Monday, June 24, 2013

Collaboration Encouraged at Patient-Centered Diabetes Care Event

Published Online: Friday, June 21, 2013

A session hosted by the American Journal of Managed Care brought together an array of groups involved in managing and treating diabetes.

In order to best serve diabetes patients, all those involved in managing the condition—including physicians, pharmacists, health plans, policymakers, and drug developers—must have a seat at the table. To foster collaboration among a number of these groups, a session titled “Patient-Centered Diabetes Care: Future Directions” was held at the University of Chicago Law School on June 20. The session was hosted by the American Journal of Managed Care in conjunction with Precision Health Economics.

The event was timed to take place just before the beginning of the annual meeting of the American Diabetes Association (ADA), which is being held June 21 to 25 in Chicago. Earlier this year, the ADA announced the results of a study finding that the total economic burden of diabetes in the United States reached $245 billion in 2012, a 41% increase since 2007. In March 2013, the American Journal of Managed Care launched Evidence-Based Diabetes Management, an indexed news publication, to help create a shared forum for physicians, health plans, pharmaceutical leaders, and policymakers.

“When the ADA announced the rise in the financial and human toll that diabetes takes from our economy and from the lives of everyday Americans, it was alarming, but sadly, not entirely surprising,” said Brian Haug, president of Intellisphere Managed Markets, which publishes the American Journal of Managed Care and Evidence-Based Diabetes Management. “Because we are in close touch with the medical community and have been for nearly two decades, we were already responding to this crisis. This week’s meeting is a continuation of that response.”

The event’s keynote speaker was Anne Peters, MD, CDE, director of the clinical diabetes program at the University of Southern California. Panel discussions addressed topics including individualizing diabetes patient treatment, the effect of diabetes patient behavior on quality of care and outcomes, and methods of improving patient adherence to diabetes medications and therapies. In the closing address, Deneen Vojta, MD, senior vice president for business initiatives and clinical affairs at UnitedHealth Group, discussed how to develop relationships between health insurers and drug developers.

Pharmacists also have the potential to play an important role in improving diabetes treatment outcomes. A study published in the May 15, 2013, edition of the American Journal of Health-System Pharmacy found that type 2 diabetes patients who were treated by a team of providers including a clinical pharmacist were significantly more likely to reach blood glucose, LDL cholesterol, and blood pressure goals than those treated by a primary care physician alone. (Click here to read our article about this study.)

At Pharmacy Times, we offer regular coverage of news relating to diabetes treatment. Earlier this month, we covered a study published in BMJ finding that use of some statins can lead to increased risk of new-onset diabetes. In April, we covered the newly released diabetes treatment guidelines from the American Association of Clinical Endocrinologists.

The print edition of Pharmacy Times regularly features Diabetes Watch, a round-up of notable recent studies. Our May 2013 issue included a review of diabetes apps that harness the power of mobile technology to help patients monitor and improve their condition. And, for a comprehensive look at diabetes as it relates to pharmacy, our October 2012 Diabetes Issue is an invaluable resource.

