Millions Paid to Ohio Medicaid Contractors On Behalf of …..(Oops!)…Deceased Beneficiaries, Feds Say

Ohio officials mistakenly  made more than $90.5 million payments to contractors for medical services under Medicaid on behalf of  beneficiaries who had died, federal officials say in an investigative report.

That was found in a random sample of 100 so-called capitation payments made to Medicaid Managed Care Service Organizations.  Ohio eventually recovered 37 payments, but did not recover the remaining 63 — which amounted to at least  $51.3 million in unapproved payments, according to the federal Health and Human Services Inspector General’s Office. That amount includes $38 million in federal funds.

“Ohio did not always identify and process Medicaid beneficiaries’ death information. Although Ohio’s eligibility systems regularly interfaced with Federal data exchanges that identify dates of death, county caseworkers did not always receive notification that beneficiaries had died,” the report said.

“We confirmed that all beneficiaries associated with the 100 capitation payments in our stratified random sample were deceased,” it added.

Not that this hasn’t happened before in the U.S.

Since 2016, Florida, Texas and Tennessee have made payments after beneficiaries’ deaths, according to HHS.- Joe Cantlupe, HealthDataBuzz


Days after vowing insurance for everyone, Trump hedges in ABC interview: “We want no one. We want the answer to be no one” to be left out.

As his administration ramps up plans to replace Obamacare, President Trump seemed to back off last night in an ABC News  interview with David Muir from his vow less than two weeks ago of “insurance for everybody” in a replacement plan.

Muir referred to Trump’s promise in an interview with  Washington Post of insurance for all Americans less than two weeks ago. Muir pressed Trump on what his plans are for an estimated 18 million people who could potentially lose their insurance if Obamacare is repealed without a replacement.

“Can you assure those Americans watching this right now that they will not lose their health insurance or end up with anything else?” Muir asked the President.

Trump went off on a tangent, assuring Muir that his plan would result in “much better health care, much better service treatment” at less cost. Twice he called Obamacare a “disaster.”

Muir asked again:”So, no one who has this health insurance through Obamacare will lose it or end up.. with anything less?”

“Say no one,” Trump said, “I think no one.”

“Ideally, in the real world, you’re talking about millions of people. Will no one (?). And then, you know, knowing ABC, you’ll have this one person on television saying how they were hurt,” Trump said, according to the transcript. “Okay. We want no one. We want the answer to be no one.”

Trump offered no details or explanation. He did say: “But I will say millions of people will be happy.” – Joe Cantlupe















Is there too much campaign money and political self-interest for the U.S. to reduce drug costs?

The problem is fairly straightforward: We Americans pay more for our drugs compared to the rest of the world. How we got to this point involves many moving pieces like the cost of new drug development and marketing and Bush-era legislation that prohibits Medicare from using a bidding process to get the best drug deals. Add to that the political money trail—lobbying costs and the big dollars invested in political campaigns and the big bucks the pharmaceutical industry spends to lobby spends on Congress is drawing a great deal of media and constituent attention.

Throw in patent limitations and we’re left to wonder how much drug prices can be regulated and how far President Trump and Congress are willing to go in an effort to tame drug costs.

Big pharma’s influence is there. But there is a broader question: do enough Republicans and Democrats have the courage to monitor drug companies to reduce prices as they continually receive big contributions from the drugmakers?

Ah, there’s the rub.

When it comes to drug pricing, Trump and Sen. Bernie Sanders (D-Vt) political polar opposites, are on the same page—they each want to reduce the consumer cost of drugs

So far, Trump has signaled that he wants to go pretty far. In the weeks leading up to Friday’s inauguration, Trump accused the pharmaceutical industry of “getting away with murder” and said he would change the way the country bids on drugs in an effort to reduce costs.

In his Twitter response, Sanders agreed with Trump’s statement that the pharmaceutical industry  is ‘getting away with murder,’ but questioned if “Trump and the Republicans have the guts to police drug companies and lower prices?”

