Ten Texas physicians and a healthcare executive who operates a group of medical practices in Florida agreed to pay a total of $1.68 million to settle kickback allegations, according to a March 22 Justice Department news release.
According to prosecutors, the Texas physicians received thousands of dollars in pay from eight different management service organizations in exchange for ordering laboratory tests from Little River Healthcare, True Health Diagnostics and/or Boston Heart Diagnostics Corp.
Here are the physicians who reached monetary settlements:
Tamar Brionez, MD, agreed to pay $85,006
Gary Goff, MD, and his affiliated practices agreed to pay $454,088
John Hierholzer, MD, agreed to pay $24,850
Bruce Maniet, DO, agreed to pay $175,43
Huy Chi Nguyen, MD, agreed to pay $211,821
Dung Chi Nguyen, MD, agreed to pay $211,721
Rakesh Patel, DO, agreed to pay $174,539
Cuong Trinh, MD, agreed to pay $45,056
Randall Walker, MD, agreed to pay $60,898
Michael Whiteley, DO, agreed to pay $52,015
As part of the settlements, the 10 physicians agreed to cooperate in the investigations against other parties involved in the alleged scheme.
In addition to the physicians, Brett Markowitz, the founder and CEO of Florida Rejuvenation Holdings, which operates medical practices in Tampa, paid $185,000 to resolve allegations of accepting kickbacks from True Health. Prosecutors said True Health paid for each patient that physicians at the medical practices referred for clinical laboratory services.
Obamacare enrollment at a record-high 14.5 million
Congress may not fund premium subsidies in 2023
The Affordable Care Act marks its 12th anniversary Wednesday, and despite a record 14.5 million enrollees, the Biden administration is preparing for the possibility that millions could lose coverage next year.
The $1.9 trillion pandemic stimulus package (Public Law 117-2), signed March 2021, reduced Obamacare premiums to no more than 8.5% of income for eligible households and expanded premium subsidies to households earning more than 400% of the federal poverty level. The rescue plan also provided additional subsidies to help with out-of-pocket costs for low-income people. As a result, 2.8 million more consumers are receiving tax credits in 2022 compared to 2021.
But without congressional action, the subsidies—and the marketplace enrollment spikes they ushered in—could be lost in 2023. A new HHS report released Wednesday, shows an estimated 3.4 million Americans would lose marketplace coverage and become uninsured if the premium tax credits aren’t extended beyond 2022.
In a briefing with reporters Tuesday, Chiquita Brooks-LaSure, administrator for the Centers for Medicare & Medicaid Services, said her agency is “confident that Congress will really understand how important the subsidies were” to enrolling more people this year. The CMS would “pivot quickly,” however, to implement new policies and outreach plans if the subsidies aren’t extended as open enrollment for 2023 begins in November.
“That said, today and tomorrow we are celebrating the Affordable Care Act,” Brooks-LaSure added. “As part of that process, we’ve been reminding ourselves that sometimes it takes some time to pass legislation. And just like the Affordable Care Act took time, we’re confident that Congress is going to address these critical needs for the American people.”
After years of legal and political brawls that turned the landmark legislation into a political football, Obamacare “is at its strongest point ever,” Brooks-LaSure said. The 14.5 million total enrollees—those who extended coverage and those who signed up for the first time—is a 21% increase from last year. The number of new consumers during the 2022 open enrollment period increased by 20% to 3.1 million from 2.5 million in 2021.
This week, the Department of Health and Human Services will highlight the impact of the ACA and the Biden administration’s efforts to strengthen the law. The CMS recently announced a new special enrollment period opportunity for people with household incomes under 150% of the federal poverty level who are eligible for premium tax credits. The new special enrollment period will make it easier for low-income people to enroll in coverage throughout the year.
Troubled times could be around the corner, however, as millions of people with Medicaid coverage could become uninsured after the public health emergency ends. Under the Families First Coronavirus Response Act (Public Law 116-127), signed March 2020, states must maintain existing Medicaid enrollment until the end of the month that the public health emergency is lifted. Once the continuous enrollment mandate ends, states will resume Medicaid redeterminations and disenrollments for people who no longer meet the program’s requirements.
Dan Tsai, deputy administrator and director of the Center for Medicaid and CHIP Services at CMS, said the agency is working with states to make sure people who lose Medicaid coverage can be transferred into low- and no-cost Obamacare coverage.
