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Articles
Hicks: Medical firms are largest perpetrators of fraud
Medicaid and Medicare fraud is where the real money lies, costing taxpayers some $100 billion a year, or 10 percent of total costs. This is many times more than the highest estimate of fraud in all other assistance programs combined. Nearly all of this fraud is perpetrated by health care providers.
American farmers confront ‘big data’ revolution
Agriculture is cautiously entering a new era in which raw planting data holds both the promise of higher yields and the peril that the information could be hacked or exploited by corporations or government agencies.
LOU’S VIEWS: Eskenazi Hospital’s healthy dose of art
Here’s just a sampling of the work found in its halls, lobbies and waiting rooms, making a visit worthwhile even if you are in perfect health.
KENNEDY: Hobby Lobby’s unintended consequences
All eyes are on the Hobby Lobby lawsuit before the U.S. Supreme Court. Most of the commentary revolves around whether a for-profit corporation should be able to disregard a law of general application if that law offends its shareholder/owners’ “sincerely held” religious beliefs.
Private colleges may be among first to see fallout from NLRB ruling
A March 26 decision by the National Labor Relations Board to let football players at Northwestern University unionize could trigger a tidal wave of changes across college athletics, including in Indiana, and for the NCAA itself.
Company news
If Indiana hospitals want an expansion of insurance coverage for low-income Hoosiers, Gov. Mike Pence thinks they should contribute toward the hundreds of millions of dollars it would cost. The Pence administration has started discussions with hospital leaders to use an existing program known as the Hospital Assessment Fee to generate money to help the state cover costs it would incur under an expansion of health coverage to as many as 400,000 Hoosiers. That expansion, called for by President Obama’s Affordable Care Act, did not happen in Indiana this year, as it did in 26 other states, in large part due to Pence’s concerns about the fiscal impact on the state. The health insurance expansion would be paid for entirely by the federal government in 2015 and 2016, but then require state contributions that could rise to $393 million per year by 2020, according to estimates by the actuarial firm Milliman Inc. Other elements of Obamacare are estimated to cost state government $123 million per year by 2020. The Hospital Assessment Fee effectively taxes hospitals to provide the state government with the funds needed to raise its reimbursement rates for Medicaid patients. When the state does that, the federal government increases its 2-for-1 matching funds to support the Indiana Medicaid program. Hospitals end up getting twice as much in new revenue as they pay out in assessments. Doug Leonard, president of the Indiana Hospital Association, said hospitals are open to Pence’s approach, but are waiting until the idea is fleshed out and numbers are attached.
Indiana University Health was chosen by a Wisconsin hospital system to provide heart and aorta surgeries there after surgeons the hospital system had been using were employed by a competing provider. Wisconsin-based ProHealth Care will pay the salaries of the three IU Health surgeons who will work in ProHealth’s Waukesha Memorial Hospital, which is midway between Milwaukee and Madison. ProHealth performs more than 400 cardiothoracic surgeries each year. IU Health performs more than 1,900 cardiothoracic surgeries at its 19 hospitals in Indiana. “The goal for the two health systems is to collaborate to establish and oversee a premier surgery program in Waukesha that will incorporate the clinical protocols, care pathways and quality metrics that have been the foundation of IU Health’s nationally ranked cardiovascular program,” IU Health spokesman Gene Ford said in an email. IU Health said it would evaluate similar opportunities, but stopped short of saying it is making out-of-state partnerships a business strategy.
Eli Lilly and Co. is in a three-way race to introduce a new kind of breast cancer drug, which at least one analyst thinks could become a $6 billion-a-year blockbuster. According to Bloomberg News, Indianapolis-based Lilly, New York-based Pfizer Inc. and Switzerland-based Novartis AG all presented data on Sunday about experimental drugs that stopped growth of breast cancer tumors. Pfizer’s drug, palbociclib, stopped tumor growth for 20.2 months in advanced forms of hormone-related breast cancer, twice the time seen with an older therapy by itself. Lilly’s bemaciclib stopped tumor growth for an average of 9.1 months. Doctors told Bloomberg that the new class of drugs, called CDK inhibitors, offers the first major new therapy in a decade for patients whose breast cancer fails to respond to other treatments. Mark Schoenebaum, an ISI Group analyst in New York, predicted Pfizer’s drug could generate peak sales of $6 billion a year.
Indiana Attorney General Greg Zoeller filed Medicaid fraud charges April 2 against Sally Metzner, 57, owner of Anderson Dental Center, and eight of her employees. According to the Associated Press, the charges allege Metzner and her employees started a scheme in 2006 to submit false and inflated claims for payment of dental services to the Indiana Medicaid program, sometimes using forged documents, to receive more than $300,000 in ineligible Medicaid payments. The allegedly fraudulent billing continued even after state, federal and local authorities executed the first of three search warrants at the clinic, the attorney general's office said. For example, instead of billing Medicaid $30 for the routine use of the anesthesia nitrous oxide, the practice allegedly billed it as a $125 intravenous procedure known as "deep sedation.”
‘The Christians’ highlights 2014 Humana Festival
Lucas Hnath creates an original, riveting, thought-provoking drama with characters whose sincerity fuels fascinating conflict.
Five things I learned from the Medicare doctor payments
From this week’s historic data dump, I learned who the top 20 recipients of Medicare payments are in Indianapolis (hint: mostly labs, ambulances and eye surgeons). But the real takeaway is that meaningful price information about doctors is still a long way away.
KENNEDY: First, eat the spinach
There is probably not a parent on the planet who hasn’t delivered the time-honored dinner lecture, “No dessert unless you eat your vegetables.” We want our children to understand that first things come first—that consuming healthy food has to come before sugary treats, no matter how tempting.
SHEPARD: Protect working class with better panhandling ordinance
A recent settlement between the city of Indianapolis and the Indiana ACLU over enforcement of the present ordinance about panhandling has put the question of writing a new ordinance back on the table.
HEAD: If legalization sounds too good to be true, you’re right
Have you ever seen a commercial for what looks like a fantastic product? Despite some convincing advertisements, after five easy payments and much anticipation these products often fail to deliver what they promise.
Investor pressure pushing drugmakers to make deals
Tuesday’s blockbuster deal involving Indianapolis-based Eli Lilly and Co. was just the latest of several that have taken place since the beginning of the year.
Citizens gets state OK for steep wastewater rate hike
State regulators on Wednesday approved a rate hike that will increase monthly wastewater bills by about 26 percent, or close to $14 on average, for Citizens Energy Group customers.
Lilly’s quarterly profit meets analyst expectations
The drugmaker, which is weathering patent expirations, saw sales fall more slowly than expected for its antidepressant Cymbalta.
Life Sciences Power Breakfast transcript
Indianapolis Business Journal gathered leaders in Indiana’s life sciences industry for a Power Breakfast panel discussion April 24. Among other topics, the panelists discussed whether Obamacare helps or hurts companies in the industry, the biggest barrier to life sciences startups, and how rising activity among angel investors has changed the life sciences landscape.
What health care really needs is a full-meal deal
Until doctors and hospitals make a whole lot more headway—or, perhaps, more accurately, are allowed to make more headway—in offering package deals, it’s hard to see major progress on containing out-of-control health care costs.
Megadeals drive torrid pace for M&A activity
The value of corporate takeovers announced in 2014 hit the $1 trillion mark Monday, reaching that level at the fastest pace in seven years.