There’s plenty of politicking that remains to be played out.

pexels-photo-dollars-in-grass-164474But the first hint of how difficult it may be to change legislation to open the door for negotiating on bidding on drugs, ostensibly to lower prices, came this month on the Senate floor when Sanders and Sen. Amy Klobuchar (D-MN) introduced a budget resolution amendment to allow pharmacies and patients to import low-cost medicine from Canada.

It was defeated, 52-46, mostly along familiar party lines although 13 Democrats voted against the budget resolution while 12 Republicans voted in favor.

Most Senators who opposed the Sanders plan have been recipients of hefty pharmaceutical industry largess, including Orrin G. Hatch, (R-UT), Mitch McConnell, (R-KY) Cory Booker, (D-NJ), Patty Murray, (D-Wash), Robert Casey Jr., (D-PA) Patrick Toomey, (R-PA) Rob Portman, (R-Ohio) and Michael Bennet (D-Col.), according to Open Secrets.  Among that group, only Chuck Schumer  (D-NY), Joe Manchin III (D-WVa) voted yes.

The GOP vote was not surprising, but the Democratic tally was particularly intriguing.

Among the Democratic “no” votes that stood out was that of New Jersey Sen. Cory Booker, D, certainly seen as a Democratic rising star, according to Open Secrets. And of course Booker represents New Jersey, headquarters of many pharmaceutical companies. From 2009 to 2016, Booker has received more than $277,000 from the pharmaceutical industry. Other Democratic naysayers included fellow Garden State senator Bob Menendez, who received $284,000, Pennsylvania’s Bob Casey, who received $291,000 and Washington Sen. Patty Murray, a recipient of $363,000.

The bottom line: costs.

In case anyone needs reminding, here are some of the comparisons between the drug prices in the U.S. and other countries.

If you went to Spain and bought one bottle of painkiller OxyContin, the price may be $36, but in the U.S. it’s $265. The average price for Humira, the immensely popular drug for rheumatoid arthritis, is about $552 in South Africa, but $2,669 in the U.S., according to the International Federation of Health Plans

“There’s no reason why there should be so many differences,” says Tom Sackville, the iFHP’s chief executive. “It illustrates the damaging effects of an inadequately regulated healthcare market.”

Trump, in a Tweet, noted: “We’re the largest buyer of drugs in the world and we don’t bid properly.” He added, “Our drug industry has been disastrous, they’re leaving left and right. They supply our drugs but they don’t make them here, to a large extent.”

As Trump says, most of our drugs are manufactured overseas. about 80% in China and India, studies show.

The loudest voice in the room?

Sure to have a loud voice in any pricing discussion and regulation is the major drugmaker lobbyist, Pharmaceutical Research & Manufacturers of America, (PhRMA) which has for now remained remarkably reticent about Trump’s comments.

When we asked about Trump’s “getting away with murder” comment, PhRMA had no direct statement. Earlier it issued a low-key statement to HealthDataBuzz, saying it is “committed to working with the new administration and Congress to improve American competitiveness and project American jobs.”

In addition, PhRMA said it plans to work with President Trump and lawmakers “to advance proactive, practical solutions to improve the marketplace and make it more responsive to the needs of patients.”

PhRMA noted how biopharmaceutical companies invested $70 million a year in research and development in the U.S. – and are responsible for 4.5 million American jobs. Jobs, of course, represent an issue close to Trump’s heart, as he loudly demonstrated in the campaign and in his inaugural speech.

Lobbying, Money and Price Negotiations

“Pharma has a lot of lobbies, a lot of lobbyists and a lot of power,” Trump said.

Indeed, in 2016, more than $186 million was spent on lobbying from pharmaceuticals and health products, with 1,429 lobbyists reported. PhRMA alone accounted for more than $18.9 million making it the biggest spender in lobbying, according to Open Secrets.

In the presidential election campaign, Hillary Clinton (D) received $2 million, Bernie Sanders (D), $310,000 and Trump (R), $259,480, according to Open Secrets

After the losing vote in the Senate on his effort to import lower cost drugs from Canada, Sanders said he intended to speak to “every Democrat who voted against the amendment to find their concerns and look forward to joining us in the future.”

