"Health apps, like prescription drugs, come with side effects, it turns out. A new study has found that an astoundingly large number of health apps may be sharing users’ medical information. Many can also switch on smartphone cameras and make changes to the software on your phone.
What was found:More than 80 percent of the 211 diabetes apps studied did not have privacy policies. And out of a randomly selected subset of 65 apps, 56 of them (86 percent) used tracking cookies, which could allow them to send information about the user to other companies, such as marketing firms, according to the analysis, published Tuesday in the Journal of the American Medical Association.
Why it matters:Co-author Sarah Blenner, now at the University of California, Los Angeles, warned that the sharing or selling of personal information could lead to discrimination. Users with certain medical profiles, for instance, could have a tougher time getting life insurance.
The apps are not bound by Health Insurance Portability and Accountability Act, or HIPAA — the federal privacy law that governs doctors and insurance plans. “They are free to trade, sell, and use the information in any way that they want,” said Mark Rothstein, an expert on health privacy at the University of Louisville."
Read more at STAT
"Just one out of every 100 U.S. doctors is responsible for 32 percent of the malpractice claims that result in payments to patients, according to a comprehensive study of 15 years’ worth of cases.
And when a doctor has to pay out one claim, the chances are good that the same physician will soon be paying out on another, researchers report in the New England Journal of Medicine.
"I think people will be surprised about the extent to which the claims are concentrated within a relatively small group of practitioners. It's actually more concentrated than in earlier studies," chief author David Studdert of Stanford University in California told Reuters Health.
The result, he said, demonstrates that there are practitioners who can accumulate large numbers of claims and continue to practice.
Earlier studies looked at malpractice claims that may or may not have had merit. This study looked at all cases in the National Practitioner Data Bank where payments were made.
Those other studies typically focused on a single insurer or a single state, and repeat offenders may have been able to avoid being tracked, by moving or switching insurers, Studdert said. "We have a kind of national all-encompassing window, so we should have been able to track the doctors wherever they go.""
Read more at Reuters
"Drug prices were big news in 2015, thanks in large part to “Pharma bro” Martin Shkreli, who drew outrage for hiking the price of a life-saving drug by 5,000 percent. Such eye-popping increases were rare. But plenty of drugs became more expensive during the past year.
How much did prescription drug prices rise overall in 2015?
More than 10 percent — well in excess of the U.S. inflation rate — according to an analysis released Monday by Truveris, a health-care data company that tracks drug prices. The firm analyzes data involving hundreds of millions of payments that public and private insurers, businesses and patients make each year to U.S. pharmacies. The result is an index that measures the average price of prescription drugs, driven by the most commonly prescribed medications.
“We’re in our third year of double-digit [increases],” said A.J. Loiacono, the firm’s chief innovation officer, adding that the increases occurred across virtually every drug category. “Double-digit inflation is concerning. I don’t care if it’s for gas or food; it’s rare.”"
Read more at the Washington Post
"A group of 32 hospitals will pay a total of $28 million to settle allegations that they submitted false claims to Medicare for a type of spinal fracture treatment, the U.S. Department of Justice said on Friday.
"A case now before the U.S. Supreme Court could mean fewer fraud lawsuits filed against healthcare providers. Or it could at least give them more clarity about what constitutes a violation of the law, experts say.
The Supreme Court announced Friday it would hear Universal Health Services v. United States ex rel Escobar, a case that focuses on one theory whistle-blowers and the government use in bringing False Claims Act cases to court. The act makes it illegal to knowingly submit fraudulent bills to the government, such as for services not actually performed.
In a variation of fraud claims, some whistle-blowers allege that providers submitted false claims by failing to follow certain regulations. Providers sometimes are held liable for not following such regulations even if the government never explicitly stated that following a regulation was a condition of payment, and even if the provider never explicitly vouched that it had complied with the regulation.
The Supreme Court will consider whether whistle-blowers and the government should be allowed to bring FCA cases under this theory, known as implied certification.
“It's a huge deal for healthcare providers,” said Larry Freedman, an attorney with Mintz Levin who defends providers in FCA cases. Legal claims based on implied certification are now “the major driver” of healthcare whistle-blower suits, he added.
Lower courts have been divided on the issue, with some saying it's unreasonable to sue organizations under the act for compliance issues arising from the thousands of pages of state and federal rules. Federal and state agencies, not the courts, should deal with such violations, some courts have said.
Allowing an implied certification argument in situations where it hasn't been clearly expressed that a regulation is a condition for payment could turn the False Claims Act into “a punitive sanction for use against minor regulatory or contractual violations,” Universal Health argues in court papers."
Read more at Modern Healthcare
"Dr. Michael Reilly's lawyer gave his client strong advice after reviewing a lucrative employment contract that the North Broward Hospital District offered him 15 years ago.
“I should throw this in the trash,” Reilly, a now-retired orthopedic surgeon, recalls the attorney telling him.
The contract, the lawyer said, had major problems, including that it violated the federal Stark law, which bars physicians from referring Medicare patients to hospitals, labs and other doctors that the physicians have financial relationships with unless they fall under certain circumstances.
Reilly didn't sign the contract.
