Wednesday, June 23, 2010

CMS starts campaing to warn seniors of Medicare fraud

As we are entering the doughnut hole season for seniors covered by Medicare Part D, the fear of fraud tends to run rampant during this season. To counter this, the Center for Medicaid and Medicare Services has started a campaign via TV, radio and print to warn seniors of the potential fraud threat.

David Sayen, Medicare Administrator for California, stated,
"We know whenever change occurs in Medicare benefits, there are people out there who try to take advantage of seniors in some way. They may say, 'I'll file for your benefits,' for example, or come up with some other scam to get part of your rebate. The important thing for Medicare recipients in the Part D doughnut hole to know is that this rebate is automatic."

Read the full article here.

Monday, June 21, 2010

MDRP Podcast: Katie Lapins, Principal, Government Pricing Specialists

MDRP has teamed up with several of the speakers at this year's Medicaid Drug Rebate Program to share some of their insights on the current healthcare reform and how it will effect the industry leading up to the conference.

Katie Lapins, Principal, Government Pricing Specialists shared her insights on these questions with us:

- We often hear the terms, “Medicaid” and “Government Programs” used interchangeably. What is meant by each of these terms, how are they similar and how are they different?
- Tell us about your current work and focus on the MDRP and Government Programs.
- You are leading a panel session at September MDRP on Translating the GP Impact of Healthcare Reform for Senior Management; tell us a little about the session and why it is important.
- With all of the changes introduced by healthcare reform, what recommendations do you have for a manufacturer if they were already unsure about their compliance status and are unsure where to begin?

To download the podcast, visit the MDRP webpage.
For a transcript of the podcast, click here.

Friday, June 18, 2010

Crack Down on the C-Suite: What impact will this have on companies?

An article in the June 2010 edition of Pharmaceutical Executive looks at the crackdown currently taking place by the Inspector General to reduce fraud in Medicaid and Medicare. The article looks at the new rules for cracking down on Medicaid and Medicare abusers and what punishment will be inflicted upon the companies that have been found guilty. Read the article here.

Wednesday, June 16, 2010

California hospital enrolls in the 340B Program

Sutter Lakeside Hospital in California has recently decided to enroll in the 340B Program in order to receive reduced cost pharmaceuticals to continue providing service to individuals who may not currently be covered under Medicaid or Medicare.

According to Lake County Board of Supervisors Chair Anthony Farrington, "Our interest in collaborating with Sutter Lakeside and taking advantage of this MOU is so that we can partner with and support the efforts of the hospital which in turn provides health care services and benefits to the community. We are hopeful that this cost reduction program from pharmaceuticals will increase access for indigent and under-insured and allow the hospital to utilize financial resources in other areas to serve the public."

Read the full article here.

Thursday, June 10, 2010


From: Danya Burakoff, Conference Producer
Re: Call for Speakers & Presentations
Event Date: January 24-26, 2011
Event Venue: Scottsdale, Arizona


The Institute for International Research (IIR) is currently seeking presenters for the 8th Annual Medicare Congress. The Medicare Congress event brings together marketing and product development, operations and revenue management, medical management and compliance executives from the nation’s leading Health Plans to obtain practical tactics and long term strategies for sustainability in the Medicare marketplace in a health reform environment.

Email or call 646-895-7337 by Wednesday, June 23, 2010

Topics being discussed for 2011 include:

- What’s next for Medicare in a health reform environment
- What CMS wants and where it is headed in the coming year
- New business models to ensure financial stability
- Innovative marketing strategies for new member acquisition and member retention
- Best practices in recruiting and training insurance agents
- Clarity on the 5-star system
- Strategies to improve quality, ensure compliance, and improve operational efficiency
- Best Practices for System Organization & Workflow to enhance HCC Data & Outcomes
- Preparing for RADV audits
- Trends in healthcare information technology
- Risk adjustment strategies
- What’s next for the Special Needs Plans

Past speakers include Mark McClellan, John Gorman, Newt Gingrich, John Rother, Tricia Neuman, Krista Bowers, among many others.

We invite you to submit a proposal for a speaking opportunity directly to Danya Burakoff by June 23, 2010. Please send to or call 646-895-7337.
Align Center
Please note: Priority is given to Medicare health plans. A limited number of opportunities will be made available for Medicare solution providers or consultants to deliver presentations based on a variety of corporate sponsorships.

Do you want to reach this audience?

We have a limited number of slots available for solution providers/consultants.
People who wish to become part of the program should contact Andrew Sinetar, Sponsorship Manager, at 646.895.7484 or
Sessions will be 30-45 minutes including Q & A.

Visit The Medicare Congress' webpage here.

Tuesday, June 8, 2010

States working to cut Medicaid Deficit

Many states are currently in a bind, as the US Government has cut funding, which will hit close to US homes in the forms of health care, education, public safety and social services. This has resulted in 30 states cutting their spending to avoid big deficit gaps.

The Medicaid provision, which would extend assistance first granted in last year’s stimulus package, was considered such a sure bet by many governors and legislative leaders that they prematurely included the money in their budgeting. But under pressure from conservative Democrats to rein in deficit spending, House leaders in late May eliminated $24 billion in aid to states from a tax and jobs bill that was approved and forwarded to the Senate.

Read the full article here.

8th Annual Medicare Congress Conference

Danya Burakoff, the Conference Producer of The Medicare Congress, would like to share this message with you:

IIR is planning its 8th Annual Medicare Congress Conference. As a reader of the Health Care - From Policy to Practice blog, we would like to include you in the preparation process of the 2011 conference. We would greatly appreciate if you take 5 minutes to take this survey, so that we can understand the challenges you are facing and address what is most important to you in a valuable program agenda at this year's event.

Please feel free to reach out to me directly to provide input or schedule a call.

I thank you in advance for your time and input, and I hope to have the opportunity to welcome you in person to our event in 2011!


Danya Burakoff
Conference Producer

8th Annual Medicare Congress

Tuesday, June 1, 2010

New Jersey receives settlement from Aventis

In May, the state of New Jersey received a $1.3 million settlement from the Pharma company Aventis. Aventis failed to provide the state their best price for the medications Azmacort and Nascort. This information resulted in losses from the programs Pharmaceutical Assistance to the Aged and Disabled (PAAD) and Senior Gold (SG) Pharmaceutical Assistance.

According to the article,

Under the Medicaid Drug Rebate statute, Aventis was required to report to Medicaid the lowest, or "best price" that it charged commercial customers and pay quarterly rebates to the Medicaid program based on those reported "best prices." State regulations require that pharmaceutical manufacturers enter into the same rebate agreement with the state in order to participate in the PAAD and Senior Gold programs. The PAAD and Senior Gold programs are funded entirely through state funds, while Medicaid is jointly funded by the state and federal government.