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Fighting Medicare Fraud - Health Care Edge: Brought to you by Pfizer RxPathways

Fighting Medicare Fraud

By Sam Baker and Clara Ritger


FRAUD FOCUS: The House Ways and Means Committee's health panel will take a closer look today at waste, fraud and abuse in Medicare. Witnesses from the inspector general's office within HHS and the Government Accountability Office are scheduled to testify about various agencies' role in preventing or combating waste and fraud in Medicare, which add up to tens of billions of dollars every year. It's also the first big focus on Medicare fraud since HHS released its list of Medicare payments to specific doctors -- a new fraud-fighting tool that's already brought extra scrutiny for high-billing doctors..

Top Health Care News

OKLAHOMA POSTPONES EXECUTION AFTER FIRST IS BOTCHED: "A doctor started to administer the first drug, a sedative intended to knock the man out, at 6:23. Ten minutes later, the doctor said that Mr. Lockett was unconscious, and started to administer the next two drugs, a paralytic and one intended to make the heart stop.

"At that point, witnesses said, things began to go awry. Mr. Lockett's body moved, his foot shook, and he mumbled, witnesses said.


"At 6 :37, he tried to rise and exhaled loudly. At that point, prison officials pulled a curtain in front of the witnesses and the doctor discovered a 'vein failure,' Mr. Patton said.

"Tuesday night's disastrous mishap ... is certain to generate more challenges to lethal injection, long considered the most humane of execution methods." (Erik Eckholm, New York Times)

IS ANOTHER OBAMACARE EXEMPTION ON THE HORIZON? Congress is eyeing modifications to health plans sold to expatriates, but some fear it could hurt millions of immigrant workers. (Clara Ritger, National Journal)

MEDICARE MAY RAISE PAY TO HEALTH CLINICS BY $1.3 BILLION: Nonprofit community clinics that usually serve low-income patients with few alternatives for treatment are getting an Obamacare-mandated boost. (Alex Wayne, Bloomberg News)



OBAMACARE ENROLLEES EMBOLDENED TO LEAVE JOBS, START BUSINESSES: A recent study by Georgetown University and the Urban Institute predicts the ACA will enable up to 1.5 million Americans to leave their jobs and become self-employed, start new businesses or retire early. (Stephanie O'Neill, National Public Radio)

INSURERS: MILLIONS MORE HAVE COVERAGE NOW: The rush of sign-ups at the end of the Affordable Care Act's enrollment period were largely young enrollees, insurance representatives said. (Kyle Cheney, Politico)

ADMINISTRATION BEGINS SEARCH FOR NEW CONTRACTORS TO RUN HEALTH CARE SITE: The online federal exchange is expected to handle much larger traffic numbers as Obamacare gets older. (Robert Pear, New York Times)

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ONE IN SEVEN KIDNEY STONE PATIENTS END UP BACK IN THE HOSPITAL: The average cost of an unplanned follow-up visit is about $30,000. (Sarah Kliff, Vox)

OHIO SURGEONS HOPE CHIP IN MAN'S BRAIN LETS HIM CONTROL PARALYZED HAND WITH THOUGHTS: "The computer was programmed to decode messages from the brain and beam their instructions to strips of electrodes strapped around the man's forearm. The electrodes were designed to pulse and stimulate muscle fibers so that the muscles could pull on tendons in his hand.

"If it all worked, a man who was paralyzed from the chest down would think about wiggling his finger, and in less than one-tenth of a second, his finger would move.

"They would bypass his broken spinal cord and put a computer in its place." (Jim Tankersley, Washington Post)


CDC DIRECTOR EXPLAINS WHAT HE HATES ABOUT ELECTRONIC CIGARETTES: "When 1.78 million of our high school kids have tried an e-cigarette and a lot of them are using them regularly … that's like watching someone harm hundreds of thousands of children," said Tom Frieden in an interview with the Los Angeles Times. (Karen Kaplan, Los Angeles Times)

NEW YORK AND CHICAGO BRING E-CIGS UNDER UMBRELLA OF LAWS: New laws to stem the popularity of the new devices took effect in the two cities Tuesday. (Cheryl Corley, National Public Radio)


WHAT STATE HEALTH CARE LOOKED LIKE BEFORE THE AFFORDABLE CARE ACT: A new Commonwealth Fund report shows that in the five years prior to the health law's implementation, states made few improvements to lower health care costs and improve access to and quality of care. (David Radley and Cathy Schoen, Commonwealth Fund)

Happening Today

DRUG ENFORCEMENT ADMINISTRATOR TESTIFIES BEFORE SENATE COMMITTEE: The full Judiciary committee will hear from DEA Administrator Michele M. Leonhart at 10 a.m. in Dirksen 226.

WOMEN'S HEALTH CAN'T WAIT: THE CONTINUED NEED FOR SEX AND GENDER BASED RESEARCH: The Society for Women's Health Research co-sponsors a program on gender equality in clinical trials at 10 a.m. in Rayburn 2358B. Democratic Rep. Rosa DeLauro is scheduled to attend.

PHARMACEUTICAL CARE MANAGEMENT ASSOCIATION FORUM: Sessions include prescription drug abuse, maximizing access to medicines, harnessing competition to reduce costs and Medicare Part D. The forum begins at 1:00 p.m.

HOUSE COMMITTEE LOOKS AT MEDICARE OVERSIGHT: The Ways and Means Committee is scheduled to gather at 2 p.m. in 1100 Longworth to discuss "Ideas to Improve Medicare Oversight to Reduce Waste, Fraud and Abuse." HHS And GAO officials are scheduled to attend.


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Health Care Edge is one of my top resources."

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