‘What The Health?’ Podcast Turns 1. Justice Kennedy Retires. Now What?

https://khn.org/news/podcast-khns-what-the-health-justice-kennedy-retires-now-what/

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The retirement of Supreme Court Justice Anthony Kennedy has triggered a political earthquake in Washington, as Republicans see a chance to cement a conservative majority and Democrats fear a potential overturn of abortion rights and anti-discrimination laws, and even — possibly — challenges to the Affordable Care Act. Kennedy has been the deciding vote in dozens of cases over his long career on the high court, mostly siding with conservatives but crossing ideological lines often enough that liberals see him as the last bulwark against challenges from the right to many policies.

The Supreme Court made other health news this week, ruling that California cannot require anti-abortion “crisis pregnancy centers” to post signs informing women of their right to an abortion and telling them that financial help is available.

And this is a special week for us. It’s our first anniversary. This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Alice Ollstein of Talking Points Memo and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s podcast:

  • Kennedy’s retirement will put all eyes on the Senate, where Republicans have a slim majority but have also changed the rules to allow confirmation with only 51 votes instead of the usual 60.
  • The fight over Kennedy’s replacement is likely to galvanize both Republicans and Democrats, but also put in the hot seat the two Republican female senators who have supported abortion rights — Susan Collins of Maine and Lisa Murkowski of Alaska.
  • This week’s primaries again put the spotlight on Democratic support of single-payer health proposals, as Alexandria Ocasio-Cortez upset the fourth-ranking Democrat in the House in New York and former NAACP head Ben Jealous won the Democratic nomination for governor in Maryland. But while Democrats have made clear that health is their top issue for the coming campaign, they have so far managed to paper over their intraparty differences on incremental versus wholesale change.
  • The California legislature could vote on a measure as soon as Thursday that would gut efforts by municipalities to put in place soda taxes. If it passes, it will mark a change in momentum away from the success of these measures across the country. The soda industry took a page from the tobacco companies in executing this plan.
  • The controversy surrounding the Trump administration’s immigration policy that separates children from their parents at the border continued to be a flashpoint this week. Health and Human Services Secretary Alex Azar was questioned about it on Capitol Hill during a hearing about drug pricing. Congressional Republicans find themselves in a difficult position. Many don’t want to defend the administration, but there doesn’t seem to be an avenue by which to move forward either.

 

 

Amazon is buying online pharmacy business PillPack

http://www.healthcarefinancenews.com/news/amazon-buying-online-pharmacy-business-pillpack?mkt_tok=eyJpIjoiTURRMU5XSTBORFJrWlRobCIsInQiOiJ1MWVYbUtMUVBrenhwcXkrNHlnQmdhZm53M2ozb3BLR0dUa0pUTHdtNjVGVktSbU0zZ0Q2NXdTVjd2blJ3Y0VHKy83cnVaRndsaUE0NGVITTByU0dJKzMzWldwank2SkZLTmxPbk12ZVRKaWI1TUVLVjZhUSsrSGNwQkhrTmdKVSJ9

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Customers pay a monthly service fee, which is often covered by insurance companies and Medicare Part D plans.

Amazon announced today it is buying PillPack, giving the online giant the ability to ship prescription drugs around the country.

Walmart was reportedly in talks to buy PillPack, but Amazon stepped in with a $1 billion offer. The deal is expected to close during the second half of 2018.

The deal follows Amazon’s offer of a Prime membership to Medicaid beneficiaries in a move seen as direct competition to Walmart.

Shares of CVS Health, which is going through the regulatory process to merge with Aetna, fell after Thursday’s announcement, as did shares of Walgreens Boots Alliance and Rite Aid, according to CNBC.

PillPack is an online pharmacy that offers pre-sorted doses of medications and home delivery in all states except for Hawaii, according to the company.

It is in-network with all major pharmacy benefit managers, including CVS Caremark, Express Scripts, Optum Rx, Prime Therapeutics, Humana Pharmacy Solutions, Cigna, Aetna, MedImpact, EnvisionRx and CastiaRX.

PillPack is a pharmacy designed for people who take multiple daily prescriptions, delivering them in pre-sorted dose packaging, coordinates refills and renewals.