St. Louis raising $100M to keep startups in town

June 23, 2013 11:09 am by  | 0 Comments
St. Louis arch
Old St. Louis wants to become hot with young startups.
Civic and business leaders are raising $100 million to kick the region’s burgeoning startup scene up a notch. Dubbed the Regional Entrepreneurship Initiative (REI), it seeks to attract venture capital over the next five years to support the “rapidly growing entrepreneurial ecosystem and high-growth startup activity” as well as fund new ventures.
“A year ago, I asked what we needed to provide the best environment to help our best startups grow, and the answer came back with a resounding ‘get them more money,’” said St. Louis County Executive Charlie A. Dooley. “Now we are saying we need the money and are putting an aggressive plan in place to raise that capital. This guaranties the best new companies will stay in St. Louis and thrive for years to come.”
St. Louis is not exactly what you’d call a startup hub. The dominant industries are manufacturing, healthcare, and shipping, and the city is home to large corporations like Anheuser-Busch, Enterprise Rent-A-Car, Purina, and Energizer. It may not be a “bastion of progressivism,” but this is beginning to change.
Local entrepreneur Aaron Perlut said that over the past couple years, the region’s business and entrepreneurial ecosystem has begun to dramatically evolve and flourish and is becoming a “tech town.” Technology job postings are on the rise, as are salaries, and St. Louis is attracting enough human, intellectual, physical, and financial capital to emerge as a center of innovation. A startup called LockerDome recently closed $6 million in Series A financing, “big data” company Appistry pulled in nearly $40 million from private investors, and closed $12.5 million.
“St. Louis is seeing an incredible amount of early-stage tech activity right now, which is leading to a strong funnel of great deals,” said Gabe Lozano, the chief executive officer of LockerDome. “Without question, we will be globally recognized as a top 10 city in technology within 10 years.”
Square cofounder Jim McKelvey is a St. Louis native and said that in the past, many St. Louis startups left the area to get their business off the ground, but now that migration is reversing. REI is designed to fuel this trend by attracting new talent and keeping native success stories home. This requires access to capital, which is one of the main roadblocks that entrepreneurs outside of the tech bubble face, and it’s one of the main reasons they head to the Valley.
The impact that a thriving startup scene can have on the economy is well known, and President Obama is a vocal supporter of initiatives that support technology and innovation. REI is not only about capital flow but also about strengthening St. Louis’s ecosystem as a whole. Other components include building a regional customer relationship management system (CRM) to track startup assistance, investment, and impact; developing a common measurement system to track results; creating marketing and communications campaigns aimed at expanding awareness and increasing participation from people inside and outside the region; establishing programs to include minority, female, veteran, and immigrant entrepreneurs; and setting up regional mentorship programs. The $100 million will also contribute funding to pre-seed companies as well as increase the availability of Series A venture capital.
REI received a $1.5 million grant from the U.S. Economic Development Administration, will be entered at, and includes a coalition of public and private sector leaders as well as the region’s leading entrepreneurs and venture capital community. Some of the existing players in the St. Louis scene include Cultivation Capital, Arch Angels, Billiken Angels, and iSELECT Fund. There are also the incubator programs Arch Grants and Capital Innovators.
The money hasn’t been raised yet, but the passion is there. It is, after all, a city with a lot to offer. It has the Gateway Arch, the Cardinals, and a wealth of American history. Plus, it’s home to the gooey butter cake, which for me is enticement enough to go.
This article originally appeared on VentureBeat

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Texas Makes Changes To Medicaid Laws And Programs

Last Updated: June 24 2013
Article by Kimberly J. Gold and Ellyn L. Sternfield

Texas Governor Rick Perry signed a series of bills into law last week modifying some of the state's Medicaid statutes and programs.  The laws will take effect on September 1, 2013.
While the legislation was purportedly aimed at enhancing the state’s ability to detect and prevent Medicaid fraud, waste, and abuse, in fact many of the statutory provisions were added to comply with federal mandates necessary to secure ongoing federal funding for the Texas Medicaid program to ensure  continued eligibility for incentive recoveries under its civil false claims act. 
The highlights of the new laws are as follows:
  • S.B. 746 brings the state's civil false claims act, the Texas Medicaid Fraud Prevention Act (TMFPA), into compliance with the federal requirement that the state statute be "at least as effective" in rewarding and facilitatingqui tam actions as the federal false claims act.  The U.S. Department of Health and Human Services Office of Inspector General gave Texas until September 1, 2013 to amend the TMFPA so that the state may continue toqualify for a 10-percentage-point increase in its share of recovery of civil Medicaid false claims judgments and settlements.
The bill extends false claims liability to any person who or entity that commits an "unlawful act" by conspiring to otherwise violate the TMFPA, or who conceals, avoids or decreases their obligations to repay funds to Medicaid.   The bill also makes procedural changes to the state civil false claims statute of limitations and public disclosure provisions, resulting in provisions that parallel those in the federal false claims act.
  • Another bill, S.B. 1803, amends the Texas Government Code to meet federal requirements allowing the state to continue receiving matching funds from the federal government for the state's Medicaid program. Among other provisions, the bill requires the Texas Medicaid program's Office of Inspector General to conduct preliminary investigations of any complaint of Medicaid fraud or abuse, mandates referrals of fraud to the Texas Medicaid Fraud Control Unit or other law enforcement entities, and requires the Medicaid program to impose a payment hold on claims for reimbursement when credible allegations of fraud exist.
  • S.B. 8 amends the Texas Government Code to require the Medicaid program to establish a data analysis unit intended to detect data trends and identify anomalies relating to compliance with Medicaid and Children's Health Insurance Program (CHIP) requirements.  The bill also limits the marketing activities of CHIP and Medicaid providers and changes the licensure of non-emergency medical transportation companies and emergency medical services providers, with a two-year moratorium on new licenses for emergency medical services providers beginning September 1, 2013.
  • H.B. 658 amends the Civil Practice and Remedies Code so that plaintiffs cannot collect post-judgment interest on any portion of a damages award that includes money subject to Medicare subrogation.  The bill responds to concerns that post judgment interest accrues in Medicare subrogation lien cases, causing defendants to pay additional costs due to the delay of a third party's issuance of a demand letter.
While at first blush the bills appear technical in nature, the result may be increased Medicaid program oversight and enhanced opportunities for whistleblowers and state enforcement authorities to bring Medicaid-based civil false claims actions in Texas.  These new laws, combined with the swelling ranks of Medicaid Recovery Audit Contractors and similar entities, mean that Texas health care providers will likely see more scrutiny of their Medicaid billing activities.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

