Author: WorkCompAcademy

The Trump Administration wants to make it easier for patients and employers to comparison shop for healthcare.  So far, the measures implemented have mostly been baby steps. But, this is about to change as President Trump is expected to soon release an executive order on healthcare price transparency.

If enacted, this executive order would mandate disclosure of prices throughout the healthcare industry, and be enforceable by federal agencies. It would provide patients and employers pricing data that reflect the negotiated rates between insurers, hospitals, and physicians.

The Trump Administration has been gradually chipping away to uncover the murky world of healthcare pricing. For example, in October 2018, President Trump signed two bills into law, the Know the Lowest Price Act and the Patients’ Right to Know Drug Prices Act. These bills removed pharmacy gag clauses, imposed by pharmacy benefit managers, which had prevented pharmacists from proactively telling consumers if their prescription would cost less if they paid for it out-of-pocket rather than using their insurance plan.

And, this month, the Department of Health and Human Services (HHS) announced that direct-to-consumer (DTC) advertisements of prescription drugs on television will soon be required to include price information.

Nonetheless, the pharmacy gag clause bills and requirement to include list price information in DTC advertisements only incrementally address prescription drug price transparency. A much bigger step would be to overhaul the prescription drug rebate system, as proposed by HHS. However, it’s unclear whether and when that will happen.

Ultimately, drug price transparency alone won’t be sufficient to create conditions conducive to a competitive market. It needs to be coupled with dissemination of information on which medications are the most effective for specific conditions or diseases.

There have been a number of efforts in the commercial sector to address this issue; MedSavvy, for example, which is a Cambia Health Solutions company. Regence Blue Cross and Blue Shield offers MedSavvy to its customers. The federal government is also supporting initiatives to improve the Patient-Centered Outcomes Research Institute’s publication of usable information on comparative effectiveness to consumers. But it’s been a very slow process with few tangible results thus far.

The Trump Administration has also focused on disseminating information regarding the quality of physician practices that serve Medicare beneficiaries. The Centers for Medicare and Medicaid Services (CMS) established a website called Physician Compare. However, nearly 80% of physicians aren’t included in the website database. Reporting is voluntary, and so there’s selection bias when it comes to the performance data that do appear. Moreover, the website doesn’t include a comparison of fees for physician services.

Beginning January 1st this year, the federal government is requiring every hospital in the U.S. to post lists of prices of services and technologies online. Such lists are known in the industry as “chargemasters” that comprise of prices of thousands of services and products for which a hospital may bill.

But, CMS acknowledges it is not yet enforcing the hospital pricing rule. Furthermore, implementation of the rules has sparked a debate about whether the price lists are creating more confusion than clarity among patients. Services and products are identified in acronyms, abbreviations, billing codes, and medical terminology that most consumers can’t be expected to understand.

The Ventura County District Attorney announced that Garrett Moore (DOB 12/26/1983), of Simi Valley, was sentenced after pleading guilty to a felony violation of Penal Code section 550(b )(1 )- making a fraudulent statement of a material fact for the purpose of obtaining workers’ compensation benefits.

Moore was placed on summary probation for a period of 36 months and was ordered to serve 90 days in the Ventura County jail.

The offense was reduced to a misdemeanor by the court because Moore had previously made restitution in full to victim insurance company, York Risk Services, in the amount of $24,000.

Moore was employed as a custodian for the Simi Valley Unified School District and injured his right shoulder on December 4, 2017.

He was placed off work on temporary total disability and began receiving medical treatment. York Risk Services learned that Moore owned a carpet cleaning business, but Moore told them he had no active role in the business and all the physical labor was performed by his father and son.

York retained private investigators who obtained surveillance video of Moore using both arms to carry hoses, pushing a large pressure washer up and down ramps, and moving large pieces of furniture and appliances. When he was interviewed by investigators, Moore denied doing any kind of strenuous physical activity.

The state legislature is considering a proposal that takes aim at Uber, Lyft and others using independent contractors by adopting the “ABC” employment test – but it could render the entertainment industry’s tax-lucrative loan-out companies useless.

The Hollywood Reporter magazine claims that Hollywood studio executives may be in for a shock when it comes to their budgets. A bill winding through California’s legislature that takes aim at gig-fueled companies like Uber and Postmates may upend long-standing showbiz practices by reclassifying scores of independent contractors as employees, and could render tax-lucrative loan-out companies useless.

The bill, AB 5, which the state assembly passed May 29, is designed to protect workers from being misclassified as independent contractors and therefore denied such employee protections as minimum wage, overtime pay and workers’ compensation. It seeks to codify and expand the California Supreme Court’s 2018 Dynamex decision, and would presume every worker is an employee – with a few exceptions for people like barbers and real estate agents – unless a company can show that the worker meets three criteria under the so-called ABC Test.

The requirement that makes Hollywood nervous is that the independent contractor must perform duties outside the usual course of the company’s business. “That test will necessarily lock talent out of being an independent contractor if it passes in its current form,” says talent lawyer Rick Genow, whose clients include Debra Messing, Anthony Anderson and Henry Golding. “The economic impact would be somewhat devastating to both talent and the studios.”