Originally founded in 2013, the company has raised around $100 million in funding. Customers using the platform pay a monthly service fee, which is often covered by insurance companies including Medicare Part D.

“PillPack’s visionary team has a combination of deep pharmacy experience and a focus on technology,” said Jeff Wilke, Amazon Worldwide Consumer CEO. “PillPack is meaningfully improving its customers’ lives, and we want to help them continue making it easy for people to save time, simplify their lives, and feel healthier. We’re excited to see what we can do together on behalf of customers over time.”

PillPack’s primary pharmacy is located in Manchester, New Hampshire, with its engineering, design, business operations and marketing teams located in in Somerville, Massachusetts and its advisory center and other corporate functions in Salt Lake City, Utah.

Ex-CFO, 3 surgeons charged in $950M kickback scheme in California

https://www.beckershospitalreview.com/legal-regulatory-issues/ex-cfo-3-surgeons-charged-in-950m-kickback-scheme-in-california.html

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Federal prosecutors unsealed charges this week against nine new defendants for their alleged roles in a kickback scheme that resulted in the submission of more than $950 million in fraudulent claims, mostly to California’s worker compensation system, according to the Department of Justice.

The nine defendants were charged in relation to the government’s investigation into kickbacks physicians received for patient referrals for spinal surgeries performed at Pacific Hospital in Long Beach, Calif. They are among the dozens of physicians and other medical professionals allegedly involved in the scheme.

Of the nine defendants recently charged, three are orthopedic surgeons. Daniel Capen, MD, agreed to plead guilty to conspiracy and illegal kickback charges. He allegedly accounted for about $142 million of Pacific Hospital’s claims to insurers. Timothy Hunt, MD, who allegedly referred spinal surgery patients to Dr. Capen and other physicians, agreed to plead guilty to a conspiracy charge involving his receipt of illegal kickbacks. Tiffany Rogers, MD, allegedly received illegal kickbacks to refer patients for spinal surgeries to Pacific Hospital.

The other defendants recently charged in the scheme include the former CFO of Pacific Hospital’s physician management arm, George Hammer. He agreed to plead guilty to tax charges based on the fraudulent classification of illegal kickbacks in hospital-related corporate tax filings. Two chiropractors as well as two companies and an individual associated with one of the chiropractors were also charged for their alleged involvement in the scheme, according to the DOJ.

Michael Drobot, former owner and CEO of Pacific Hospital, ran the 15-year-long kickback scheme. He was sentenced to more than five years in prison in January.

 

 

DOJ charges more than 600 in historic fraud takedown involving $2B in false claims

https://www.fiercehealthcare.com/payer/doj-jeff-sessions-medicare-strike-force-fraud-takedown-opioids-oig?mkt_tok=eyJpIjoiTXpRelpESTBaVE5tTVRBNSIsInQiOiJmTnBaRmJoVDJaOVZYRkhCd05cL2JXOVNoYU50NlVYN3pIb3ZlRFg1a3RqRWhXbjVMYm5SeEY3Y1ZNdENBb3NQSkZBTXRSR0tDSjZ4R2pJd0RjUFZ2bmRGbnhqXC9pQ2oxaTVCdHN3TUx0b25Ib09rblVuYlJVMW51NlVDcUdzRGNnIn0%3D&mrkid=959610

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Another year, another record-setting healthcare fraud takedown.

This year, the Department of Justice charged 601 individuals involved in fraud schemes totaling $2 billion in losses to the federal government. That’s nearly 200 more people and an additional $700 million than the previous year’s takedown.

There was a clear emphasis on opioid distribution, with 162 individuals charged with illegally prescribing or distributing narcotics. Of those charged for opioid fraud, 76 were physicians.

“Healthcare fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” Attorney General Sessions said in a statement. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes.”

Federal enforcement agencies have zeroed in on medical providers as a source of opioid diversion. Last year the DOJ created a new Opioid Fraud and Abuse Detection Unit with 12 dedicated U.S. attorneys and a focus on data analytics. In January, Sessions said the Drug Enforcement Agency (DEA) would direct agents to focus on prescribers and pharmacies and that dispense an unusual amount of drugs.

“This year’s operations, focusing on opioid-related schemes, spotlight the far-reaching impact of health care fraud,” said HHS Deputy Inspector General Gary Cantrell.

