Monday's health stories

Physician company pays $60 million in upcoding settlement
TeamHealth, a physician staffing firm, has agreed to pay the federal government $60 million to resolve allegations its physicians fraudulently billed Medicare and Medicaid.
The primary issue is a process called upcoding. It's when physicians submit bills to insurers for more expensive care than was actually delivered. For example, instead of billing for a less pricey medical code that covers 15 minutes of hospital bedside care, physicians would submit the more expensive code for 35 minutes, even though they only spent 15 minutes with the patient. In this case, it was hospital-based doctors from IPC Healthcare, which TeamHealth had acquired.
Why this matters: Allegations of upcoding have been rampant in the industry, as the Center for Public Integrity has reported. This rather large settlement shows the government is paying attention. But in reality, the penalty is a slap on the wrist for TeamHealth, which recently was taken private by Blackstone and was on pace for $4.5 billion of revenue in 2016.

Express Scripts fires back on drug costs
Drug spending increased 3.8% in 2016 for employers and health insurers that hired Express Scripts to manage drug costs for their commercially insured members, according to an annual report from the pharmacy benefits manager.
The big takeaway: Express Scripts cheered the findings as evidence their negotiations with drug companies and pharmacies kept drug spending lower than people might expect. The report is also being used as a way to push back against drug companies that have blamed pharmacy benefits managers for the drug pricing problems. "We don't do anything to set prices for the drug manufacturers. They do," Dr. Glen Stettin, chief innovation officer at Express Scripts, told Axios.
Yes, but: This report did not reveal anything about the rebates Express Scripts collects, nor did it touch Medicare drug spending. A recent federal government report showed that Medicare Part D rebates to middlemen were eating up a much larger chunk of total drug spending. Stettin said Express Scripts would release its own Medicare report soon, and it would disprove the "fallacy of rebates driving up the cost of medications."

How Tom Price can unravel Obamacare without Congress
Tom Price, who is expected be confirmed as Secretary of Health and Human Services this week, is expected to immediately start picking apart Obamacare legislation once approved by the Senate. Here are the things he can do, per Politico, without waiting for Congress.
- Loosen Obamacare's benefit rules and give insurers more leeway in determining which healthcare benefits they'll pay for.
- Target the contraception coverage mandate by halting enforcement of the law. He could go even further, targeting the individual mandate itself.
- Tighten the enrollment rules and ramp up monitoring of Obamacare enrollees.
Once confirmed, Price will have plenty of room to singlehandedly shift healthcare toward a free-market system. Doing so will show that Price is taking the reins on unraveling Obamacare legislation, and in turn giving stonewalled congressional Republicans more clarity about what to do next.

Insurers could get stronger after Obamacare — if they survive the transition
Obamacare didn't kill the health insurance industry, and whatever comes after won't kill it either — as long as it can scrape through the next few years.
There's been a lot of nervous talk from insurance CEOs about how they need to know what's happening next. That's a real problem, as Republicans struggle to figure out what they're actually going to do about Obamacare. But the bigger picture looks much better.
Wall Street analysts are betting health insurers — who have mostly thrived under Obamacare despite their recent setbacks — will become even stronger under Donald Trump and Republicans, who plan to shred regulations and push more taxpayer-funded programs into private control.


Trump pre-Super Bowl interview; picks Pats by 8
Here are the key parts of Trump's interview with Bill O'Reilly during the Super Bowl pre-game show:
- Relationship with Russia: "I say it's better to get along with Russia than not... And if Russia helps us in the fight against ISIS, which is a major fight, and Islamic terrorism all over the world -- that's a good thing... Will I get along with him? I have no idea."
- Pressed about Putin's history of violence: "There are a lot of killers. We've got a lot of killers. What do you think? Our country's so innocent?"
- Millions of illegal votes: "Forget about that." Trump said there were many problems with registration rolls; dead people, people registered in more than one state, non-citizens
- Is Mexico corrupt? Trump didn't go as far to label them as corrupt, but he did admit that "they have problems controlling aspects of their country." He added that "the drugs and cartels are number one."
- When will see tax reform kick in? Americans can expect a tax cut by the end of 2017
- On whether new healthcare law will be rolled out this year: "We're in the process" of replacing Obamacare now, he said. But it might take until next year. "It's very complicated," he added.
Final question from O'Reilly: "You get 4 hours of sleep... when you head into the pillow do you ever say to yourself "'I cant believe I'm president of the United States?'"
- Trump: "I must tell you, the other day i walked into the main entrance of the White House and I thought to myself, this is amazing... "It's sort of surreal, but you have to get over it because there's so much work to do."
One fun thing: Who's going to win the Super Bowl?

Now it's the Republicans who are facing angry Obamacare town halls
Republicans are starting to face angry crowds at town halls as people protest their Obamacare repeal plans — a mirror image of the furious protests Democrats faced at their own town halls in 2009 from people who didn't want them to pass Obamacare.