A doomsday scenario for Hollywood would look like this: A law is enacted with no exemption for entertainment workers; companies opt to treat everyone as employees for all purposes to avoid complications; and loan-outs are effectively dead in the water.

It’s often financially beneficial for talent to form their own corporation, and then that company loans out their services to other employers instead of those employers hiring them directly. Adds business manager Harley Neuman, who represents Ellen DeGeneres and Scarlett Johansson: “It would be catastrophic to our business if loan-outs went away.”

It’s unclear how much this bill would cost the entertainment business in total, but the state of California estimates it loses out on $7 billion in payroll tax revenue each year because of alleged misclassification across all industries. Economist Chris Thornberg of Beacon Economics says the bill aims to solve a problem that’s been overblown. “California’s economy has the lowest unemployment rate it has ever had,” he says. “People have options, and they’re still choosing to drive Uber or Lyft. The idea these people are being exploited and need help just doesn’t fly.” He expects film and TV productions would either leave the state or find ways to cut costs.

The language of the bill isn’t final, so some of the potential negative impacts could be avoided through amendments. The deadline to pass legislation before sending it to Gov. Gavin Newsom’s desk is Sept. 13.

A psychiatrist who practiced at a Santa Ana clinic has been sentenced to 57 months in federal prison for issuing prescriptions for dangerous and addictive narcotics, such as the opioid oxycodone, without a medical purpose, to a drug dealer in exchange for cash, knowing the drugs would be sold on the street.

Dr. Robert Tinoco Perez, 57, of Westminster, was sentenced by United States District Judge Andrew J. Guilford. Perez pleaded guilty on February 25 to one felony count of conspiracy to distribute controlled substances.

Perez was a 1994 graduate of the University of California, Irvine College of Medicine. He was licensed as a physician and surgeon in California on November 2. 1994. On May 1, 2019 the Medical Board accepted the surrender of his license, and he is no longer licensed in California. At the time disciplinary charges were pending against Perez for alleged sexual exploitation and sexual misconduct with a patient, among other charges.

Perez wrote prescriptions for “patients” he had never met or examined, including an undercover officer. Perez also created fictitious medical records for drug customers to provide justification for their prescriptions.

Perez used bogus patient names to write the fraudulent prescriptions to co-defendant William Jason Plumley, 41, of Huntington Beach, who sold the prescribed drugs – and also heroin and methamphetamine – to an undercover law enforcement officer. Plumley now is serving a 70-month federal prison sentence for selling prescriptions written by Perez as well as the drugs filled from Perez’s prescriptions. Plumley pleaded guilty in October 2018 to one count of conspiracy to distribute controlled substances.

The drugs prescribed illegally by Perez included oxycodone and hydrocodone (both opioid pain medications), amphetamine salts (sold primarily under the brand name Adderall), and alprazolam (sold primarily under the brand name Xanax).

Perez admitted in his plea agreement that between December 2017 and January 2018, he wrote prescriptions for fictitious patients for 240 pills of Adderall, 300 pills of Roxicodone (oxycodone), and 250 pills of Norco (hydrocodone). Perez sold the prescriptions to Plumley for at least $1,400, according to Perez’s plea agreement.

This case is part of Operation Hypocritical Oath, a series of investigations led by the Drug Enforcement Administration targeting medical professionals with criminal charges, search warrants, and administrative actions that have led to the revocation of DEA licenses.

This case is the result of an investigation by the Drug Enforcement Administration and the Costa Mesa Police Department. The case is being prosecuted by Assistant United States Attorney Rosalind Wang of the Santa Ana Branch Office.

IBM, Merck and Walmart have been chosen for a U.S. Food and Drug Administration pilot program that will explore using blockchain technology to improve the security of prescription drug supply and distribution.

The companies said they would work with consultancy KPMG to create a shared blockchain network that will allow real-time monitoring of products in the pharmaceutical supply chain.

The project has been authorized under the U.S. Drug Supply Chain Security Act. DQSA, was enacted by Congress on November 27, 2013. Title II of DQSA outlines steps to build an electronic, interoperable system to identify and trace certain prescription drugs as they are distributed in the United States.

The act was passed to improve FDA’s ability to help protect consumers from exposure to drugs that may be counterfeit, stolen, contaminated, or otherwise harmful. The system will also improve detection and removal of potentially dangerous drugs from the drug supply chain to protect U.S. consumers.

Additionally, the DSCSA directs FDA to establish national licensure standards for wholesale distributors and third-party logistics providers, and requires these entities report licensure and other information to FDA annually.

The FDA has previously used the DSCSA to issue a warning letter to drug distributor McKesson Corp for violations involving opioid medications.

The new project is aimed at reducing the time needed to track and trace prescription drugs, improving access to reliable distribution information and ensuring products are handled appropriately and stored at the right temperature while being distributed, the companies said in a statement.

Blockchain technology, originally conceived a decade ago as the basis for the cryptocurrency bitcoin, will help stakeholders establish a permanent record and can be integrated with existing systems used to trace products while they are distributed.

The project is scheduled to be completed in the fourth quarter of 2019 and results will be published in a report, the companies said.