More hospitals settle in kyphoplasty case and other news

Modern Healthcare

  • Thirty-two more hospitals have agreed to settle allegations that they billed Medicare for kyphoplasty procedures as inpatient rather than outpatient services to make more money, the U.S. Justice Department announced Friday. The settlements, which have yielded a total of $28 million, are the latest in a long-running whistle-blower lawsuit that alleges that equipment-maker Kyphon encouraged hospitals to perform the procedures on an inpatient rather than an outpatient basis to help pay for kits used in the procedures, and to help hospitals make money. In all, more than 150 hospitals across the country have now settled in the case. A lawyer who worked with one of the whistle-blowers whose lawsuit launched the federal probe said he doesn't think the latest settlements will be the last.

  • Turing Pharmaceuticals, the target of public scorn for drastically hiking the price of a generic drug for a rare disease, ousted its unpopular CEO Martin Shkreli Friday in the wake of his arrest on charges of securities fraud. Turing Board Chairman Ron Tilles will serve as interim CEO until a permanent replacement is determined, the company said. Shkreli was arrested by the FBI on charges that he misled investors of a hedge fund he managed while he was head of another biopharmaceutical company, Retrophin.

  • The CMS declined to allow Michigan to increase cost-sharing for its Medicaid beneficiaries, but granted enough other provisions of its unusual take-it-or-leave-it waiver application to avoid triggering a sunset provision in the state legislation that extended eligibility for about 600,000 residents. Michigan proposed requiring residents above the federal poverty level to buy private plans through HealthCare.gov after they have been enrolled in Medicaid for 48 months, or else see their cost-sharing obligations rise to 7% of their income. The CMS rejected that proposal, but allowed other provisions that will make it easier for the state to drop people from the program, called Healthy Michigan.
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