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Tag Archives: Charles Ornstein

Insurers Using Generic Drugs To Shift Costs To Sick?

17 Wednesday Sep 2014

Posted by Celia C. Elwell, RP in Affordable Care Act, Drug Promotion, Health Care Benefits, Health Law, Health Reform

≈ Comments Off on Insurers Using Generic Drugs To Shift Costs To Sick?

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Affordable Care Act, Charles Ornstein, Co-Payments, Generic Drugs, Health Insurance, Insurers, Pre-Existing Conditions, ProPublica

A New Way Insurers are Shifting Costs to the Sick, by Charles Ornstein, ProPublica (This story was co-published with The New York Times’ The Upshot.)

http://tinyurl.com/kaaelvg

By charging higher prices for generic drugs that treat certain illness, health insurers may be violating the spirit of the Affordable Care Act, which bans discrimination against those with pre-existing conditions.

Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions. But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs.

Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as ‘non-preferred’ and charging higher co-payments. But according to an editorial published Wednesday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs.

The Affordable Care Act bans insurance companies from discriminating against patients with health problems, but that hasn’t stopped them from seeking new and creative ways to shift costs to consumers. In the process, the plans effectively may be rendering a variety of ailments ‘non-preferred,’ according to the editorial.

‘It is sometimes argued that patients should have ‘skin in the game’ to motivate them to become more prudent consumers,’ the editorial says. ‘One must ask, however, what sort of consumer behavior is encouraged when all generic medicines for particular diseases are ‘non-preferred’ and subject to higher co-pays.’ . . .

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ProPublica’s Ongoing Series and Investigation Into Medicare Waste And Fraud.

12 Saturday Jul 2014

Posted by Celia C. Elwell, RP in Criminal Law, False Claims Act, Health Law, Medicare Fraud

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Charles Ornstein, Daniel Crespi, Medicare Fraud, Medicare Part D, Prescriptions, ProPublica

Fanny Pack Mixup Unravels Massive Medicare Fraud Scheme, by Charles Ornstein, ProPublica

http://www.propublica.org/article/fanny-pack-mixup-unravels-massive-medicare-fraud-scheme

This article is part of an ongoing investigation by ProPublica into Medicare fraud. This is just one of several articles currently at ProPublica about its investigation. -CCE

Two secretaries in a doctor’s office have pleaded guilty and a pharmacy owner faces charges in a scam that Medicare allowed to thrive for more than two years.

The fraud scheme began to unravel last fall, with the discovery of a misdirected stack of bogus prescriptions — and a suspicious spike in Medicare drug spending tied to a doctor in Key Biscayne, Fla.

Now it’s led to two guilty pleas, as well as an ongoing criminal case against a pharmacy owner.

Last year, ProPublica chronicled how lax oversight had led to rampant waste and fraud in Medicare’s prescription drug program, known as Part D. As part of that series, we wrote about Dr. Carmen Ortiz-Butcher, a kidney specialist whose Part D prescriptions soared from $282,000 in 2010 to $4 million the following year. The value of her prescriptions rose to nearly $5 million in 2012, the most recent year available.

But no one in Medicare bothered to ask her about the seemingly huge change in her practice, Ortiz-Butcher’s attorney said. She stumbled across a sign of trouble last September, after asking a staffer to mail a fanny pack to her brother. But instead of receiving the pack, he received a package of prescriptions purportedly signed by the doctor, lawyer Robert Mayer said last year. Ortiz-Butcher immediately alerted authorities.

Since then, investigators have uncovered a web of interrelated scams that, together, cost the federal government up to $7 million, documents show. . . .

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A Tool to Find Drug Companies’ Payments to Doctors For Drug Promotion.

29 Sunday Dec 2013

Posted by Celia C. Elwell, RP in Drug Promotion, Evidence, Health Law, Health Reform

≈ Comments Off on A Tool to Find Drug Companies’ Payments to Doctors For Drug Promotion.

Tags

Charles Ornstein, Dan Nguyen, Doctors, Drug Companies, Drug Promotion, Health, Jeremy B. Merrill, Pharmaceutical industry, Physicians, ProPublica, Sisi Wei, Tom Carper, Tracy Weber

Dollars for Docs – How Industry Dollars Reach Your Doctors, by Jeremy B. Merrill, Charles Ornstein, Tracy Weber, Sisi Wei, and Dan Nguyen, ProPublica

http://projects.propublica.org/docdollars/

ProPublica’s website provides a wealth of information about the ways the drug companies use medical institutions and physicians to promote their products. -CCE

Drug companies have long kept secret details of the payments they make to doctors and other health professionals for promoting their drugs. But 15 companies have begun publishing the information, some because of legal settlements. Use this tool to search for payments.

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