July 19, 2012

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.

In New Angle on Stark Cases, Government Hits Hospitals for Lack of Physician Profit
Reprinted from Report on Medicare Compliance

Hospitals that employ physicians may run afoul of the Stark law in the eyes of the government if they don’t make a profit on the physicians’ professional services. According to recent cases being pursued by some government attorneys, most employment arrangements would not be commercially reasonable — a criterion of Stark exceptions — unless they generate a profit, one lawyer says .... Read Full Story

CMS Drops the Other Shoe, and It Hurts United

CMS has made clear in recent months, if not years that it considers problems Medicare Part D enrollees have in getting prescriptions filled promptly and at the proper price to be a high priority ... Read more

“What was really surprising to me was the shockingly low level of confidence…payers have in the data provided to them [by pharmaceutical companies].” Only 5% of respondents to a recent PwC survey are “very confident in the economic data provided by the drug industry when making coverage and formulary placement decisions.”

— Todd Evans, a director in the pharmaceutical life sciences practice at PwC, told AIS’s Specialty Pharmacy News.

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

Today's Datapoint

26 … states will be ready to start fully state-operated exchanges in January 2014, according to Kansas Insurance Commissioner Sandy Praeger, the chair of NAIC’s health insurance and managed care committee, who responded to this question from AIS’s Health Reform Week at a recent news conference.

From AIS's HEALTH REFORM WEEK.

Healthcare prices, spending at new lows

Healthcare spending remains relatively depressed, while healthcare price increases were at their lowest rates since the 1990s, according to new reports from the Altarum Institute ... Read more

• Congressional Record
• Federal Register

Inclinix-PMG Holdings named John Rubino, M.D., medical director; promoted Jennifer Byrne to president and chief operating officer (COO) of PMG Research Inc.; and promoted Denise Robinson to president and COO of Inclinix, Inc. Rubino was medical director of Triangle Medical Research....The SSI Group, Inc. said that Founder, CEO and President, Bobby E. Smith is retiring. James M. Lyons, the current vice president and chief financial officer, as the new president and CEO, effective Aug. 1, 2012.

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