News for Insurers
Top stories summarized by our editors
6/21/2018

GlaxoSmithKline will present detailed clinical trial results of a new combination therapy for HIV from the company's ViiV Healthcare unit next month at the International AIDS Conference.

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Reuters
6/21/2018

A dentist who provided services at nursing homes in Nebraska and Iowa pleaded guilty to one count of health care fraud and was ordered to pay more than $82,500 to the Nebraska Department of Health & Human Services and more than $4,700 to the Iowa Department of Inspections & Appeals. The dentist submitted false Medicaid claims between Feb. 12, 2013, and Jan. 22, 2016, authorities say.

6/21/2018

The newly formed American TeleDentistry Association aims to develop best practices for teledentistry and orthodontics, educate dental professionals and the public, expand access to orthodontic and dental care, and ensure the availability of the technology as it matures, says founder Marc Ackerman, director of orthodontics at Boston Children's Hospital. "It's our mission to modernize access to care through teledentistry with advocacy for the implementation of innovative teledentistry guidelines and solutions," Ackerman said.

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mHealth Intelligence
6/21/2018

Illinois will reimburse Medicaid managed care organizations for preventive dental care for adults and will cover preventive dental care for adults not in a managed care program. The cost of expansion is expected to be offset by prevention of expensive restorative care and avoidance of emergency department visits for dental problems, says state Rep. Greg Harris, D-Chicago.

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Medicaid, Illinois
6/21/2018

Michigan scored well on a recent national survey of oral health policy, but the state could do even better, writes Lisa Wegner of the Barry-Eaton District Health Department. The Eaton County Oral Health Coalition supports higher Medicaid reimbursement rates for dental care, more coordination between medical and dental care providers, a 10% increase in the number of communities with fluoridated drinking water, improvements in oral health literacy and understanding, and wider access to oral health care for at-risk populations, she writes.

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Michigan
6/21/2018

The Massachusetts Dental Society supports Delta Dental's proposed change to the company's Premier plan that eliminates annual reimbursement rate increases tied to dental industry inflation and will allow the company to continue offering the plan alongside the lower-cost Total Choice PPO. The agreement "is the result of candid, productive conversations that we've had over the past year with dentists, the Massachusetts Dental Society, state lawmakers, employers and business groups about the important role that the dental community must take in addressing health care cost containment," said Delta Dental President Dennis Leonard.

6/21/2018

Gregory Garro, a dentist from Omaha, Neb., received a 10-month prison term and was ordered to pay over $87,200 in total restitution to Nebraska and Iowa's Medicaid programs after pleading guilty to health care fraud. Garro admitted to submitting fraudulent claims to Nebraska and Iowa's Medicaid programs for dental services to nursing home residents from Feb. 12, 2013, to Jan. 22, 2016.

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Medicaid
6/21/2018

Healogics, a Jacksonville, Fla.-based operator of almost 700 wound care centers in the US, agreed to a settlement deal worth up to $22.5 million to resolve whistleblower lawsuits accusing the company of violating the False Claims Act by submitting fraudulent Medicare claims for medically unnecessary or unreasonable hyperbaric oxygen therapy services from 2010 to 2015. The firm also entered into a five-year corporate integrity deal with HHS as part of the settlement.

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Healogics, HHS
6/21/2018

Ruby Powell of Junction City, Kan., was ordered to serve 12 months of probation and pay $1,607.27 in restitution after entering a no-contest plea to theft by making a false claim to the Medicaid program. An investigation showed Powell, who serves as a personal care attendant to her mother, improperly billed Medicaid for 460 hours of unprovided home-based care services from 2013 to 2015.

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Medicaid
6/21/2018

Rachel Dolezal, former president of the NAACP chapter in Spokane, Wash., entered a not-guilty plea to welfare fraud over allegations she fraudulently received public assistance. Dolezal, now legally known as Nkechi Diallo, allegedly collected $8,847 in food and childcare assistance she was not entitled to from Aug. 1, 2015, to Nov. 30, 2017, court records show.

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KING-TV (Seattle)