Healthcare Law Blog : Medical Groups, Health Plans, Hospital & Facility Lawyers & Attorneys: Sheppard Mullin Law Firm

By Robert Rose 

Dr. Harkonen was the CEO of InterMune, Inc, a pharmaceutical company that developed, marketed and sold drugs for lung and liver diseases, including Actimmune. In 2002, the FDA had approved Actimmune to treat only two conditions: chronic granulomatous disease and severe malignant osteopetrosis. A year before the approval, an Austrian clinical trial concluded that Actimmune’s active ingredient was associated with improvement in patients with idiopathic pulmonary fibrosis (IPF), a rare and fatal disease of unknown origin. InterMune did its own clinical trial to confirm whether Actimmune was an effective treatment for IBF.

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By Robert Rose

Last month, in a joint letter by HHS and DOJ to five prominent hospital associations, the government warned that some providers are using electronic medical records (EMR) to “game the system.” The September 24th letter gave examples of “troubling indications” of EMR misuse:

• Cutting and pasting the same examination findings for multiple patients—known as “cloning”—to make it appear that physicians conducted more thorough exams that were actually done
• Upcoding the intensity or severity of a patient’s condition simply to profit without improving the quality of care

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By Ken Yood

The California Department of Health Care Services recently announced that it will start its Dual Eligibles Coordinated Care Demonstration in June 2013 instead of January. The Dual Eligibles Coordinate Care Demonstration is expected to lead to the enrollment of up to 560,000 of California’s dual-eligible Medicare-Medicaid patients into managed care plans designed to lower health care costs while maintaining quality of care. Although dual-eligibles in Los Angeles, San Diego, Orange, and San Mateo counties were supposed to be enrolled beginning in January 2013 under the original timeline, DHCS has determined that more time is required, and that those four counties will join San Bernardino, Alameda, Santa Clara, and Riverside counties and begin enrolling beneficiaries in July 2013. California has the largest number of dual-eligibles in the nation, totaling over 1.2 million beneficiaries.  

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By Ken Yood and Lynsey Mitchel

The mission of the Office of the Inspector General ("OIG") is to protect the integrity of the programs and operations of the Department of Health & Human Services, for example Medicare, by detecting and preventing waste, fraud and abuse, and identifying opportunities to improve program economy, efficiency and effectiveness. The Work Plan describes both the ongoing and new audits and evaluations that the OIG plans to address in fiscal year 2011.
 

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