The future may come soon enough.

Sanders said he will soon introduce legislation with Rep. Elijah E. Cummings (D-MD) to allow Medicare to negotiate with drugmakers and to permit the importation of safe and affordable drugs from other countries.

In the meantime, PhRMA is getting ready for a big marketing campaign this month to get its messages across, with the idea of spending “tens of millions” each year to get the word out about its industry, according to Fierce Markets.

The drug pricing battle may have just begun.

– By Joe Cantlupe and Margaret Dick Tocknell


Will the anti-depressant you take work? Researchers looking for clues: smiles included

As more Americans take antidepressants, the feeling is that the already large numbers may grow considerably in the stress-filled world we are in. Look how turbulent the past 12 days have been in light of the elections.

What if we can predict what antidepressants would work for some patients, or not, based on their childhood stresses, and brain activity, and studying their facial expressions, such as smiles?

That could mean a big difference, not only for patients, but for healthcare, and its spending on medications.

A team from Stanford University led a study to do that very thing; they “created a model, based on brain activity and exposure to stress in childhood, that predicts the likelihood that antidepressants will benefit a patient,” according to a recent National Institutes of Health Research Matters story Predicting the Usefulness of Antidepressants. The model has a80 percent accuracy for prediction of antidepressants helping patients.

“Addressing this question could provide a new mechanistic understanding of why some individuals respond to antidepressant treatments and others do not, as well as offer new targets for intervention,” the researchers said in the study.

The study findings indicate that many patients who faced stressful situations should be considered for other therapy techniques before medication.

Certainly, however, many people are now taking the meds.

In 2013, Roni Caryn Rabin of The New York Times wrote that the use of antidepressants skyrocketed, with one of 10 Americans taking antidepressant medications. Last November, Justin Karter reported in Mad in America that from 1999 to 2012, the percentage of Americans on antidepressants increased from 6.8% to 13%, citing the Journal of American Medical Association.

Not only are the numbers increasing, but a report in the Medical Daily show that most people take some type of anti-depressants, even though they don’t need it.

Finding the keys to antidepressants

As Tianna Hicklin, a writer at the NIH who wrote about the federal agency sponsored study, notes, antidepressant medications usually are linked to the treatment of depression, but done so as a result of a “trial and error” process.

So researchers looked into the mechanism of depression, examining patients’ stressors at childhood, and the brain’s handling of emotions. They reviewed  data from 70 patients who had  major depressive disorders, and asked them how many life stressors they had experienced before age 18, Hincklin wrote. Those stressors could include abuse, neglect, family conflict, illness, or death and natural disasters, she said.

In the meantime, the  researchers evaluated the amygdala activity of the brain linked to depression. Amygdala is a mass of gray matter inside each cerebral hemisphere. The researchers found that amygdala circuitry and early life stress (ELS) are both “strongly and independently implicated in the neurology of depression,” the team, led by Leanne Williams and Andrea-Golstein-Piekarski said. Williams did not respond to questions from Health Data Buzz.

Impact of Smiles

Using an MRI, the researchers measured brain activity in patients  and  viewed pictures of “emotional faces,” including smiling,  Hicklin wrote. Brain scans were taken before and after patients started taking antidepressants.

Ironically, antidepressants were less likely to work for those patients considered in the high -stress category, but “these patients had a greater chance of benefiting from the medications if their brains were highly responsive to happy facial expressions,” Hicklin added.

Also, patients with low childhood stress were most likely to benefit from antidepressant treatment. Their chances increased if their brains were less sensitive to both happy and fearful stimuli,” according to Hicklin.

“These results suggest that, for some patients, it might help to first try therapy techniques that address the impact of trauma in a person’s life before considering medication,” she wrote.




Progress Against Tobacco Use. Yes. But…36 Million Smokers…Still

Lots of people are quitting cigarette smoking, current federal data  released  yesterday show, but there is a lot more to do to crash that fogged-up window of nasty tobacco use, with an uneven effort seen in too many states to enact tobacco prevention or control programs. Indeed, there are still 36 million smokers in this country, according to the Centers for Disease Control and Prevention.

