District Of Columbia

DC sues area Blue plan, demands it donate millions to community

Anne Zieger — Thu, 26 Jun 2008 00:37:24 -0400

The government of Washington, DC, has launched a two-pronged attack on the region's largest health plan, filing a suit alleging that the non-profit plan must donate millions to the community, while also launching an official investigation of the plan. Both the District and the state of Maryland have criticized CareFirst BlueCross BlueShield for many years, arguing that it wasn't making appropriate charitable use of its annual surpluses. Over the past year, the District has been at war with CareFirst, upset that the plan didn't donate the expected annual $5 million contribution to a universal healthcare program officials planned. When CareFirst posted a $754 million surplus for 2007, that was the last straw for District officials. Not only did interim Attorney General Peter Nickles file a suit against the Blue plan, but the D.C. Council Committee on Public Services and Consumer Affairs also voted to begin an investigation, giving chairman Mary Cheh the authority to issue subpoenas. In the suit, Nickels contends that CareFirst is required to put $100 million into the community, but that it's handing out large executive salaries instead.

To learn more about the suit and investigation:
- read this Washington Post article

Related Articles:
DC investigates CareFirst provider contracts
MedChi protests CareFirst rate cuts
New York AG expands health plan investigation

OH hospitals lose $79 million award in DSH appeal

Mon, 02 Jun 2008 06:59:58 -0400

A group of 25 Ohio hospitals has lost the latest stage in their ongoing battle to recover a disputed $79 million in Medicare disproportionate-share payments. The hospitals had won a favorable ruling in June 2007, but last week the District of Columbia U.S. Court of Appeals reversed the decision.

The dispute stems from a disagreement over how hospitals should measure their burden related to caring for low-income patients. A federal statute requires hospitals to measure this burden based on the number of Medicaid-eligible patients they serve, but CMS had excluded patients treated under Ohio's Hospital Care Assurance Program, which subsidizes free care for indigent patients partly through Medicaid DSH funds.

To learn more about this case:
- read this Modern Healthcare article (reg. req.)

Related Articles:
Federal bill would increase DSH funding eligibility
Hospitals fail to get back DSH payments
TX may use Medicaid funds to subsidize insurance for poor

Express Scripts pays $9.5M settlement over drug switching

Wed, 28 May 2008 06:59:58 -0400

Pharmacy benefit manager Express Scripts has agreed to pay a total of $9.5 million to 28 states and the District of Columbia to settle allegations that it engaged in deceptive prescription-switching practices. The attorneys general involved had been investigating the company, arguing that Express Scripts switched patients to brand-name cholesterol drugs in an attempt to maximize the volume rebates it got from drug manufacturers. While patients were told they'd benefit from the switch, they actually ended up incurring some expenses from the change, according to the Pennsylvania AG's office. In signing the agreement, the company didn't admit any wrongdoing.

Under the terms of the settlement, Express Scripts agrees that it no longer will solicit patient drug switches if the cost exceeds that of the original script, if the original drug has a generic equivalent while the switch doesn't, if the original drug's patent will expire in six months, or if the patient was switched within the last two years. Express scripts also agreed to disclose any financial incentives it may have for soliciting a prescription switch and to reimburse patients for any related costs they might incur.

To learn more about the settlement:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
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Merck agrees to $58M settlement on Vioxx ads

Wed, 21 May 2008 06:59:58 -0400

Merck has agreed to a $58 million settlement with 29 states and the District of Columbia to settle allegations that it downplayed heart risks created by Vioxx in direct-to-consumer advertising. Under the terms of yesterday's agreement, Merck will submit all new TV ads for its drugs to the FDA for seven years, and follow all agency-suggested changes before airing the ads. Merck also agreed to end its practice of "medical ghostwriting," in which paid consultants or employees, rather than physicians listed as lead authors, wrote studies on Vioxx.

The agreement follows a $4.85 billion settlement, which is still pending, that ended most lawsuits resulting from findings that the drug doubled risks of heart attack and stroke. Merck withdrew Vioxx from the market in 2004.

To learn more about the new agreement:
- read this Kaiser Daily Health Policy Report item

Related Articles:
Despite safety issues, Vioxx still in demand
Vioxx defense dealt a blow by new study results
Vioxx lawsuits continue to multiply

VA, DC begin routing stroke patients to centers

Tue, 01 Apr 2008 07:59:54 -0400

In some states, ambulance crews who suspect that a patient is having a stroke are required to take the patient to a designated stroke center hospital (unless the closest is too far away). This happened first in Massachusetts, where officials came to realize that most hospitals were having trouble getting on-call specialists in place to treat stroke victims. The state created a stroke care system in 2004. Now, it looks like Virginia and the District of Columbia are moving this direction, too. In Virginia, Gov. Tim Kaine (D) already has signed a bill requiring ambulance crews to take stroke patients to Joint Commission-certified primary stroke centers. Meanwhile, DC's Fire and Emergency Medical Services soon will issue a rule requiring that District crews do the same.

To learn more about stroke transport in these states:
- read this Washington Post article (reg. req.)

Related Articles:
Studies: Hospital stroke deaths rise on weekends. Report
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Study: Hospital clot care inadequate. Report
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