In this year’s takedown announcement, the DOJ said “virtually every health care fraud scheme requires a corrupt medical professional to be involved” and “aggressively pursuing” providers has a deterrent effect and ensures they cannot use their license to perpetuate schemes.

The agency highlighted one particular scheme in which a pain management specialist in New York and New Jersey was accused of taking cash from patients in exchanges for oxycodone and Subsys. He was also charged with second-degree murder after a patient died from an overdose.

Other areas of the country included equally egregious schemes:

  • In Texas a pharmacy owner and pharmacists were charged with using fraudulent prescriptions to fill more than 1 million hydrocodone and oxycodone pills and distributed them to drug dealers.
  • In California, an attorney was accused of offering prostitutes and expensive meals to two podiatrists in exchange for preprinted prescription pads.
  • In Michigan and Illinois, individuals were charged with home health fraud schemes totaling $44 million.
  • In Southern Florida, a hotbed for healthcare fraud, the owner and director of a sober home were charged for a scheme involving widespread fraudulent urine testing and $106 million in claims for substance abuse treatment.

Fraud takedowns of this size and scale have become an annual event, dating back nearly a decade. Both the number of individuals and the amount of money involved in the schemes have gradually increased over the years as the DOJ and the Office of Inspector General (OIG) have emphasized the use of analytics as an investigative tool.

Federal enforcers have also relied on a collaborative approach to enforcement. Like last year, this week’s takedown involved multiple federal agencies, including the Department of Health and Human Services, the OIG, the Centers for Medicare & Medicaid Services (CMS) and the Medicare Fraud Strike Force.

Since 2016, federal agencies have charged more than 1,300 individuals tied to $4.2 billion in fraudulent billing schemes.

 

Preexisting Conditions Can Define Your Future

http://www.philly.com/philly/health/health-costs/pre-existing-condition-protections-aca-lawsuit-20180628.html

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Labor Unions Will Be Smaller After Supreme Court Decision, but Maybe Not Weaker

 

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With the Supreme Court striking down laws that require government workers to pay union fees, one thing is clear: Most public-sector unions in more than 20 states with such laws are going to get smaller and poorer in the coming years.

Though it is difficult to predict with precision, experts and union officials say they could lose 10 percent to one-third of their members, or more, in the states affected, as conservative groups seek to persuade workers to drop out.

The court’s decision is the latest evidence that moves to weaken unions are exacting a major toll. Beyond the dropout campaigns aimed at members, conservatives are bringing lawsuits to retroactively recover fees collected by unions from nonmembers.

In May, President Trump signed three executive orders making it easier to fire government workers and reining in the role of unions representing federal workers.

Dropping out of a union is a more attractive proposition now that workers no longer have to pay a so-called agency fee, typically about 80 percent of union dues, if they choose not to belong to a union. (Those doing so generally account for a small fraction of the workers whom public-sector unions represent.)

In the five years after Michigan passed a law ending mandatory union fees in 2012, the number of active members of the Michigan Education Association dropped by about 25 percent, according to government filings, a much faster attrition rate than before. Its annual receipts fell by more than 10 percent, adjusting for inflation.

Still, the more interesting question is whether the unions, whatever the blow to their ranks and finances, will be substantially weaker.

Union leaders insist that they won’t — that the crisis posed by the case, Janus v. American Federation of State, County and Municipal Employees, has brought more cohesion and energy to their ranks.

“No one wanted this case,” said Randi Weingarten, president of the American Federation of Teachers. “But the gestalt around the country has been to turn an existential threat into an opportunity to engage with our members like never before.”

There are reasons to believe that the claim is not merely desperate bravado.

One parallel to the current development is a 2014 Supreme Court ruling known as Harris v. Quinn, which struck down mandatory union fees for home-based workers who serve private individuals but are paid through government programs like Medicaid.

As of late 2013, the Service Employees International Union represented about 60,000 public-sector home care and child-care workers in Illinois, about 40 percent of whom were union members. (The rest paid agency fees.)

Receipts for the service employees union local representing home-based workers in Illinois dropped significantly in the four years after the decision. But an aggressive membership campaign largely offset the loss of members.

