Health insurers sue state over rate caps

The Patrick administration and the state’s leading health insurers are facing off in court over an attempt to cap small business premium growth. Read more

Obama nominates Mass. doctor to head CMS

President Barack Obama has nominated Massachusetts pediatrician Donald Berwick, known for his work to improve patient care, to head the Centers for Medicare and Medicaid Services. Read more

Litigation concern may prompt increase in cardiac testing

A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant heart problem, according to a study published in the New England Journal of Medicine. Read more

Court: Thimerosal didn’t cause autism

The vaccine additive thimerosal is not to blame for autism, a special federal court has ruled in a legal battle by parents who claim that there is a connection.

The ruling was issued by the “vaccine court,” a special branch of the U.S. Court of Federal Claims established to handle claims of injury from vaccines. It may be appealed in federal court.

The parents presented expert witnesses who argued that mercury can have a variety of effects on the brain, but the ruling said none of them offered opinions on the cause of autism in the three specific cases at hand. They testified that mercury can affect a number of biological processes, including abnormal metabolism in children.

The ruling said that the parents were arguing that the effects from mercury in vaccines differ from mercury’s known effects on the brain.

The court concluded that the parents had failed to establish that their children’s condition was caused or aggravated by mercury from vaccines.

The decision that autism is not caused by thimerosal alone follows a parallel ruling in 2009 that autism is not caused by the combination of the measles-mumps-rubella vaccine with thimerosal and other vaccines.

Health reform to trump whistleblower ruling

The U.S. Supreme Court has ruled that potential whistleblowers are barred from filing lawsuits on behalf of the government if the suits are based on information obtained through a state, federal or local report - but the ruling’s impact will be short-lived. Read more

Study: CMS failed to act on findings of RAC demonstration project

The Centers for Medicare & Medicaid Services could have collected an additional $231 million in improper Medicare payments during the three-year Recovery Audit Contractor (RAC) demonstration had it taken steps to correct the “vulnerabilities” the program uncovered, according to a new analysis by the Government Accountability Office. Read more

Massachusetts joins lawsuit against J&J

Attorney General Martha Coakley’s office has joined a federal lawsuit that contends that Johnson & Johnson paid tens of millions of dollars in kickbacks to get its drugs, especially the powerful antipsychotic Risperdal, prescribed in nursing homes, according to The Boston Globe.

The action was taken as Coakley’s office disclosed that it is also scrutinizing companies that market antipsychotics to Massachusetts nursing homes. These drugs are widely used in some homes to treat residents suffering from dementia.

Antipsychotics are approved to treat people with severe mental illnesses, such as schizophrenia, but it is legal for physicians to prescribe them “off label” to treat people with dementia. Pharmaceutical companies are prohibited from marketing or promoting off-label uses of their products.

Doctor offers reform ideas to lawmakers

State policy makers should consider setting rates for medical services to counteract the dominance of certain hospitals, a prominent doctor told state policymakers at a hearing organized by the Patrick administration and Attorney General Martha Coakley’s office. Read more

Health insurers sue state over rate caps

The Patrick administration and the state’s leading health insurers are facing off in court over an attempt to cap small business premium growth.

Six leading companies sued the Division of Insurance, alleging that its decision to reject the bulk of premium increases that were to have taken effect April 1 was arbitrary and will affect their bottom line.

The administration says the insurers did not justify increases ranging from 8 to 32 percent. Gov. Deval L. Patrick says the hikes are keeping small businessmen from adding jobs critical to the state’s economic recovery.

The insurers contend that capping their rates without any change in the charges made by doctors and other medical providers could cause them to lose hundreds of millions of dollars.

Suffolk Superior Court Judge Stephen E. Neel denied an injunction sought by the insurers in early April, upholding the state’s rejection of 235 proposed rate hikes; however, the insurers’ suit against Insurance Commissioner Joseph G. Murphy will go forward.

Neel agreed with the state that the insurers should appeal Murphy’s decision within the insurance division before bringing their fight to the courts.

All six of the insurers who saw rates rejected received letters threatening them with fines if they failed to revise their premium rates by April 16. At press time, two of those insurers, Harvard Pilgrim Health Care and Fallon Community Health Plan, reportedly had yet to comply.

Obama plan shows gap in children’s coverage

President Barack Obama’s top health care official has put health insurers on notice that the new health overhaul law requires them to cover children with medical problems, trying to dispel uncertainty over a much-publicized benefit. Read more

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