“A substantial portion of individuals who will no longer be eligible for Medicaid will be eligible for other forms of coverage,” including marketplace coverage, Tsai told reporters Tuesday.
In a statement, President Joe Biden acknowledged the law’s great impact. “This law is the reason we have protections for pre-existing conditions in America. It is why women can no longer be charged more simply because they are women. It reduced prescription drug costs for nearly 12 million seniors. It allows millions of Americans to get free preventive screenings, so they can catch cancer or heart disease early—saving countless lives. And it is the reason why parents can keep children on their insurance plans until they turn 26.”
U.S. jobless claims set a more than 50-year low last week as the red-hot labor market shows few signs of cooling in the near-term.
The Labor Department released its latest weekly jobless claims report Thursday at 8:30 a.m. ET. Here were the main metrics from the print, compared to consensus estimates compiled by Bloomberg:
Initial jobless claims, week ended March 19: 187,000 vs.210,000 expected and a revised 215,000 during prior week
Continuing claims, week ended March 12: 1.350 millionvs.1.400 million expected and a revised 1.417 million during prior week
At 187,000, new jobless claims improved for a back-to-back week and reached the lowest level since September 1969. Continuing claims also fell further to reach 1.35 million — the least since January 1970.
The labor market has remained a point of strength in the U.S. economy, with job openings still elevated but coming down from record levels as more workers rejoin the labor force from the sidelines.
Going forward, however, some economists warned that new cases of the fast-spreading sub-variant of Omicron, known as BA.2, could at least temporarily disrupt mobility and economic activity across the country. As of this week, about one-third of COVID-19 cases in the U.S. have been attributed to the sub-variant, though overall new infections have still been trending down from January’s record high. The impact on the labor market — and on demand in the service sector especially — remains to be seen.
“Right now, U.S. cases are in the sweet spot between the bottom of the initial Omicron wave and the impending explosion in BA.2 cases, but this probably won’t last long,” Ian Shepherdson, chief economist at Pantheon Macroeconomics, wrote in a note this week. “Our bet … is that the coming BA.2 wave will trigger a modest but visible pull-back in the discretionary services sector, thereby dampening consumption in the first month of the second quarter.”
Still, many economists and policymakers have pointed out that the labor market withstood prior disruptions due to the Omicron wave earlier this year. Non-farm payrolls grew more than expected in each of January and February despite the outbreak.
And Federal Reserve Chair Jerome Powell reiterated his assessment of the labor market’s strength earlier this week, just days after calling the current job market “tight to an unhealthy level” in his post-Fed meeting press conference last week.
“The labor market has substantial momentum. Employment growth powered through the difficult Omicron wave, adding 1.75 million jobs over the past three months,” Powell said in a speech Monday. “By many measures, the labor market is extremely tight, significantly tighter than the very strong job market just before the pandemic.”
The tightness of the labor market has also strongly informed the Fed’s decisions in pressing ahead with tightening monetary policy, with the economy showing clear signs of strength and the ability to handle less accommodative financial conditions. Last week, the Fed raised interest rates by 25 basis points in its first rate hike since 2018. And St. Louis Fed President Jim Bullard, the lone dissenter of that decision who had called for a more aggressive 50 basis point rate hike last week, justified his vote in part given the strength of the U.S. labor market even in the face of decades-high rates of inflation.
“U.S. labor markets are today already stronger than they have been in a generation,” Bullard said in a statement.
As parents await an approved vaccine for children under 5, Moderna said on Wednesday a study had found its two-dose pediatric vaccine to be safe for young children, toddlers and babies. Its effectiveness, however, was complicated by the spread of the coronavirus’s omicron variant. While the pediatric vaccine generated an immune response equivalent to that of young adults before the highly transmissible variant emerged, those immune defenses were less strong in the face of omicron. In children, the pediatric vaccine was about 40 percent effective, Moderna said. The company plans to submit the data to the Food and Drug Administration for consideration in the coming weeks.
