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POLITICO New York Health Care: Kickback, Medicaid claims settled; Pfizer settlement terms

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written by Dan Goldberg and Josefa Velasquez

SETTLED Three New York hospitals and an out-of-state health care provider have agreed to pay $8 million to settle prosecutors' accusations of illegal kickbacks for detox referrals and of Medicaid and Medicare fraud. It is the latest in a string of settlements Attorney General Eric Schneiderman has made with Missouri-based SpecialCare. The settlement, secured under the False Claims Act, followed an investigation into illegal referrals from Missouri-based health care provider SpecialCare Hospital Management to Columbia Memorial Hospital in Hudson and St. Joseph’s Medical Center in Yonkers. Under the terms of the settlement, SpecialCare and its former CEO Robert McNutt agreed to pay $6 million in penalties and are barred from from doing business with any Medicaid or Medicare provider in New York for five years. [PRO]

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THAT DIDN’T TAKE LONG — Leslie Noble is suing the Opera House Hotel, according to the Associated Press, claiming its "negligence, carelessness and recklessness" caused him physical pain and mental anguish. Noble, a 54-year old security guard, was one of 128 people sickened because of the Legionnaires’ disease outbreak, which city health officials say began at the Bronx hotel.

NOW WE KNOW — Single people can be happy, according to research published by the Society for Personality and Social Psychology. "It's a well-documented finding that single people tend to be less happy compared to those in a relationship, but that may not be true for everyone," lead researcher Yuthika Girme, a psychology doctoral candidate at the University of Auckland in New Zealand, said in a press release accompanying the article. “Single people also can have satisfying lives.”

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SLASHED — Crain’s reports: “UnitedHealthcare is slashing its rates with independent practice associations affiliated with academic medical centers. The insurer is consolidating those fee schedules into a uniform academic medical center IPA rate. ...According to a notice from the New York Weill Cornell IPA, the fees for United will be 100 percent to 130 percent of the current rate in the first year of the new schedule and will fall to 90 percent to 100 percent in the second. For Oxford Freedom products, the rates will be 90 percent to 110 percent of current rates in the first year and 90 percent to 100 percent in the second. For Oxford’s Liberty plan, rates will drop 85 percent to 90 percent in year one; for United Compass, they will drop 75 percent to 81 percent.”

HAPPENING TODAY — Brooklyn Borough President Eric Adams will host a press conference featuring a local resident struggling with K2, a synthetic marijuana. Adams is seeking to highlight the danger of the drug and its prevalence. The press conference will take place at 10 a.m. at Borough Hall.

OPINION — A column in the Democrat & Chronicle argues that violence in Rochester should be treated as a disease. “If we want to promote all the factors to make us healthy, how do we treat violence? We call it what it is — a threat to public health. A threat not just to physical health, but to the social, mental, environmental and even the economic health of this community. And not just the city, but the suburbs that are lumped, for better or worse, into the Greater Rochester area.”

PHARMA REPORT: Pfizer will have to sell the rights to four drugs to generic drug company Alovgen to settle FTC charges that its proposed $16 billion acquisition of Hospira is anticompetitive. The commission said the divestitures were necessary to preserve competition in the sterile injectable pharmaceutical market and keep prices from rising. Pfizer will have to supply Alvogen with one of the drugs for three years while it transfers manufacturing technology to the company. It will also have to assist Alovgen in establishing manufacturing capabilities and securing FDA approval to market all of the divested drugs. The FTC will decide whether to make the consent order final after a 30-day public comment period.

-ACQUISITION — DaVita Healthcare Partners will acquire Renal Ventures Limited for $415 million, according to Modern Healthcare.


-POST: SALADS ARE OVERRATED — “As the world population grows, we have a pressing need to eat better and farm better, and those of us trying to figure out how to do those things have pointed at lots of different foods as problematic. Almonds, for their water use. Corn, for the monoculture. Beef, for its greenhouse gases. In each of those cases, there’s some truth in the finger-pointing, but none of them is a clear-cut villain. There’s one food, though, that has almost nothing going for it. It occupies precious crop acreage, requires fossil fuels to be shipped, refrigerated, around the world, and adds nothing but crunch to the plate. It’s salad, and here are three main reasons why we need to rethink it.” Reason number one: salads have low nutritional value due to the lettuce. Two: salad makes people on diets make poor food choices. Three: Lettuce is the leading culprit for foodborne illness. Read more from the Washington Post.

-SPEAKING OF MYTHS — You really don’t have to drink eight glasses of water a day, and Aaron Carroll explains why.

-SECOND CANCERS — The Associated Press reports that second cancers — meaning a different tissue type or site — are on the rise.

-OBAMACARE ONLINE — From POLITICO’s David Pittman: “Obamacare is going virtual. Most large health insurers and many smaller ones will offer patients the option to phone or video chat a doctor in plans sold on Affordable Care Act exchanges this fall, analysts say. Health insurers are rapidly turning to telemedicine as a way to prevent unnecessary emergency room visits, to soak up demand from newly insured patients who can’t immediately find a physician, and to meet state requirements for fielding enough doctors in their plans.Health plans can avoid paying those costly bills if successful in getting patients to talk with doctors online rather than heading to the ER for a sore throat or back pain. For insurers selling products on Obamacare exchanges, many of which have been criticized for planning sharp premium increases next year, holding down costs is critical to sales of their products. Telemedicine is a low-cost, low-risk answer.”

-THE UNIVERSAL PATIENT — The New York Times has a story about how a hospital in Dallas has rooms built for obese patients. “We designed with this idea of the universal patient in mind,” said Jim Henry, an associate vice president of the architectural consulting firm HDR, which worked on the new building. (One assumes he means ‘universal’ in the sense of all people, not as a unit of measurement for one patient.)

-UNIVERSAL FLU VACCINE?— Two groups of researchers have created vaccines they say “lays the groundwork” to protect against every type of flu. “The teams of researchers independently focused on a protein called hemagglutinin, found on the surface of the flu virus H1N1. It has two major components: the head — the portion of the virus that mutates and changes from strain to strain — and the stem, which is similar across most flu strains,” according to Science magazine. “The teams tried to remove the variable head region and keep the stem as the base of their vaccines. But hemagglutinin turns out to be rather feeble. Once beheaded, the stem falls apart, and antibodies can no longer to bind to it.”

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TODAY'S TIP — Comes from the state health department, which reminds us that “smart phones can be lifesavers during emergencies. Plan today by looking for and downloading emergency apps on your phone.”


-NARROW NETWORKS Researchers from the University of Pennsylvania found that at least half of the plans sold on Affordable Care Act exchanges in 16 states offered narrow networks. Georgia led the way with 83 percent of its plans considered narrow, meaning they included fewer than one-quarter of the providers in the area they served. In California, Florida and Oklahoma, at least three-quarters of the products sold on their marketplaces had narrow networks.

-MENTAL ACUITY — Older adults who regularly engage in moderate to vigorous physical activity have higher cognitive function, brain structure and functional integrity, a study in PLOS One found.

-HEART DRUG LINKED TO INCREASE CANCER SURVIVAL RATE — Researchers analyzing a database of 1,425 women with “tough-to-treat” cancer found those who had taken a certain type of beta blocker, a common heart drug, lived, on average, more than four years longer than those who hadn’t been prescribed the drug, the Wall Street Journal reports.

-IMPACT OF ABUSE — A study in the Journal of the American Academy of Child and Adolescent Psychiatry found that children who have been abused have more intense emotions than their nonabused peers but can regulate their emotions with neutral responses.

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