The U.S. Medicare and Medicaid federal health insurance programs will cover the non-invasive Sapien heart valve replacement system from Edwards Lifesciences Corp, U.S. regulators said on Tuesday. The Sapien system is meant for patients deemed too sick to have heart valve replacement using more traditional open-heart surgery. The U.S. Food and Drug Administration approved the Sapien valve, which is estimated to cost about $30,000, in November. The U.S. Centers for Medicare & Medicaid Services (CMS) posted its reimbursement decision for the Transcatheter Aortic Valve Replacement (TAVR) system on Tuesday. The Sapien is widely considered to be one of the most important future growth drivers for Edwards.
The CEO of the former Parkway Hospital in Queens was sentenced Tuesday to four months in prison for bribing crooked ex-state Sen. Carl Kruger. "I'm sorry for this mistake," Dr. Robert Aquino, 55, said in Manhattan Federal Court. "This was poor judgment on my part." Aquino paid Kruger a $60,000 bribe in 2008 in a futile effort to keep Parkway open. Kruger was sentenced to seven years in prison last week for soliciting Aquino and others for bribes. Aquino's plea deal called for up to three years in jail.
In 2006, under Gov. Mitt Romney, Massachusetts became the first state to extend insurance coverage to all its residents. Now it's looking to slow the growth of its healthcare costs in equally groundbreaking ways. In the next few months, Massachusetts is expected to take up legislation that would overhaul how doctors, hospitals and other providers are paid. The forthcoming payment-reform bill is expected to include many incentives for hospitals to accept "global payments," or a flat fee for all the care delivered for a specific person or group of people.The hope is to take away the financial incentives to provide more care when less might be equally effective. So far, Massachusetts businesses have proved amenable to such payment changes. In many ways, they've moved in that direction without any direction from the government.
Humana Inc. (HUM), the second-biggest provider of private Medicare coverage, said the U.S. Justice Department is investigating its coding of medical claims from South Florida doctors and loans made to physician practices. The U.S. Attorney's Office in Miami requested documents and other information from Humana and its affiliates on Jan. 6, the Louisville, Kentucky-based health insurer said in a regulatory filing yesterday. Humana didn't say how it responded, and didn't respond immediately to a telephone call seeking comment. The company said yesterday its internal probe is continuing and involves "relationships" between some of its Florida employees and Medicare and Medicaid providers, the financial support of nonprofit or provider centers that enroll Medicare patients and "financial support" made to doctor practices.
A hospital chain serving Eastern Kentucky is seeking an emergency order to avoid disruptions to patients and widespread layoffs it says will occur in the state's poorest region unless a judge intervenes. Attorneys for Appalachian Regional Healthcare on Tuesday asked a federal judge to issue an injunction ordering Coventry Cares to let its members continue to receive services through the hospital chain. Coventry Cares is one of three companies approved by the state to provide managed-care services to poor, disabled and elderly people throughout most of the state under Medicaid. Coventry said it would cancel its contract with ARH after Friday. The termination, if it happens, would affect about 25,000 Medicaid recipients in the ARH service area.
Maryland officials face a decision Wednesday on a controversial plan that would effectively freeze payment rates to hospitals in the state over the next year. Hospital representatives say they could be forced to lay off workers if the proposal is approved by the Health Services Cost Review Commission—an independent agency made up of seven commissioners appointed by the governor. For the past two years, the commissioners have increased hospital rates by less than the inflation rate hospitals faced, said Carmela Coyle, president and chief executive of the Maryland Hospital Association. "We are very concerned that this will really jeopardize hospitals' financial condition at a time when we need to strengthen it," Coyle said. "This will have serious consequences."