The FDA also faces requests to authorize a second booster vaccine dose for adults. But even if they are authorized, Biden administration officials said they lack the funds to purchase those shots. They said they’ve bought enough doses for Americans age 65 and older, as well as the potential initial regimen for children under 5, but can’t buy more doses for people in other age groups unless Congress passes a delayed $15 billion funding package. It’s not yet clear whether additional doses for adults will be necessary, but officials said placing orders for doses ahead of time has been an important lesson of the pandemic. White House officials have expressed worry that vaccine manufacturers will prioritize orders placed by other countries.
That concern comes as omicron’s BA.2 subvariant of the coronavirus now amounts to as much as 70 percent of new infections in much of the United States, according to the genomic surveillance company Helix. That version of the virus has prompted a surge of cases in Europe and fear that the United States will experience its own wave, similarly to how it has mirrored Europe in the past. A broad increase in cases has so far not happened in the United States, and disease experts don’t know for sure whether it will. If it does, it’s unclear whether the pandemic policies of the Biden administration and private institutions would substantially change.
A program to ensure global vaccine equity was doomed from the beginning to fall short, a Washington Post analysis found. The initiative, called Covax, was meant to convince wealthy and poor countries to combine their money to order vaccine doses in advance and then share them in a way that would protect the most vulnerable people first. But the program’s supporters underestimated the desperation of the wealthier countries, which snatched up doses from manufacturers for their own residents. Covax was also slow to adapt as nations declined to participate. Now, more than one-third of the world has not received a vaccine dose — a result that not only is inequitable, but also makes it easier for new variants to emerge.
In a study published Monday, people who had covid-19 had a 46 percent higher risk of developing Type 2 diabetes or being prescribed medication to control their blood sugar within a year than those who had not had the coronavirus. Greater severity of covid symptoms was associated with a higher chance of developing diabetes, but even people with less severe or asymptomatic infection had an increased risk, according to the study of more than 181,000 Department of Veterans Affairs patients. The study did not prove cause and effect but did show a strong association between covid-19 and diabetes.
Other important news
Omicron’s BA.2 subvariant has become the world’s dominant form of the coronavirus. The Post created a map and several charts to help you visualize how it’s spreading around the world.
White House press secretary Jen Psaki said Tuesday that she had tested positive for the coronavirus a second time. She had been scheduled to travel to Europe with President Biden and other administration officials, but canceled her trip.
A new spring brings another anniversary of the Affordable Care Act. Twelve (sometimes tumultuous) years later, this remarkably resilient law is on firmer ground than ever before.
And there are currently no existential legal threats to the law working their way through federal courts.
In some ways, this rosy report feels unremarkable. Why expect otherwise with the law now in place for more than a decade and baked into every part of the health care system?
But this outcome was far from inevitable.
Just five years ago, Congress tried to repeal as much of the law as possible. When those broader efforts failed, Congress eliminated the much-maligned individual mandate penalty. We appeared to have reached a stalemate: Democrats could not improve the law while Republicans could not repeal it.
Could this be the moment we moved on from ACA politics?!
Enter the courts. In early 2018, Republican attorneys general sued to invalidate the mandate and, with it, the rest of the law. That lawsuit—California v. Texas—was ultimately heard by a new Supreme Court one week after the 2020 election, and the ACA was upheld just last summer.
This marked the third time that the Supreme Court largely rebuffed what could have been a crippling legal challenge to the law. It feels like ancient history now, but it is worth remembering that we were still playing “will they or won’t they?” with the Supreme Court and ACA only one year ago.
In the meantime, the Trump administration tried to undermine access to coverage under the law—except when it didn’t. I won’t list all the relevant Trump-era policies, but they had an impact: the uninsured rate rose, and marketplace enrollment declined until the 2021 plan year.
Ironically, one policy meant to destabilize the market had the opposite effect: so-called “silver loading” led to more generous marketplace subsidies and likely helped stave off even greater coverage losses.
This is the recent history that is top of mind as I reflect on the year ahead—and the work left to do to achieve universal coverage. Here are just some of the major issues facing policymakers:
• The clock is ticking toextend the American Rescue Plan Act subsidies. If Congress fails to do so, millions will face premium hikes next year and marketplace enrollment will likely drop.
• More than 2 million low-income peopleremain stuck in the Medicaid coverage gap in the 12 states that have not yet expanded their Medicaid program.
• Up to 15 million people, including nearly 6 million children, could lose Medicaid coverage at the end of the COVID-19 public health emergency.
