November 1, 2010 Legislation





The waivers for the Obamacare plan are coming.  Now UnitedHealth and WellPoint are requesting waivers for the 85% on healthcare rule.  The companies state that individuals will be hurt by this due to expenses involved.  They want the rule suspended until 2014 when other changes will occur to lessen the expenses.

The National Association of Insurance Committee (NAIC) has met and agreed to give the administration all that it asked for.  They did some wordsmithing but nothing of substance.  This means the 80% and 85% amounts that the insurers must pay will hold.

The ongoing feud between Senator Grassley of Iowa and CMS is escalating.  Grassley sent a second letter to CMS Sebelius asking for direct answers to three direct question.  The Senator's questions are prompted by a Florida psychiatrist who wrote 96,685 prescriptions for mental health drugs in a 31 month period.  State records show Dr. Mendez-Villamil wrote twice as many prescriptions for mental health drugs as the number two prescriber in the state.  The physician has been terminated from the Medicaid program.  The physician states he works long hours and gives each patient 4 or 5 prescriptions.  Grassley stated although the numbers in themselves do not suggest any illegal or wrongful behavior, they do suggest overutilization or even health care fraud.  He states that the only way to get veracity is via appropriate oversight by HHS and continued monitoring by Congress.

The London Daily Telegraph reports that a plan to force pharmacies to switch patients to generics has been scrapped.  The experts warned the new rule would put lives at risk due to the generics are not always as potent as the labeled drugs.  Most drugs on the national formulary are generics so the new rule would save little money.

The Telegraph also ran a story that told of the government telling GPs that they must cut back on prescribing meds.  These are the 15 most common drugs including statins for high cholesterol.  The government wants to give cheaper alternatives first, reserving brand drugs for severe cases, prescribe them for the shortest time possible and take them off the drugs for three months if the response has not been considered adequate.  They are also limiting long acting insulin.  Boy, we have a lot to look forward to. 

Continuing in England, the government has set up a two hundred million pound fund to be administered locally for cancer drugs that are not covered under NHS policy.  This will undermine the agency (NICE) that determines the drugs to be used in the country.     Top


Rhode Island Hospitals was fined $300,000 after a surgical instrument was discovered in his scalp three months post operative.  The hospital did not do an x-ray as required under its rules when a piece of equipment is missing.  The fine was only the tip of the iceberg.  CMS then ordered the hospital to undergo a full inspection.  The hospital had failed to report "numerous" errors in post operative instrument counts.  The hospital also had a drill bit break off during a neurosurgical case and this was never accounted for.  No x-ray was performed even though it is hospital protocol.  The bit was in the scalp.        Top

DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.