New Downloadable Article "Has HHSC-OIG Misled the Texas Legislature?"

Dallas, Tx (PRWEB) June 11, 2013

A new 8-page downloadable article is now available online questioning testimony given by representatives of the Texas Health and Human Services Commission Office of the Inspector General in January and February, 2013, to various Texas legislative committees regarding the agency's investigations into Medicaid fraud.
The article is entitled "Has HHSC-OIG Misled the Texas Legislature?" and begins with the following introductory paragraphs:
"Over the last year, the Health and Human Service’s Commission Office of the Inspector General (“OIG”) has been in the spotlight on Texas Medicaid. Representatives of OIG -- Inspector General Douglas Wilson and his apparent deputy for enforcement Jack Stick -- have made numerous public statements regarding Medicaid fraud in Texas, in particular about dental orthodontic services.
"One of OIG’s chief purposes is to interdict Medicaid fraud. Certainly every decent person is in favor of stopping fraud. But OIG has painted a picture of rampant fraud by orthodontic dentists -- a picture which is not, at this point, borne out by court decisions.
"In fact, OIG has only had its claims on rampant fraud tested in court (the State Office of Administrative Hearings, “SOAH”) one time. That decision, which upended OIG's claims, has been upheld by an HHSC administrative judge. This precedent-setting decision -- that of Harlingen Family Dentistry (“HFD”)* -- came out last September and was upheld in early January of this year."
"This precedent-setting case is well-known to OIG, Medicaid providers and their attorneys. Yet OIG statements to the legislature this session ignored this legal decision and its implications for future orthodontic cases. In fact, OIG has seriously downplayed the facts in several instances. One could even go so far as to say that legislators were misled."
The article goes onto compare testimony given to various committees of the Texas Legislature in this light.
The article can be downloaded here.
  • SOAH Docket No. 529-13-3180 Harlingen Family Dentistry vs. Texas Health and Human Services Commission

Read the full story at

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More than 300,000 uninsured in Valley, federal official says at healthcare fraud conference - The Monitor: Local News

McALLEN — The billions lost to fraud and the thousands of uninsured here are interconnected inside the broad and complicated world of health care.
To address the topics, the two-day Rio Grande Valley Healthcare Fraud and Compliance Conference was held at the McAllen Convention Center. It ended Wednesday and brought hundreds of healthcare providers together to learn more.