• There is increasingly an affordability and underinsurance crisis, including for those with job-based coverage: an estimated 87 million peoplewere underinsured in 2018.
Congress and the White House are working to address these challenges, but much uncertainty remains.
“It feels like ancient history now, but it is worth remembering that we were still playing ‘will they or won’t they?’ with the Supreme Court and Affordable Care Act only one year ago.” – Katie Keith
Looking beyond Congress, 2022 will be an important year for regulatory changes. The Biden administration has proposed, but has not yet finalized, major marketplace changes. Other already-identified priorities include fixing the family glitch, limiting short-term limited duration insurance, and enhancing nondiscrimination protections. We could see movement on at least some of these rules soon.
While the Biden administration may be waiting out Congress before initiating some rulemaking, time is of the essence. New rules take many months to adopt and then take effect—followed by more time to deal with the legal challenges that typically follow.
Follow along as I dive deep on these issues and more in a new Health Affairs’ Health Reform newsletter.
We’ll highlight the latest health policy developments—from legislation to litigation—and explain what these changes mean for patients, payers, providers, and other key health care stakeholders.
It’s Your Birthday, Affordable Care Act!
In March 2020, Health Affairspublished a theme issue to celebrate the tenth anniversary of the Affordable Care Act. The issue contains many illuminating research articles on the landmark legislation, from its impact on “the cost curve” to Medicaid expansion.
Above is a datagraphic from the issue showing how the ACA affected insurance coverage.
A new omicron subvariant of the virus that causes COVID-19, BA.2, is quickly becoming the predominant source of infections amid rising cases around the world. Immunologists Prakash Nagarkatti and Mitzi Nagarkatti of the University of South Carolina explain what makes it different from previous variants, whether there will be another surge in the U.S. and how best to protect yourself.
What is BA.2, and how is it related to omicron?
BA.2 is the latest subvariant of omicron, the dominant strain of the SARS-CoV-2 virus that causes COVID-19. While the origin of BA.2 is still unclear, it has quickly become the dominant strain in many countries, including India, Denmark and South Africa. It is continuing to spread in Europe, Asia and many parts of the world.
The first omicron subvariant, BA.1, is unique in the number of alterations it has compared to the original version of the virus – it has over 30 mutations in the spike protein that helps it enter cells. Spike protein mutations are of high concern to scientists and public health officials because they affect how infectious a particular variant is and whether it is able to escape the protective antibodies that the body produces after vaccination or a prior COVID-19 infection.
BA.2 has eight unique mutations not found in BA.1, and lacks 13 mutations that BA.1 does have. BA.2 does, however, share around 30 mutations with BA.1. Because of its relative genetic similarity, it is considered a subvariant of omicron as opposed to a completely new variant.
While standard PCR tests are still able to detect the BA.2 variant, they might not be able to tell it apart from the delta variant.
Is it more infectious and lethal than other variants?
BA.2 is considered to be more transmissible but not more virulant than BA.1. This means that while BA.2 can spread faster than BA.1, it might not make people sicker.
Does previous infection with BA.1 provide protection against BA.2?
Yes! A recent study suggested that people previously infected with the original BA.1 subvariant have robust protection against BA.2.
Because BA.1 caused widespread infections across the world, it is likely that a significant percentage of the population has protective immunity against BA.2. This is why some scientists predict that BA.2 will be less likely to cause another major wave
However, while the natural immunity gained after COVID-19 infection may provide strong protection against reinfection from earlier variants, it weakens against omicron.
How effective are vaccines against BA.2?
A recent preliminary study that has not yet been peer reviewed of over 1 million individuals in Qatar suggests that two doses of either the Pfizer–BioNTech or Moderna COVID-19 vaccines protect against symptomatic infection from BA.1 and BA.2 for several months before waning to around 10%. A booster shot, however, was able to elevate protection again close to original levels.
Importantly, both vaccines were 70% to 80% effective at preventing hospitalization or death, and this effectiveness increased to over 90% after a booster dose.
How worried does the US need to be about BA.2?
The rise in BA.2 in certain parts of the world is most likely due to a combination of its higher transmissibility, people’s waning immunity and relaxation of COVID-19 restrictions.
CDC data suggests that BA.2 cases are rising steadily, making up 23% of all cases in the U.S. as of early March. Scientists are still debating whether BA.2 will cause another surge in the U.S.
