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July 5, 2011

Today’s issue is brought to you by AIS's Report on Medicare Compliance, the nation's leading source of news and strategic information on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers.

Today's Featured Story

DOJ Appears Open to Idea that Medical Necessity, NCD Don’t Always Overlap
Reprinted from Report on Medicare Compliance

Medicare coverage of implantable cardiac defibrillators (ICDs) may not be as black-and-white as fraud enforcers contend, which gives hospitals some pushback in the national investigation of billing for ICD implants, some lawyers tell AIS .... Read Full Story


From the AIS Blogs

FDA: Companion Diagnostics Guidance May Be Out in 'Two to Three Weeks'

After more than two years of rumors that FDA guidance on companion diagnostics was imminent, it appears that imminent may finally be here, according to one FDA official ... Read more


Quote of the Day

“I think as we see ACOs that don’t have pharmacists on staff looking to take risk, they are going to need help from pharmacists in both managing quality and to make sure that they do OK on the 65 quality measures….”

— Marissa Schlaifer, pharmacy affairs director for the Academy of Managed Care Pharmacy, told AIS’s Drug Benefit News.

Click here to read the DRUG BENEFIT NEWS article in which this quote appeared. (Free for DBN subscribers; $17 for non-subscribers).


Today's Datapoint

61% … of biopharma execs included “outcomes” (as opposed to, or in addition to “cost”) in their definition of “value” in health care, while just 36% of managed care execs, 29% of physicians and 6% of patients mentioned “outcomes,” according to The New Health Report 2011, issued by Quintiles Transnational Corp.

Click here to read the SPECIALTY PHARMACY NEWS article in which this datapoint appeared. (Free for SPN subscribers; $17 for non-subscribers).


FierceHealthPayer News from our partner FierceMarkets

Blue Cross-Highmark deal bolstered under new state law

Blue Cross Blue Shield of Delaware and Highmark inched closer toward affiliation with the state legislature's passage of a law that allows the insurers to evade restrictions set forth by the attorney general's office .... Read more


Today from Washington

People on the Move

Novavax, Inc. named Timothy Hahn senior vice president of manufacturing. Hahn was vice president of vaccine manufacturing at MedImmune, LLC....The Blue Cross Blue Shield of Massachusetts Foundation appointed Owen Heleen senior director of grantmaking, and Anna Gosline director of policy and research. Heleen was vice president for grant programs at The Rhode Island Foundation, and Gosline was project manager for an examination of Vermont's health care system.


Today's Featured Health Business Job Opening

Medicare Compliance Officer
Albuquerque, N.M.

Place Your Ad Here

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Accounting for HIPAA Disclosures in EHRs: How to Comply with Onerous New HHS Rules
Thursday, July 7, 2011

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Health Plans vs. Drug Coupons: Tactics to Combat Brand-Name Drug Promotions
Wednesday, July 13, 2011

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Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, July 14, 2011

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2012 Plan Design: What New Products Will Health Plans and Employers Roll Out This Fall?
Thursday, July 21, 2011

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Managing Oncology Drugs: New Challenges and Payer Solutions
Tuesday, August 23, 2011

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AIS's Health Business Daily