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Wednesday, August 8, 2012

Health Care Reform Articles - August 8, 2012

Pfizer Settles U.S. Charges of Bribing Doctors Abroad




The Securities and Exchange Commission announced on Tuesday that it had reached a $45 million settlement with Pfizer to resolve charges that subsidiaries of Pfizer and Wyeth, which it acquired in 2009, bribed overseas doctors and other health care workers to increase sales of their drugs.
At the same time, the Justice Department announced that another subsidiary, Pfizer H.C.P. Corporation, had agreed to pay a $15 million penalty to settle similar charges.
The allegations, which date to 2001 and in the case of Wyeth are said to have continued after Pfizer’s acquisition of the company, involve violations of the Foreign Corrupt Practices Act, which forbids paying bribes to government officials. In many countries, doctors are government employees.
“Pfizer subsidiaries in several countries had bribery so entwined in their sales culture that they offered points and bonus programs to improperly reward foreign officials who proved to be their best customers,” Kara Brockmeyer, chief of the unit of the S.E.C. enforcement division that enforces the Foreign Corrupt Practices Act, said in a news release. “These charges illustrate the pitfalls that exist for companies that fail to appropriately monitor potential risks in their global operations.”
In a statement, Pfizer said that it had reported the activity to the federal government in 2004 after discovering improper payments by employees of a recently acquired affiliate in Croatia. It then conducted a multiyear investigation and briefed federal officials along the way. Pfizer said that it learned of the improper payments involving Wyeth soon after closing on the acquisition, and reported that activity as well.

latimes.com

Op-Ed

A Medicaid opportunity

by Tom Campbell

The Congressional Budget Office recently estimated that 30 million Americans still will be left without health insurance in 2022, after the U.S. Supreme Courtruling that largely upheld President Obama's healthcare plan. The part of the plan that was not upheld by the high court, however, contains the key to lowering that number.
The issue revolves around what it means to be covered by health insurance, and who decides. Before the Supreme Court's ruling, the answer was unambiguous. Medicaid (known as Medi-Cal in California) is a program paid jointly by the state and federal governments, but only the federal government had the authority to say what kind of coverage was sufficient. If a state, for example, wanted to cover more people by cutting out more expensive kinds of treatment, a federal waiver was required — and seldom given.
But under a reasonable interpretation of the court's recent decision, that might no longer be true. If California wants to cover more of its residents without health insurance but with a more plain-vanilla kind of coverage, for example, it should now be able to do so.


In-store clinics look to be a remedy for healthcare law influx

Mary Hull, left, a family nurse practitioner, examines Blake Howard as part of a $49 physical at the MinuteClinic at a CVS pharmacy in Arcadia as his mother, Monique Howard, fills out paperwork. (Gary Friedman, Los Angeles Times / July 18, 2012)
If you thought it was hard getting a doctor's appointment now, just wait until 30 million more Americans join the line.

Nearly 3 in 4 California counties already lack a sufficient number of family physicians, and by 2020 the U.S. faces an estimated shortage of 40,000 primary-care doctors with no way to remedy that in just a few years.

As a result, more consumers may soon find themselves getting their checkups and help in managing their high blood pressureheart disease or diabetes at the local pharmacy or Wal-Mart as the Affordable Care Act extends health insurance to 30 million people and puts unprecedented strain on an already fragile network of primary care.http://www.latimes.com/business/la-fi-clinic-medical-care-20120730,0,2527207.story


Health insurers owe nearly $74 million in rebates to Californians

By Chad Terhune
2:55 PM PDT, July 31, 2012


Nearly 2 million Californians will receive $73.9 million in rebates from health insurers as part of the federal healthcare law, according to state officials.
Insurers notified government regulators in June of how much they owed customers in rebates or premium credits because they didn't spend at least 80% or more of 2011 premiums on medical care. The minimum threshold is 85% for employers with more than 51 workers.
Figures released Tuesday mark the final tally for California; insurers must issue refunds by Wednesday. Many employers and consumers have already received letters informing them of their rebate amount.
The average rebate is $65 per family, according to the state insurance department


The Supreme Court ruling on Obamacare: A physician’s perspective

By Ann Settgast, M.D.
Southside Pride (Minneapolis), Aug. 6, 2012
The day the Affordable Care Act (ACA) was upheld by the Supreme Court was ironic for me as a physician. Two of my patients asked me to prescribe medication for uninsured family members: A mother asked me for an inhaler for her adult son with uncontrolled asthma, and another asked me if I could refill her husband’s blood pressure medications for a month or two until he is able to find another job following his lay off. He cannot see his doctor due to his uninsurance.
One might think I felt better at the end of that morning clinic knowing the ACA had been upheld. But, I didn’t. You see, even with the ACA in place, we have no reason to believe these two men will obtain access to care. In Minnesota, more than 250,000 will remain uninsured after the ACA’s implementation. These Minnesotans will remain invisible like the family members I describe, and some of them may die. After all, uninsurance is a risk factor for preventable death in the United States. However, this is not the only problem. Thousands more will remain underinsured. Any practicing physician can tell stories about underinsurance —we see it when recommendations we make to our insured patients are not taken because the deductible hasn’t been met or the co-pay is unaffordable. Minnesota ranks second in the nation for uptake of high-deductible plans, so underinsurance here is alive and well.

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