NEW YORK (Reuters)—U.S. antitrust officials on Thursday moved to block an unprecedented consolidation of the national health insurance market, filing suit against Anthem Inc.’s proposed purchase of Cigna Corp. and Aetna Inc.’s planned acquisition of Humana Inc. The U.S. Department of Justice (DOJ) says the two mergers would reduce competition, raise prices for consumers and…
Practicing Telemedicine Raises Legal Considerations for Rheumatologists
With the evolution and advancement of technology, it was only a matter of time before such changes affected the medical industry. Although the concept of telemedicine dates back more than 50 years, emphasis on cost-effective quality healthcare coupled with technological advancements has caused a resurgence of telemedicine in recent years. What constitutes telemedicine largely depends…
U.S. Judge Cuts $500 Million Verdict over Johnson & Johnson Hip Implants
NEW YORK (Reuters)—A U.S. judge has slashed a $500 million verdict against Johnson and Johnson and its DePuy unit over allegedly defective metal-on-metal Pinnacle hip implants to approximately $151 million. On Tuesday, U.S. District Judge Ed Kinkeade in the Northern District of Texas says he was compelled to reduce the verdict under a Texas state…
FDA Seeks Suspension of 4,402 Illegal Prescription Drug Websites
(Reuters)—The U.S. Food and Drug Administration said on Thursday it, along with international authorities, has formally sought to suspend 4,402 websites that illegally sell potentially dangerous, counterfeit or unapproved prescription drugs to U.S. consumers. The move is part of a global effort being led by the INTERPOL, the world’s largest police organization, to identify the…
Patient Can’t Always Access Complete Medical Records, Doctors Say
(Reuters Health)—Technology makes it possible for patients to access medical records online, but a thicket of legal issues may still keep people from always seeing everything in their chart, some doctors say. The Health Insurance Portability and Accountability Act (HIPAA) gives U.S. patients the right to access their medical records and control who else has…
Preparing for Increased HIPAA Audits Among Smaller Rheumatology Providers
Recent enforcement activities of the Department of Health and Human Services’ Office for Civil Rights (OCR) have shown an increase in fines and penalties assessed against smaller providers for failing to comply with the privacy, security and breach notification requirements of the Health Insurance Portability and Accountability Act (HIPAA). Historically, OCR has focused on larger…
U.S. Probes Contracts Between Drugmakers, Pharmacy Benefit Managers
(Reuters)—The U.S. Attorney’s Office for the Southern District of New York is investigating contracts between drugmakers and companies that manage prescription benefits, according to regulatory filings. Federal prosecutors have approached at least three companies, including Johnson & Johnson, Merck & Co. and Endo International Plc., demanding information about their contracts with pharmacy benefit managers. Pharmacy…
Health Insurer Anthem Sues Express Scripts over Drug Pricing
(Reuters)—Health insurer Anthem Inc. said it had sued pharmacy benefit manager Express Scripts Holding Co. to recover damages from drug pricing it believes was too high. The lawsuit, filed on Monday in U.S. District Court for the Southern District of New York, is the latest development in a month’s long dispute over Anthem’s contract with…
Johnson & Johnson Hit with $500 Million Verdict in Trial over Hip Implants
NEW YORK (Reuters)—Johnson & Johnson and its DePuy unit were ordered by a Texas federal jury on Thursday to pay a total of about $500 million to five plaintiffs who said they were injured by Pinnacle metal-on-metal hip implants. Following a two-month trial, jurors found that the Pinnacle hips were defectively designed, and that the…
What Rheumatologists Need to Know about Payer Audits
Both government and private payers continue to aggressively monitor providers to prevent and recover overpayments. This is evidenced by the fact that the number of audits conducted in recent years has increased dramatically. A negative audit finding can result in the need to repay five- or seven-figure amounts. Types of Audits Private Payer Audits Private…
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