Healthcare is constantly in a state of transition, and it doesn’t take the summers off. July has seen several CMS announcements, innovations, and healthcare fraud busts. Hot off the digital presses, Advize has rounded up this month’s biggest stories so far.

2018-07-19 IHS Launches Opioids Website

The Indian Health Services launched their new opioid website to educate the public and improve communication on opioids with stakeholders across Indian Country. This website was designed to help patients, providers, tribal leaders, and program administrators on opioid abuse prevention, pain management, funding opportunities, and more.

2018-07-23 California Doctor and his Assistant Charged in Scheme to Distribute Prescription Drugs and Commit Health Care Fraud

Dr. Paul Michael Hoover and Marcia Ramsier Arthurs are facing a 15-count indictment for charges such as: conspiracy to distribute prescription drugs, conspiracy to commit health care fraud, and money laundering for suspected crimes that took place between January 2018 and June 2018. If convicted, California law’s maximum sentencing calls for 20 years and prison, a fine of $1M, or both.

2018-07-23 Walmart Hires Former Humana VP to Front Health and Wellness Initiatives

Commercial giant Walmart has hired Humana’s former VP of Innovation as its Senior VP of Health and Wellness. Walmart CEO Greg Foran also announced that Walmart will be looking for more opportunities to grow their health and wellness business.

2018-07-24 – CMS Adopts the Methodology for the Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act for the 2017 Benefit Year

CMS posted a final rule that reissued and explained the risk adjustment methodology that had been established for transfers related to the 2017 benefit year. The goal of this rule is to gap-fill and quell some of the questions brought forth by the New Mexico litigation. This new rule marks the continuation of $10.4B in risk-adjustment payments to insurance companies with plans existing on the individual market.

2018-07-24 – CMS Welcomes New Leadership Team, Makes Additional Staffing Announcement

Since Seema Verma’s placement within CMS in early 2017, the administrator has been making leaps and bounds at filling CMS with a diverse, experienced staff.

“…I am pleased to welcome two distinguished and experienced leaders that not only have a wealth of knowledge managing complex healthcare issues, but also have hands-on experience at the local level in the practice and implementation of policy. These new additions will further strengthen our executive team and will help deliver on the promises made by the Trump Administration to better serve the American people.”

2018- 07-24 – Anthem Reports Higher Q2 Profits

Anthem’s profits increased 23.2% over the prior year quarter, while revenue was up by about 2.4%. The insurer reported a net income of $1.1B on revenues $22.9B their second quarter. To achieve these margins, Anthem increased their premiums and took steps to minimize medical costs. These efforts lowered the organization’s loss ratio by nearly 3% – an impressive and beneficial shift for the insurer.

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