It also built and reinforced personal relationships with members, who could be summoned to make demands of politicians in nearly every legislative district.

“Our members go and meet Sam McCann,” said Keith Kelleher, who until last year was president of the local representing these home-based workers, referring to a Republican state senator. “He says yes most of time because he’s got hundreds of members in his district.”

Public home-based workers in Illinois, a state with a notably anti-union Republican governor, continue to notch victories as a result. Last summer, home care workers won a 48-cent-an-hour wage increase from the state, up from an average wage of $13, in a budget that the legislature passed by overriding the governor’s veto. This spring, home child-care workers won more than a 4 percent raise.

In anticipation of the Janus ruling, major public-sector unions have invested heavily in recent years in reaching out to current members — an effort known as internal organizing — and to prospective members to keep their numbers from dropping precipitously and to create a more activist culture. They plan to continue funding these initiatives even if it requires cutting spending elsewhere.

Mary Kay Henry, the international president of the service employees union, said the union used projections derived from its experience after the Harris decision to cut its budget by 30 percent shortly after Mr. Trump was elected. She said the union, which represents about two million workers, roughly half of them in the public sector, was focusing its spending on recruiting members and mobilizing workers to face down employers and elect pro-labor politicians.

“We intend to prioritize the political and organizing work,” she said.

Government filings show that the union has cut contributions to organizations that it had traditionally supported, including the Children’s Defense Fund, People for the American Way, and the National Immigration Law Center. (The union says it provides nonmonetary support to some of these groups.)

At the same time, the union is investing tens of millions of dollars in a door-to-door canvassing initiative for the midterm elections, intended to turn out people who don’t normally vote.

Lee Saunders, president of the American Federation of State, County and Municipal Employees, said that his union’s two highest priorities going forward would be its internal outreach and helping to organize nonunionized workplaces, and that the union would probably “have to make adjustments” to fund these programs. The union spent more than $15 million during the 2016 campaign cycle supporting political candidates, parties and committees.

Mr. Saunders said the union, which represents over 1.2 million workers, had held one-on-one conversations with nearly 900,000 members since 2013. Among the goals of these conversations, he said, is to inoculate members against campaigns by conservative groups to urge them to quit.

“If someone knocks on their door talking about how you can get out of the union — ‘it would be so easy, you don’t have to pay union dues’ — our folks are prepared to tell them to get the hell off their doorstep,” he said.

Alexander Hertel-Fernandez, a political scientist at Columbia University who studies corporate and conservative efforts to weaken labor, said organized interest groups had traditionally had the greatest impact on elections by educating members about candidates and through on-the-ground canvassing rather than large campaign contributions. “It’s doubly so for unions,” he said, adding that the focus “seems like a wise decision, but the effectiveness has to be weighed against what happens to membership and overall revenues.”

The unions enjoy certain advantages. States like California and New Jersey have tried to ease the blow from Janus pre-emptively by passing legislation that, for example, guarantees public-sector unions access to new hires and their personal contact information to help in recruiting.

There is also a substantial wind at their back: a rising energy on the left during the Trump era. Workers in particular appear more willing to take to the streets and state capitols, including tens of thousands of teachers who walked off their jobs this year in conservative states to protest the underfunding of public education.

When the Supreme Court ruled last month that employment contracts could prohibit workers from bringing class-action lawsuits, activists in states like New York, Vermont and Oregon escalated their efforts to pass so-called private attorneys general legislation, allowing workers to bring cases on the state’s behalf that could benefit all affected workers, the same way litigation by an attorney general would.

“We’ve had many, many folks calling: ‘I heard about this legislation you helped design. How do we make this happen?’” said Deborah Axt, co-executive director of Make the Road New York, an advocacy group pushing the measure. Ms. Axt said the group planned to campaign for the legislation’s enactment this summer.

That kind of energy appears to be benefiting unions. A Gallup poll last summer showed labor’s approval at its highest level since 2003, and unions in West Virginia and several other states where teachers walked off the job this year report gains in members.

“We’ve seen a 13 percent jump in membership because of the walkout,” said Ed Allen, president of the Oklahoma City American Federation of Teachers. “We have over 300 people signed up to work in political campaigns. We’ve never seen those kinds of numbers before.”