Keynote speaker Majorie McColl Petty said 4.8 million uninsured Texans will be able to enroll via a state Health Insurance Marketplace, created under the federal Affordable Care Act (ACA), beginning Oct. 1.
President Barack Obama appointed Petty as director of region VI — which includes Texas, New Mexico, Oklahoma, Arkansas and Louisiana — under the U.S. Department of Health and Human Services.
In Hidalgo and Cameron counties, there are 328,941 uninsured residents, according to information Petty provided. The area, she said, is among the top seven in the nation with large uninsured populations.
Employers and existing federal insurance programs like Medicaid and Medicare — for the low-income and elderly, respectively — already provide insurance, Petty said.
“But, there’s a large population that is left uncovered,” she explained, saying state marketplaces are aimed at this group.
Starting Jan. 1, 2014, plans selected via the marketplace will take effect.
The Texas marketplace, or insurance exchange, will be run by the federal government because state leaders have said they will not implement it. Texas is also one of more than a dozen states that have opted out of the ACA’s Medicaid expansion, though residents will still pay federal taxes for the program.
An obvious proponent of the ACA, Petty listed a number of points about the federal legislation she said has begun to shift people’s thinking on health care and spark important dialogues.
The federal reform, she said, has also allowed for changes in the way services are carried out that help curtail fraud.
“I don’t think we could be at a better place in time,” she told a large audience, adding that healthcare reform has been a hot topic for decades.
Rachanna Rodriguez, director of programs for Senior Community Outreach Services, Inc. — the nonprofit group hosting the event — said it was the first of its kind on such a large scale. FBI representatives and other officials spoke to healthcare providers about how to avoid, prevent and report fraud.
McAllen Mayor Jim Darling attended a session with Petty along with officials from other cities, public agencies and hospital administrators. He said for cities, health care is a crucial economic component also tied to the well-being of residents.
“It’s important that we do it right,” he said. “It’s hard to get that kind of education in any one place, so I think this is a fantastic opportunity for (healthcare providers). It’s a great program.”
Petty couldn’t immediately point to federal data supporting the widespread claim that the Valley is the second-ranked hot spot for federal healthcare fraud. She declined to discuss factors why, saying it would be speculation.
“It’s everybody’s responsibility to, just like with the Senior Medicare Patrol, to monitor it — to be certain that all of us are being responsible and scrutinizing our bills,” she said.
Senior Medicare Patrol, a federally funded program, recruits volunteers who conduct outreach about healthcare fraud among seniors.
As Rodriguez, who is also involved with the SMP, closed her own remarks, she said fraud has damaged the reputation of healthcare providers here.
“That overshadows anything and everything that you do that’s good,” she said to the audience.
Fraud is so widespread, Rodriguez said, that most people at the conference likely know of someone who’s been busted.
“So, today I end with a question: Who’s next?” she said.
Go to to learn more about the ACA and state marketplace.

More than 300,000 uninsured in Valley, federal official says at healthcare fraud conference - The Monitor: Local News

Pierce County oncologists settles health care fraud claim | U.S. District Court

JUNE 23, 2013 · 3:38 PM

Dr. Alfred H. Chan, an oncologist in Lakewood and his family, have agreed to pay the United States $3.1 million to settle allegations that he and his wife defrauded federal health care programs by significantly and repeatedly overbilling for cancer treatment medications.
From at least April 2006 through April 2009, the government contends that Dr. Chan and his wife Judy Chan intentionally inflated claims to Medicare, TRICARE, and other federal health care programs, resulting in a loss to the government estimated at over $1 million.  Today’s settlement represents a recovery of almost three times the estimated loss to federal health care programs.
“Dr. Chan and Judy Chan blatantly and persistently defrauded the government of more than a million dollars and traded the safety of cancer patients for their own personal gain,” said U.S. Attorney Jenny A. Durkan. “They continue to try to avoid criminal sanctions by remaining outside the U.S.  This civil settlement recoups the financial damage they inflicted on taxpayer funded programs.”
The government was alerted to the Chans’ fraud through a “qui tam” or “whistleblower” lawsuit brought under the False Claims Act by one of Dr. Chan’s former employees, Ruth Ruckman.  Ms. Ruckman observed that Dr. Chan – with the assistance of his wife, Judy – routinely billed federal healthcare programs for twice (or more) the amount of cancer treatment drugs actually administered to his patients.  The couple then destroyed records and falsified patients’ medical records in order to conceal the fraud.  Ms. Ruckman provided the government with Dr. Chan’s treatment orders, which showed the actual dosages of drugs administered to certain patients, and the invoices, which showed how much Dr. Chan overbilled for the treatments.
Upon learning of the government’s investigation, the Chans attempted to sell, transfer, and conceal millions of dollars in assets in an ultimately unsuccessful attempt to prevent the government from recovering its overpayments.  In February 2011, the Chans fled to Taiwan.  A grand jury sitting in the Western District of Washington has returned a criminal indictment against Alfred and Judy Chan relating to their fraudulent conduct.
Pursuant to the False Claims Act, Ms. Ruckman is entitled to share in the government’s recovery and will receive $620,000 of the $3.1 million settlement for exposing the Chans’ fraudulent conduct.
Government agencies supporting and/or participating in the successful resolution of this matter include: the Office of Inspector General of the Department of Health and Human Services; the Department of Defense Office of Inspector General, Defense Criminal Investigative Service; the Office of Inspector General of the Office of Personnel Management; the TRICARE Management Activity Office of General Counsel; the Washington State Health Care Authority; and the Washington State Attorney General’s Office.