Though there may be an uptick of BA.2 infections in the coming months, protective immunity from vaccination or previous infection provides defense against severe disease. This may make it less likely that BA.2 will cause a significant increase in hospitalization and deaths. The U.S., however, lags behind other countries when it comes to vaccination, and falls even further behind on boosters.
Whether there will be another devastating surge depends on how many people are vaccinated or have been previously infected with BA.1. It’s safer to generate immunity from a vaccine, however, than from getting an infection. Getting vaccinated and boosted and taking precautions like wearing an N95 mask and social distancing are the best ways to protect yourself from BA.2 and other variants.
Over the next few weeks, the U.S. should expect an increase in cases from the BA.2 variant, Dr. Anthony Fauci told ABC News, but it may not lead to as severe a surge in hospitalizations or deaths.
“I would not be surprised if in the next few weeks we see somewhat of either a flattening of our diminution or maybe even an increase,” Fauci told ABC News’ Brad Mielke on the podcast “Start Here.”
His prediction is based on conversations with colleagues in the U.K., which is currently seeing a “blip” in cases, Fauci said. The pandemic trajectory in the U.S. has often followed the U.K. by about three weeks.
However, he added, “Their intensive care bed usage is not going up, which means they’re not seeing a blip up of severe disease.”
The BA.2 variant, a more transmissible strain of omicron, now represents around 23% of all cases in the U.S., according to the latest data from the Centers for Disease Control and Prevention.
And while Fauci predicted that the BA.2 variant will eventually overtake omicron as the most dominant variant, it’s not yet clear how much of a problem that will be.
“Whether or not that is going to lead to another surge, a mini surge or maybe even a moderate surge, is very unclear because there are a lot of other things that are going on right now,” Fauci said.
Similar to the U.K., much of the U.S. has recently relaxed mitigation efforts like mask mandates and requirements for proof of vaccination. At the same time, people who were vaccinated over six months ago and still haven’t gotten a booster shot, which is about half of vaccinated Americans, according to the CDC, are facing continuously waning immunity.
It’s also not yet clear how long immunity from prior infection will last, Fauci said.
Taken together, it’s why Fauci and other experts, including CDC Director Rochelle Walensky, have increasingly predicted that elderly people will need a second booster shot soon. The Food and Drug Administration began reviewing data from Pfizer on the safety and efficacy this week, and its advisory panel will debate if and when the additional booster shot is necessary in the coming weeks.
At the same time, Fauci urged Americans who haven’t yet gotten their first booster, which would be their third shot in a Pfizer or Moderna series, to do so.
A resurgence of cases could also mean Americans are asked to wear masks again, which Fauci predicted would be an uphill battle.
“From what I know about human nature, which I think is pretty much a lot, people are kind of done with COVID,” Fauci said.
Still, he defended the CDC decision to loosen its mask recommendations earlier this month by shifting to a strategy that focused more on severe outcomes, like hospitalizations and deaths, rather than on daily case spread.
“You can go ahead and continue to tiptoe towards normality, which is what we’re doing, but at the same time, be aware that you may have to reverse,” Fauci said.
And if the U.S. does continue to make its way back toward normal times, Fauci himself has a personal choice to consider. At 81 years old, the director of the National Institute of Allergy and Infectious Diseases is “certainly” thinking about retirement.
“I have said that I would stay in what I’m doing until we get out of the pandemic phase and I think we might be there already, if we can stay in this,” Fauci said, referring to the falling cases and hospitalizations in the U.S.
“I can’t stay at this job forever. Unless my staff is gonna find me slumped over my desk one day. I’d rather not do that,” he said, laughing.
While he doesn’t currently have retirement plans, the recent hire of Dr. Ashish Jha, dean of the Brown University School of Public Health, to be White House coronavirus coordinator, could alleviate some of his pandemic response duties and give him a window.
But Fauci, who has dedicated his career to public health, primarily studying HIV and AIDS, and worked under seven U.S. presidents, said he doesn’t have any particular hobbies waiting for him in retirement.
“I, unfortunately, am somewhat of a unidimensional physician, scientist, public health person. When I do decide I’m going to step down, whenever that is, I’m going to have to figure out what it is I’m going to do,” he said.
“I’d love to spend more time with my wife and family. That would really be good.”
HENRY KOTULA 