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Health Management Technology News
  May 15, 2014
In this issue:
 

 Health Management Technology’s Resource Guide sign-up

 2 Orlando hospital workers test negative for MERS

 Alberta health minister asks U.S. company why it charges Canadians more for drug

 90 people, 16 doctors, charged with defrauding $260 million in false Medicare billings

 The key to lower healthcare costs is in your hands

 Insurers to publish healthcare prices online

 Billionaire heiress seeks healthcare fortune: Corporate India


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2 Orlando hospital workers test negative for MERS

Two employees tested negative for a rare virus days after coming into contact with a Saudi resident infected with the second confirmed MERS case in the U.S., a spokeswoman for an Orlando hospital said Wednesday.

One of the two employees tested after showing symptoms of Middle East Respiratory Syndrome was hospitalized Monday, said Katie Dagenais of Dr. P. Phillips Hospital. The other was discharged the same day. The hospitalized patient, identified only as a woman, was expected to be released sometime Wednesday, according to Dr. Antonio Crespo, the Infectious Diseases Specialist at Phillips.

Hospital officials were still awaiting test results from 18 other health care workers who are being monitored for potentially having the virus. The workers are based at Phillips and Orlando Regional Medical Center. Dr. Kevin Sherin, health officer with the Florida Department of Health in Orange County said Wednesday afternoon that all of the remaining health care workers have undergone at least some initial MERS testing, and those results have all been negative. However, he said they will continue to be subjected to more testing going forward.

Sherin added that doctors tracking the case in Orlando "believe that this infection is contained" and that there was "minimal risk to the community."

MERS is a respiratory illness that begins with flu-like fever and cough but can lead to shortness of breath, pneumonia and death.

Read the full article from Bradenton Herald
here


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Alberta health minister asks U.S. company why it charges Canadians more for drug

Alberta's health minister says he had some hard questions for a U.S. company about why Canadians have to pay more for a lifesaving drug that treats a rare form of cystic fibrosis.

But the company that makes the drug says it has offered a price that is as good as or better than what the 15 countries where the drug is now reimbursed are paying.

Fred Horne, representing provincial and territorial health ministers along with a representative from the Yukon, met in Toronto on Tuesday with Stuart Arbuckle, chief commercial officer of Vertex Pharmaceuticals.

Horne said there was no breakthrough, but negotiations with the company will continue this week.

"We are extremely disappointed that today's meeting did not result in an agreement to allow the eligible children and adults with CF in Canada to receive this medicine through public reimbursement," Arbuckle said in a statement.

"People with CF are still waiting for access to Kalydeco, and this process is taking much longer than they expect and deserve."

Kalydeco, which helps people who have the fatal genetic disease, costs about $300,000 a year per patient in Canada.

Alberta has been leading negotiations with Vertex for nearly a year to lower the drug's price so it can be covered by Medicare.

"We wanted to know why should Canadian patients be expected to pay a higher price for this drug than U.S. patients," Horne said.

Read the full article from CTV News here

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90 people, 16 doctors, charged with defrauding $260 million in false Medicare billings

The Medicare Fraud Strike Force in six cities charged 90 individuals -- 27 doctors, nurses and other medical professionals -- for their alleged participation in Medicare fraud schemes involving hundreds of millions.

Attorney General Eric Holder and Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, said Medicare Fraud Strike Force operations, part of the Health Care Fraud Prevention & Enforcement Action Team, was created in 2009 by the Department of Justice and HHS to coordinate efforts to prevent fraud and enforce current federal anti-fraud laws.

It is a multi-agency team of some 400 law enforcement agents from the FBI, HHS-Office of Inspector General, Medicaid fraud control units and other federal, state and local law enforcement agencies designed to combat Medicare fraud via Medicare data analysis and community policing.

The defendants allegedly participated in schemes to submit Medicare claims for treatments that were medically unnecessary and often never provided, court documents said. For example, a Los Angeles doctor was charged for causing almost $24 million in losses to Medicare through his own fraudulent billing and referrals for durable medical equipment, including more than 1,000 power wheelchairs, and home health services unnecessary and often not provided.

Read the full article from UPI here

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The key to lower healthcare costs is in your hands

For as long as anyone can remember, U.S. health care has used a pretty simple model: If you didn't feel well, you went to your doctor. If you were acutely ill or injured, you went to the hospital.

With numerous pilot programs in the Affordable Care Act (ACA) tweaking that paradigm, the country may see some progress on reducing medical costs, which are among the highest in the industrialized world.

Academics admit that they may be stymied by one huge barrier: habits. Millions may be using emergency rooms even when they don't need to go. They may avoid doctors in the early stages of a disease, making further treatment more expensive. Or they may feel that long hospital stays are the "best way to get better."

Read the full article from The Fiscal Times
here


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Insurers to publish healthcare prices online

Three major health insurance companies have agreed to publish their healthcare prices in a free online portal starting next year.

The unprecedented move is designed to boost transparency in the U.S. healthcare system, notorious for its hard-to-access and seemingly random prices.

Advocates hope public prices will lower healthcare costs over time as consumers make more informed choices in obtaining medical care and experts study pricing trends with greater ease.

The nonprofit Health Care Cost Institute (HCCI) will create and administer the online portal in partnership with Aetna, Humana and UnitedHealthcare.

Other insurers are expected to join the initiative soon, HCCI said.

"Consumers, employers and regulatory agencies will now have a single source of consistent, transparent health care information based on the most reliable data available, including actual costs, which only insurers currently have," said HCCI Executive Director David Newman in a statement.

"Voluntarily making this information available will be of immeasurable value to consumers and other health system participants as they seek to manage the cost and quality of care," Newman said.

Read the full article from The Hill here

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Billionaire heiress seeks healthcare fortune: Corporate India

Roshni Nadar Malhotra, the daughter of Indian billionaire Shiv Nadar, is stepping out of her father’s shadow to make a foray into health care. She’s using her family’s computer business as a springboard.

The 33-year-old plans to spend 10 billion rupees ($168 million) to build a network of health clinics to treat acute and chronic ailments including diabetes, asthma, stomach and skin conditions, she said in an interview. Her venture will start with 50 centers in and around New Delhi before expanding to small towns, the only offspring of the founder of HCL Technologies Ltd. (HCLT) and HCL Infosystems Ltd. (HCLI) said.

“The focus is on providing outpatient care, something that can fill in for the disappearing tradition of family physicians,” Nadar said from her office in the outskirts of the nation’s capital. “We aren’t building hospitals. Not yet.”

Nadar is seeking to tap a market for primary care in the second most-populous country where state delivery is poor or inadequate, while private hospitals run by Apollo Hospitals Enterprise Ltd. (APHS) and Fortis Healthcare Ltd. (FORH) are unaffordable to a majority. Health-care spending in India may surge sevenfold to $280 billion in the decade to 2020, a study by the Federation of Indian Chambers of Commerce and Industry shows.

The effort of HCL Avitas, as the venture is known, will be to provide a cheaper alternative for those wanting treatment for the common cold, flu, chest congestion and other conditions, Nadar said. A single appointment at a private hospital in Mumbai might cost $20, compared with $5 at an HCL Avitas facility.

Read the full article from Bloomberg.com here

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