That moment marked the beginning of Reilly's quest to hold North Broward Hospital District—a taxing district that operates five hospitals in Broward County in South Florida—accountable for alleged violations of the law. Reilly later filed a whistle-blower lawsuit against North Broward under the False Claims Act. In September, North Broward and the government settled the case for $69.5 million, with Reilly getting $12 million. North Broward did not admit to any wrongdoing. It declined to comment for this article.
Both plaintiff and defense attorneys predict that more False Claims Act cases alleging Stark violations are on the way, with whistle-blowers largely driving the U.S. Justice Department's enforcement—exponentially multiplying the government's regulatory eyes inside healthcare facilities. That's partly because two giant cases, involving Tuomey Healthcare System and Halifax Health, alerted potential whistle-blowers inside hospitals to the riches they could pocket by bringing such cases, some attorneys say.
In October, Tuomey in Sumter, S.C., agreed to settle with the government for $72.4 million, resolving allegations that it paid doctors in ways that rewarded them for referring patients to the hospital. Last year, Halifax in Daytona Beach, Fla., agreed to pay $85 million to settle allegations that it also had compensated physicians in illegal ways. Halifax did not admit to any wrongdoing. The whistle-blower in the Tuomey case got $18.1 million, while the whistle-blower in the Halifax case bagged $20.8 million."
Read more at Modern Healthcare
"The CMS has revealed that it underpays health plans that enroll large numbers of people who are dually eligible for Medicare and Medicaid, and the agency plans to modify its risk-adjustment model to make up for the underpayment.
In response to persistent and vocal complaints from health plans questioning the accuracy of the CMS' model for predicting costs of dual-eligible beneficiaries, the agency conducted a retrospective analysis of its 2014 plan data.
The CMS uses a prospective model (called the CMS-HCC) to calculate risk scores, using health status in a base year to predict costs in the following year. Those scores drive adjustments to capitated payments made for elderly and disabled beneficiaries enrolled in Medicare Advantage (MA) plans and certain demonstration programs.
“Our findings show that the community segment of the 2014 model … somewhat underpredicts for full-benefit, dual-eligible beneficiaries,” the CMS said in an under-the-radar notice sent to plans on Oct. 28. The agency did not reveal a dollar amount for the underpayment.
In the highly technical document, the agency outlined some tweaks to its risk model that officials believe will lead to more accurate payments to plans. The CMS is seeking comments on the proposed alterations by Nov. 25, and will publish final changes in a notice for the following payment year in February 2016."
Read more at Modern Healthcare
"California regulators fined two insurance giants for overstating their Obamacare doctor networks and said the companies will pay millions of dollars in refunds to patients who paid too much for care.
The state’s Department of Managed Health Care levied fines of $350,000 against Blue Shield of California and $250,000 for Anthem Blue Cross.
At issue were the companies’ error-riddled provider directories that frustrated many consumers statewide as they tried to find doctors during the rollout of the Affordable Care Act in 2014. As a result, some patients incurred big unforeseen medical bills because they unwittingly went out of network for care.
In addition to the state's enforcement action, consumer lawsuits are still pending against both insurers."
Read more at LA Times
More than 450 hospitals, including 27 in California pay over $250 million in cardiac-device investigation
"More than 450 hospitals have settled with the government for more than $250 million as part of a yearslong, nationwide investigation into the suspected overuse of implantable cardiac devices, the U.S. Justice Department announced Friday.
The hospital systems involved include many of the country's largest, such as Adventist, Ascension Health, Banner Health, Catholic Health Initiatives, Community Health Systems, HCA, Tenet Healthcare Corp. and Universal Health Services among others.
At 42, HCA had the most hospitals involved in settlements and is paying the highest portion of the settlement, $15.8 million, followed by Ascension Health with 32 settling for $14.9 million and then Community Health Systems with 31 settling for $13 million.
None of those three systems admitted to any liability as part of their settlements.
Community Health Systems said in a statement Friday it agreed to the settlement to “avoid the continuing delay, uncertainty, inconvenience and expense of protracted litigation.”
“The issue involved a highly technical interpretation of a Medicare national coverage determination that was the subject of strong disagreement in the medical community," Community Health Systems said.
Ascension spokesman Nick Ragone said in a statement that Ascension was pleased to have reached an agreement with the Justice Department. “We are proud and appreciative of the cardiac care provided by our physicians, nurses and other caregivers nationwide to individuals in the communities we serve,” Ragone said."
Read more a Modern Healthcare
A pharmaceutical firm's recent decision to hike the cost of a prescription drug that treats foodborne illness from $18 to $750 per tablet outraged millions of Americans.
The move prompted Democratic presidential candidate Hillary Clinton to accuse the Swiss-American company Turing of "price gouging." The following day, Clinton unveiled her national plan to rein in drug prices -- and borrowed an idea from California: cap out-of-pocket costs for some prescriptions to save patients with chronic or serious health conditions thousands of dollars.
The Golden State's effort to tackle the issue of skyrocketing drug prices is among the most aggressive in the nation, opening up a wider debate over an industry whose sales account for 10 percent of the nation's $3 trillion in annual health care costs.
There seems little doubt that the controversy over rising drug prices will rage on and become a key issue in the presidential race. Though average generic drug prices have fallen by more than half since 2008, costs for the name-brand prescription drugs that treat chronic and life-threatening diseases have more than doubled over that period, up 127 percent, far more than the 11.24 percent inflation rate.
Read more at San Jose Mercury News