Charges against Detroit-area doctors add to long list of local health care fraud, prescription drug dealing cases

Khalil AlHajal | kalhajal@mlive.comBy Khalil AlHajal | 
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on June 22, 2013 at 8:00 AM, updated June 22, 2013 at 8:07 AM
pills.JPGA long list of Detroit-area health care professionals have been accused in schemes to defraud insurance providers and illegally distribute prescription drugs in recent months. 
DETROIT, MI -- Two local doctors were charged in an indictment unsealed Friday with health care fraud and illegal distribution of prescription drugs.
The federal case adds to a long list of Metro Detroit health care professionals recently accused of defrauding Medicare and Medicaid of millions of dollars, and in the process releasing highly addictive drugs into the black market.
The Michigan Department of Licensing and Regulatory Affairs within the last 10 days announced license suspensions of four Detroit-area pharmacists and a physician's assistant after convictions in similar cases.
Hussein Awada, 43, and Luis Collazo, 53, are accused in the most recent indictment of billing Medicare and other insurance providers for unnecessary testing and procedures performed at two Warren locations of Midwest Family Practice, according to the U.S. Attorney's office.
They're also charged with paying patient recruiters with drugs like Oxycodone, Roxicodone, and Opana.
James Lyons, 39, of Detroit is also charged in the case as an alleged recruiter.
Medicare paid more than $6.6 million in patient services and prescriptions issued at the practice from December 2010 through 2012, according to the indictment.
(View the indictment here.)
Federal agents seized more than $600,000 and three automobiles during the investigation.
“These charges represent a serious abuse of the health care system," said Detroit FBI Special Agent in Charge Bob Foley. "Those motivated by greed who unlawfully take from a system designed to care for patients will be tirelessly pursued by the FBI and prosecuted for their crimes.”
After Awada's offices were raided last year, he called the surfacing allegations against him "preposterous and baseless."
The state Department of Licensing and Regulatory Affairs over the last 10 days announced a series of separate health care license suspensions in similar cases:
- Pharmacist Babubhai Patel of Canton, convicted in February health care fraud conspiracy and distribution of controlled substances, sentenced to 17 years in prison and ordered to pay more than $17 million in restitution.
- Pharmacist Viralkumar Thaker of Findlay, Ohio, convicted in February of health care fraud and conspiracy to distribute controlled substances, sentenced to two years in prison and ordered to pay $215,653.00 in restitution.
- Pharmacist Lokesh Tayal of Northville, convicted in January of health care fraud conspiracy and conspiracy to distribute controlled substances, sentenced to five years, eight months in prison and ordered to pay more than $3 million in restitution.
- Pharmacist Brijesh Rawal of Canton convicted in January of health care fraud conspiracy and conspiracy to distribute controlled substances, sentenced to five years, eight months in prison and ordered to pay more than $1.7 million in restitution.
- Physician’s assistant John Roberts of Mount Pleasant, convicted in October 2012 of conspiracy to pay and receive health care kickbacks, sentenced to four months in prison and ordered to pay $70,000 in restitution.