News in brief - Sept. 10, 2001

Court rules against clinic owner who used father's Medicare ID - Kaiser Foundation publishes HMO liability law report - Report describes Medicare's impact on women - Drug wholesalers' merger approved - Privacy rules threaten research, medical schools say - SCHIP spurs kids' dental coverage - States expand Medicaid to women with breast, cervical cancer

Court rules against clinic owner who used father's Medicare ID

The 9th U.S. Circuit Court of Appeals in August upheld a ruling that the owner of a physical therapy clinic knowingly violated the federal False Claims Act by having his office manager and billing firm use his father's physician Provider Identification Number on claim forms submitted to Medicare between 1992 and 1996.

But the court said the amount the federal district court determined clinic owner Peter Mackby had to pay the government -- $729 million -- may be too much. The lower court developed that number based on the $5,000 civil penalty for each patient Mackby submitted a false claim for, plus treble damages for Medicare overpayment. The 9th Circuit, though, remanded that decision back to the lower court, asking it to consider whether the $729 million was excessive.

Kaiser Foundation publishes HMO liability law report

The ongoing debate over congressional patients' bill of rights legislation has heightened interest in state HMO liability laws. The Kaiser Family Foundation has a report on states' experiences with such laws. The report is at its Web site (http://www.kff.org/content/2001/3155/).

Report describes Medicare's impact on women

The Kaiser Family Foundation has released a report detailing women's relationship with Medicare. Because women have longer life expectancies than men, more than half of the people covered by the program are women, the report notes. By the time women are 85 and older, they account for nearly three-quarters of all Medicare enrollees in that age group. Female beneficiaries are also more likely than males to have multiple chronic conditions and incomes below the federal poverty level. The report, and others on "The Faces of Medicare," can be found online (http://www.kff.org/content/1999/1481/).

Drug wholesalers' merger approved

AmeriSource Health Corp., Valley Forge, Pa., and Bergen Brunswig Corp., Orange, Calif., will be allowed to merge, making the combined company the third largest firm in the drug wholesaling business. The Federal Trade Commission closed its investigation of the deal in August.

In a statement, the FTC said there was no evidence that shows a merger would lead to price increases or prevent further price reductions in the drug wholesaling business.

Privacy rules threaten research, medical schools say

Assn. of American Medical Colleges representatives last month told a Dept. of Health and Human Services advisory committee that physicians, hospitals and health plans that use or disclose data for research purposes will face new civil and criminal liability under federal regulations.

"This rule needlessly intrudes upon the current institutional review board system of research oversight, burdening biomedical and behavioral research with onerous procedures, ambiguous regulations and extensive new liability concerns," said Jennifer Kulynych, a director in AAMC's Division of Biomedical and Health Sciences Research.

During the hearing before the National Committee on Vital and Health Statistics' subcommittee on privacy and confidentiality, AAMC asked HHS to exempt research currently subject to IRB oversight from the authorization, waiver and other provisions in the Health Insurance Portability and Accountability Act. It also asked HHS to create a "de-identification" standard for IRB-approved research that requires removal of direct identifiers only.

SCHIP spurs kids' dental coverage

Although dental coverage is not required under the State Children's Health Insurance Program, almost every state is offering it, and benefits appear to be fairly comprehensive, says a new Urban Institute report. Most non-Medicaid SCHIP programs include preventive, diagnostic and restorative services, the study of 18 states notes. Cost-sharing requirements appear quite low. The study is online (http://newfederalism.urban.org/html/occa50.html).

States expand Medicaid to women with breast, cervical cancer

The Health and Human Services Dept. has approved requests from nine states to extend Medicaid benefits to uninsured women who are diagnosed with breast or cervical cancer by a federal screening program.

Alabama, Georgia, Iowa, Mississippi, Missouri, North Dakota, South Carolina, Virginia and Washington received approval in August to take advantage of the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000. The act allows states to expand Medicaid coverage to these women, who otherwise would not have health coverage. The total number of participating states now stands at 19.

To qualify, women must be younger than 65, uninsured and not otherwise eligible for Medicaid.