“Sadly, nearly half (of the people) could die prematurely from tobacco-related illnesses, including 6 million from cancer, unless we implement the programs that will help smokers quit,” said CDC Director Tom Frieden in a statement.

Forty percent of cancers diagnosed in the U.S. may have a link to tobacco use, according to the CDC’s Vital Signs report.

Tobacco use is the leading preventable cause of cancer and cancer deaths. Each year, between 2009 and 2013, about 660,000 people in the U.S. were diagnosed with, and about 343,000 people died, from a type of cancer-related to tobacco use, according to the  CDC. Three in 10 cancer deaths are linked to cigarette smoking, but since 1990 about 1.3 million tobacco-related cancer deaths have been avoided, the agency said.

“When states invest in comprehensive cancer control programs – including tobacco control – we see greater benefits for everyone and fewer deaths from tobacco-related cancers,” said Lisa C. Richardson, director of CDC’s division of cancer prevention and control.

“We have made progress, but our work is not done,” Richardson said.

There has been progress indeed. Cigarette smoking among U.S. adults declined from 29.0 % (45.1 million) in 2005 to 15.1% (36.5 million) in 2015.

During 2014-2015 alone, there was a 1.7 percentage point decline, resulting in the lowest prevalence of adult cigarette smoking since the CDC’s National Health Interview Survey began collecting data in 1965.

The CDC has touted “comprehensive cancer control programs” that the agency says “focuses on reducing cancer risk, detecting cancer early and improving cancer treatments.” That helps more people survive cancer, or improve survivors’ quality of life.

But “not all states or all people have experienced the benefits of these efforts,” the CDC says, noting: “tobacco prevention and control resources, along with access to medical care and cancer treatment, vary widely across the U.S.”

The incidence and death rates were highest:

  • Among African-Americans compared with other races or ethnicities
  • People who live in counties with a low proportion of college graduates
  • People who live in counties with high poverty levels.

Tobacco use was highest in the Northeast (202 per 100,000 people) and lowest in the West, (17 per 100,000 people). Tobacco-related  cancers were higher among men (250 per 100,000 people) =then women (148 per 100,000 people).

It’s time for states, counties and local communities to help our neighbors stop smoking. Smokers can get free help by calling 1-800-QUIT-NOW. You can also get additional  resources from the CDC on the internet.





Trump: Ditch Obamacare on Day One. Will He?


Donald Trump’s stunning victory early this morning as the 45th president of the U.S., coupled with the GOP takeover of the Senate and House, could mean trouble – or the end – of Obamacare.

Just ask President-elect Trump.

Trump said  Hillary Clinton called to concede, and that he  wanted to “bind the wounds of division.”  There may be many division ahead, not the least of which what may happen with Obamacare. Trump didn’t mention it but remember: “On day one of the Trump Administration, we will ask Congress to deliver a full repeal of Obamacare,” Trump says on his campaign website.

In the weeks before last night’s election, in which everything from FBI miscues to miscalculations by pundits was highlighted, Obamacare also played a role when it was announced recently some premiums would be increased by 25%.

While the defeated Hillary Clinton was ready to continue Obamacare, or the Affordable Care Act, Trump has been defiant anytime he discussed it.

“As it appears Obamacare is certain to collapse of its own weight, the damage done by the Democrats and President Obama, and abetted by the Supreme Court will be difficult to repair unless the next President and a Republican Congress lead the effort to bring much –needed free market reforms to the healthcare industry,” Trump said on his website.

“It is not enough to simply repeal this terrible legislation,” he said. “We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country.”

While Trump continually has pounded on the campaign trail about Obamacare, he specifically lambasted the administration for increased Obamacare premiums.

“On November 1, just before the election on November 8, new numbers are coming out which will show 40, 50, 60% increases,” CNN quoted Trump saying at a September 16 campaign rally in Miami. “They want to delay it until after the election because it’s … a disaster.”

As USA Today reported in October as federal exchange opened up, premiums would be increased 25% for plans for which the tax subsidies are calculated.