or expanded their false claims laws this year, bringing the number of states with their own false claims statutes to nearly 30, according to the Taxpayers Against Fraud Education Fund.
Many state false claims laws are similar to the federal law, financially penalizing those who knowingly submit false claims to state programs such as Medicaid. Many of the state laws also allow whistle-blowers to initiate lawsuits on behalf of the state."
Read more at Modern Healthcare
"National Nurses United and the affiliated California Nurses Association say they've won the rights to unionize nurses at Kaiser Permanente's flagship hospital in Los Angeles, months after it called for a strike at the hospital despite not representing its nurses.
NNU won the vote Thursday at Los Angeles Medical Center by nearly 70% with 696 votes, beating out the San Dimas-based United Nurses Associations of California-Union of Health Care Professionals, which received 305 votes, according to NNU. One nurse voted against unionization in the secret ballot vote conducted by the National Labor Relations Board, the union said.
In April, NNU called for nurses at LAMC and eight other hospitals to go on strike over concerns about nurses staffing, even though LAMC's unionization vote was yet to take place. Kaiser criticized the union's tactics and said it was “entirely inappropriate to attempt to disrupt patient care or service as part of a union organizing effort.""
Read more on Modern Healthcare
"It’s one of the grand ideas that is supposed to revolutionize U.S. health care: reward doctors who keep patients well with fewer tests, procedures, and appointments.
That might register as barely profound to most of us, but it is a radical shift in the incentives that doctors and hospitals face. Under the Affordable Care Act, some doctor’s groups and hospitals have banded together in accountable care organizations to treat Medicare patients under this new philosophy. If the patient stays healthier with fewer appointments, the providers get a share of the cost savings.
But a new study published Monday in the Annals of Family Medicine examined how doctors have been making money in this brave new world vs. the status quo, and found pretty negligible differences."
Read more on Washington Post
"Nearly 100,000 Americans are hospitalized each day. That adds up to nearly 40 million hospitalizations per year. With so many lives at stake and so many opportunities to hone their care, hospitals could be expected to meet demanding quality standards. After all, manufacturing, commercial aviation and other major industries have achieved high degrees of consistency and safety.
But health care is different. Some hospitals excel in treating exceedingly difficult cases, while others too often fail even patients whose medical needs are relatively straightforward. As a result, health care consumers need to take care when they choose a hospital. To help patients make smart, well-informed choices, U.S. News has published annual hospital rankings for more than two and a half decades. These rankings and the quality data from which they're derived highlight hospitals that perform best in specific areas of care.
The focus of the Best Hospitals rankings has long been on meeting the needs of the most challenging and medically complex patients. These patients represent cases where the stakes are greatest – often a matter of life or death – and where, for some patients, it makes sense to venture beyond a trusted community hospital to seek care at a truly exceptional medical center. With these patients in mind, U.S. News today published its 2015-16 national rankings, which cover complex care in 16 medical and surgical specialties."
Read more on US NEWS
"If you've ever waited to see a specialist in the emergency room, you'll be happy to know that a new app, the so-called "Instagram for doctors" could put a specialist at your doctor's fingertips in minutes rather than hours.
The app, called Figure 1, allows doctors around the world to upload anonymous photos of their most compelling (and confusing) cases to a photo sharing platform with goals of trading information and asking for advice.
"Images and learning medicine go hand in hand," said Dr. Josh Landy, the app's creator and a doctor in an intensive care unit in Toronto. "Images have been used in medicine to teach and learn for thousands of years." "
Read more on Huffington Post
"Pager, a Manhattan-based doctor-on-demand service, has raised $14 million in Series A funding from Maryland-based New Enterprise Associates and Ashton Kutcher's Sound Ventures.
The funding will be used to expand to cities outside New York, including San Francisco within two months, and to upgrade the company's technology, said co-founders Gaspard de Dreuzy and Philip Eytan. Mr. de Dreuzy and Mr. Eytan founded the company in May 2014 with Oscar Salazar, a co-founder of Uber. Other investors in the round included Goodwater Capital, Lux Capital and Montage Ventures.
The service, available in all five boroughs, gives patients the option of forgoing the emergency room or an urgent-care center and summoning a doctor for a house call for treatment of, for example, common infections such as bronchitis. A home visit costs $50 for first-time users and $200 thereafter. Patients can consult a doctor by phone for $25 and exchange text messages with photos in the case of a condition such as a rash or insect bite."
Read more on Craine's New York Business
"Most physicians in the United States continue to work in small practices despite the challenging healthcare working environment, according to an updated Policy Research Perspectives from the American Medical Association (AMA).
"These data show that the majority (60.7%) of physicians were in small practices of 10 or fewer physicians, and that practice size changed very little between 2012 and 2014 in the face of profound structural reforms to healthcare delivery," AMA president-elect Andrew W. Gurman, MD, says in a news release.
But the percentage is down markedly from 30 years ago, when more than three quarters of doctors worked in the small practice setting, the report notes. "It is clear that physician practice has undergone marked changes over the past 30 years," the report says."
Read more on Medscape
"Millions of Americans are recording their workout routines and activities on apps that are giving fitness experts new insights into the habits of a logged-in population.
Data compiled by fitness and workout tracker apps, MyFitnessPal and MapMyFitness, show that California, Colorado and Washington are the U.S. states with the most active residents based on the length, frequency and type of exercise they recorded.
South Carolina, Delaware and North Dakota are at the other end of the spectrum in the ranking.
"Seven of our top 10 active states were western states," said Rebecca Silliman of MyFitnessPal, which analyzed information recorded by its 65 million users."
Read more at Reuters
"Los Angeles-based managed care provider Health Net is being acquired by Centene Corp. in a deal valued at $6.8 billion. The deal could mean job losses at Health Net offices in Rancho Cordova, where more than 2,400 of the Woodland Hills-based health insurer's employees work.
The deal, which is expected to close by early 2016, will add Health Net's Medicare platform to Centene's existing Medicaid programs and create a managed care firm with more than 10 million members nationwide and approximately $37 billion in revenue."
Read more at Biz Journals.
"In a scathing audit, state tax officials slammed nonprofit health insurer Blue Shield of California for stockpiling "extraordinarily high surpluses" — more than $4 billion — and for failing to offer more affordable coverage or other public benefits.
The California Franchise Tax Board cited those reasons, among others, for revoking Blue Shield's state tax exemption last year, according to documents related to the audit that were reviewed by The Times. These details have remained secret until now because the insurer and tax board have refused to make public the audit and related records."
Read more at LA Times
© 2023 Elizabeth Shubov