Author: WadeEmmert

Press Release, Texas Attorney General:

Kenric Wakeen Griffin, co-owner of New Horizons Durable Medical Equipment based in Frisco, TX, was sentenced to 49 months of federal incarceration to be followed by a year of supervised release for his role in a medical equipment fraud scheme. In addition, Griffin was ordered to pay $5,114,016.19 in restitution to government health care programs. A jury convicted Griffin of conspiracy to defraud the United States and to pay and receive healthcare kickbacks, as well as seven counts of payment and receipt of kickbacks.

Griffin obtained patients by offering and paying kickbacks to marketers as well as disguising illegal payments as marketing services and outsourced business services. Griffin then submitted false claims to both Medicaid and Medicare for orthopedic equipment that was never provided, not medically necessary, and not authorized by a physician.

Steve Adler, for The HIPAA Journal:

The Biden Administration has unveiled its National Cyber Workforce and Education Strategy (NCWES) which seeks to address the current cyber workforce shortages and prepare the country for a cyber future.

The NCWES was developed by the Office of the National Cyber Director in collaboration with 34 agencies, departments, and EOP components and lays out a comprehensive approach for addressing immediate and long-term cyber workforce needs while ensuring all Americans have the cybersecurity skills they need to participate in the digital ecosystem.

The aim of the strategy is to empower all Americans looking to participate in the digital ecosystem, including communities that are currently underrepresented in the cyber workforce, and to promote and develop pathways for well-paying and fulfilling cyber careers. Under the strategy, the Biden Administration and its partners will leverage adaptable ecosystems to effect change at scale, enable the lifelong development of cyber skills, and grow and enhance the cyber workforce through diversity and inclusion.

The National Cyber Workforce and Education Strategy [PDF]

Texas Attorney General Press Release:

ApolloMDx offered illegal kickbacks in order to purchase both recipient information from marketers and orders for genetic testing from doctors. In some cases, doctors made fraudulent diagnoses to make it appear as though recipients were eligible for testing when they were not. In addition, ApolloMDx altered dates of service on testing orders to make it appear that multiple DNA samples were collected on different dates to enable billing for multiple dates of service.

Medical weight-loss locations have skyrocketed, driven by semaglutide medications. But a recent article from Chad Terhune, for Reuters, calls into question its staying power:

Only about one-third of patients prescribed a popular weight-loss drug like Novo Nordisk’s (NOVOb.CO) Wegovy were still taking it a year later, while total healthcare costs for the group rose sharply, according to an analysis of U.S. pharmacy claims shared with Reuters.

The annual cost of overall care for patients prior to taking Wegovy or a similar drug was $12,371, on average, according to the analysis. The full-year cost after starting the medication jumped by 59% to $19,657, on average.

Jill McKeon, for Health IT Security:

In June 2022, journalists discovered that a third of Newsweek’s top 100 hospitals in America had the Meta Pixel installed on their websites, which allegedly sent a packet of data to Facebook whenever a visitor clicked a button to schedule a doctor’s appointment. …

… The Markup, also observed the Meta Pixel operating inside the password-protected patient portals of seven health systems, sending patient names, medication information, and appointment details to Facebook. …

Following the article’s publication, an influx of breach notifications and lawsuits rolled in, with hospitals across the country admitting that tracking tech originally installed to measure and evaluate website visitor trends had inadvertently been disclosing sensitive information to tech companies such as Meta and Google.

In the year since these discoveries were made, healthcare data security and privacy experts have raised concerns not only about why this technology remains so widespread across healthcare, but why many hospitals were not even aware that this tech was quietly operating on their systems for years.

Understanding the root causes of this issue requires a deep dive into what this tracking tech promises to provide its customers, and the communication, technical, and regulatory gaps that contributed to this problem going unnoticed at some healthcare organizations.

Medicare does not currently cover Wegovy or other medications specifically for obesity. But some Medicaid programs, which are administered by individual states, are negotiating discounts for the popular semaglutide treatments.

Ganny Belloni for Bloomberg Law:

Nine states from California to Rhode Island have begun to cover expensive, next-generation weight-loss drugs like Novo Nordisk’s Wegovy on their Medicaid preferred drug lists. Preferred drug status allows patients to receive coverage for weight-loss drugs without the need to undergo step therapy, where patients are required to try less expensive and potentially less efficacious drugs before receiving their original drug of choice.

The move to cover weight-loss medication comes as states find new ways to grapple with the high yearly costs for patient care stemming from obesity-related comorbidities like diabetes ($9,601), heart disease ($18,953), and cancers ($21,503). The Milken Institute, an economic think tank, estimates the ensuing health costs and lost productivity of the obesity epidemic cost the US over $1.7 trillion in 2019.

With 44% of Medicaid beneficiaries qualifying as obese, expanding coverage to all eligible beneficiaries will present a significant financial challenge for state Medicaid programs. Wegovy, the most recent weight-loss drug to be added to Medicaid formularies, retails at over $1,300 per month and must be taken indefinitely to maintain results.

Dan Martin, for Medical Economics:

When you deviate from your peers, be especially sure to document the legitimate reasons for that deviation. Expect that insurance companies, regulatory agencies, and law enforcement officials will examine such deviations. Note any relevant information that supports why your treatment might differ from that of your peers. Such information might include the unique characteristics of your patient population, the nature of your referral network, the unique training you completed, or the difference in availability/unavailability of certain treatment options.