Notable News – January 28, 2011

Here are some recent, notable news stories in the healthcare industry. Skim them before your work week is done or save them for some weekend reading:

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Notable News – December 13, 2010

Here are some more recent, notable news stories in the healthcare industry. Start your week off right by giving them a quick read and stay informed:

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Notable News – December 10, 2010

Here are some recent, notable news stories in the healthcare industry. Skim them before your work week is done or save them for some weekend reading:

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CVS Caremark Sued over Claims of Unfair Business Practices

MCAG recognizes that as healthcare becomes more and more integrated the risk for abuse goes higher and higher. Our AWP/Patient Benefit Plan services have focused on giving clients the information and understanding they need to see how major news can affect even the smallest business and their patients or employees. The following story is a perfect example; MCAG will continue to monitor this case and its impact on our clients and the larger prescription drug market.

CVS Caremark is the target of a new lawsuit filed in federal court last month by a group of independent pharmacists in Texas. They claim that CVS Caremark is creating an unfair and anticompetitive environment by allegedly breaking a number of laws including the federal RICO act, trade secret misappropriation, and HIPAA.

The suit alleges that CVS and Caremark, as a result of their 2007 merger, have not established or have been circumventing a firewall between their retail pharmacy divisions and the prescription benefits manager divisions, which was a key requirement for the merger approval by the Federal Trade Commission. The suit claims that CVS Caremark instead set up a system to share and mine information across all departments in the company including the marketing department. The suit further alleges this information sharing is being used to push patients to use CVS pharmacies and physicians to prescribe CVS Caremark drugs.

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Notable News – December 6, 2010

Here are some more recent, notable news stories in the healthcare industry. Start you week off right by giving them a quick read and stay informed:

  • Appeals court lets West Penn lawsuit proceed (via Modern Healthcare): West Penn Allegheny Health System’s antitrust lawsuit against a rival health system and insurer Highmark will continue after an appeals court overturned a decision to throw it out. The decision by the 3rd U.S. Circuit Court of Appeals rejected an October 2009 decision to dismiss the lawsuit, which alleged the University of Pittsburgh Medical Center and Highmark conspired to protect one another from competition…
  • McKesson’s Horizon Clinicals Receives ONC-ATCB Certification via Drummond Group (via McKesson): McKesson’s Horizon Clinicals ® , the industry’s most comprehensive software suite used by clinicians, patients and healthcare executives to promote high quality, safe care, has received Complete EHR certification — deeming the software capable of enabling providers to meet the Stage 1 meaningful use measures required to qualify for funding under the American Recovery and Reinvestment Act (ARRA). Tested and certified under the Drummond Group’s Electronic Health Records Office of the National Coordinator Authorized Testing and Certification Body (ONC-ATCB) program, the EHR software is 2011/2012 compliant in accordance with the criteria adopted by the Secretary of Health and Human Services…
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Notable News – December 3, 2010

Here are some recent, notable news stories in the healthcare industry. Skim them before your work week is done or save them for some weekend reading:

  • What new insurance provisions on preventive care mean for your practice (via AMA): The health system reform law requires an increasing number of insurance plans to cover 100% of widely accepted preventive health care without co-pays or coinsurance. Experts say this will complicate collecting the appropriate patient portion. But some preparation of medical office staff combined with patient education may simplify the situation…
  • Appeals Court Overturns Prescriber Data-Mining Law (via MedPage Today): A federal appeals court has ruled that a Vermont law restricting the commercial use of physician prescribing data is unconstitutional. The case involved a 2007 law that bans the sale and use of prescriber-identifiable information for marketing or promoting a drug — including drug detailing — unless a physician specifically gives his or her permission to use the information…
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BCBS Michigan Under Fire for Contract Terms

The U.S. Justice Department, joined by the State of Michigan, filed an antitrust lawsuit in District Court against Blue Cross Blue Shield of Michigan (BCBSM) alleging the healthcare payer is engaging in anticompetitive practices, which require most major Michigan hospitals to overcharge competing healthcare payers. The suit alleges the Most Favored Nation (MFN) clause in their contract is creating an unfair market which guarantees BCBSM with the lowest cost among its competitors essentially creating a monopoly.

This highlights why MCAG takes such a close look at contractual terms when working with clients involved in Claim Review and Recovery and Contract Enforcement. It is not uncommon for insurance payers to use language to ensure the best case scenarios for doing business with practices who may never realize what they are agreeing to in an industry that puts such a large emphasis on the fee schedule portion of agreements.

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Notable News – Week of November 12, 2010

Here are a couple notable news stories in the healthcare industry from the past week. Skim them before your work week is done or save them for some weekend reading.

  • LA expands WellPoint lawsuit while targeting another insurer: The city attorney’s office has expanded its lawsuit against WellPoint and added HealthMarkets to their list of targets alleging the use of deceptive tactics to sell limited coverage to consumers by passing it off as comprehensive coverage. This case could potentially impact the entire industry as a whole and we’ll be watching for the outcome.
  • The Unintended Consequences of $4 Generics: The $4 generic prescription program at a number of pharmacies nationwide may be helping consumers but it’s causing problems for many in the healthcare industry. Many pharmacies don’t want to bother filing a claim on a $4 prescription, which has implications across the industry. This is just another reminder that we need multiple options for managing claims to encourage cooperation on all levels.
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United Healthcare Settles After Ingenix Database Shortchanges Physicians

United Healthcare agreed to a $350 million settlement in federal court in early 2009 after it was alleged that the Ingenix database, which was used by nearly all healthcare payers to determine out-of-network payments, was based on faulty logic.

The Ingenix database, which is owned by United Healthcare, is alleged to have systematically undercut the UCR (usual, customary, and reasonable) payments made to physicians for out-of-network services. As a result, physicians were left to write off the difference or pass the additional cost on to patients. The $350 million has been set aside to reimburse any physician that has been short-changed by the Ingenix database for out-of-network care.

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