Appeals court weighs case against ACA preventive care provision
A federal appeals court this week heard arguments over whether it should continue the brief pause on a popular provision of the Affordable Care Act (ACA) while the case is being appealed. In May, the Fifth S. Circuit Court of Appeals had temporarily blocked a federal judge ruling that struck down the ACA requirement for insurers to provide coverage for preventive care at no-cost to members. The appeals court panel on Wednesday gave both sides until 5 p.m. Friday to submit terms of a compromise over how to pause the ban while the case winds its way through the courts. The case was brought by individuals and an employer in Texas who contend the preventive care requirement is unconstitutional and that coverage of HIV prevention treatment can violate an employer’s religious rights. U.S. District Judge Reed O’Connor, a longtime critic of the ACA, in March ruled it was unconstitutional, a move that threatens the free coverage of preventive services for 150 million Americans. The Justice Department wants to block O’Connor’s ruling from applying nationwide during the appeals process.
Supreme Court maintains Medicaid recipients right to sue
The Supreme Court on Thursday by a 7-2 vote ruled that Medicaid enrollees have the right to sue state agencies. Justice Ketanji Brown Jackson wrote the opinion with Justices Clarence Thomas and Samuel Alito dissenting. The case, centered on the family of the now deceased Gorgi Talevski, who filed a lawsuit against the Health and Hospital Corp of Marion County, Indiana (a municipal corporation of the state that operates nursing facilities) claiming that the nursing home’s use of psychotropic drugs as chemical restraints, involuntary transfers, and attempted involuntary discharge to a dementia facility violated a federal law that governs nursing homes that receive federal funding. The hospital system asked the Supreme Court to limit the ability for people to use the federal law to sue for civil rights. Although a district court ruled in the nursing home’s favor, the decision was reversed by the 7th U.S. Circuit Court of Appeals. Larry Levitt, executive vice president for health policy, KFF, wrote on Twitter that the case is “quite significant because the federal government's ability to enforce Medicaid requirements on states is limited to the blunt tool of withholding funding, which is rarely used.”
DOJ: Chief compliance officer convicted of $50M Medicare fraud scheme
A federal jury has convicted the former chief compliance officer of a pharmacy holding company for fraudulently billing Medicare over $50 million for dispensing lidocaine and diabetic testing supplies that Medicare beneficiaries did not need or want.
Steven King, 45, operated A1C Holdings LLC, which held pharmacies in various states, including All American Medical Pharmacy, in Warren, Mich. When A1C secured prescriptions and refills on behalf of its pharmacies for medically unnecessary lidocaine and diabetic testing supplies, it violated Medicare and pharmacy benefit manager rules, according to the Department of Justice.
The jury convicted King of conspiracy to commit health care fraud and wire fraud. His sentencing is scheduled for Sept. 14, and he faces a maximum penalty of 20 years in prison. A federal district court judge will determine King’s sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
Merck files lawsuit to stop Medicare drug price negotiations
Merck & Co sued the U.S. government this week to stop it from negotiating Medicare drug prices. The drugmaker argues the negotiations, which were approved as part of the Inflation Reduction Act, violates the Fifth and First Amendments to the U.S. Constitution, Reuters reported. The White House said it was confident that the administration will win the lawsuit, which was filed in U.S. District Court for the District of Columbia. “There is nothing in the Constitution that prevents Medicare from negotiating lower drug prices,” White House Press Secretary Karine Jean-Pierre said in a press briefing. “Anytime profits of the pharmaceutical industry are challenged, they make claims about it hindering their ability to innovate. Not only are these arguments untrue, but the American people do not buy them.”