Blog-Worthy Events for 2009

By: Grete Dudek, CIS Compliance Specialist
gretedudek@cis-partners.com

Just a few weeks into the New Year, there are already so many blog-worthy news events that I couldn’t choose just one to write about. Here are some fascinating stories to think about that have been published in 2009.

1. Americans were the top spenders on prescription drugs in 2005, the most recent year that has been analyzed. “U.S. patients shelled out an average of $792 each for their meds in 2005, almost double the overall average among all industrialized countries. That average was $401, a number that not only depends on drug prices, but on per capita consumption of them” (1). So even with the slower economy and a shift toward lower priced generics, our spending was greater per person than in any other country.

2. Overall, healthcare spending in the U.S. grew by 6.1 percent in 2007, the slowest growth rate since 1998. “Health care spending, however, continues to outpace overall economic growth, which grew by 4.8 percent in 2007” (2). Healthcare spending accounted for 16.2% of the nation’s gross domestic product (GDP) in 2007, or $2.2 trillion, which comes out to $7,421 per person (2).

3. Seven hospitals filed 14,000 fraudulent Medicaid claims between July of 2002 and the end of 2006. The “hospitals in New York State are accused of bilking Medicaid of some $50 million” (3). One hospital, which closed in November, allegedly paid its employees to go to homeless shelters to lure people into entering detox programs. The hospital workers offered the homeless free beer, cigarettes and food for attending a three day program, and then billed Medicaid for their stays (4). The other hospitals fabricated and exaggerated records so their patients were eligible for the hospital’s detox programs, which did not have the correct state operating licenses needed to run the programs. There was no filing of “criminal charges, but authorities can collect triple the financial damages in civil cases and can also close a facility” (5).

4. As of January 1, 2009, forty drug manufacturers signed an agreement to stop distributing free goods, such as pens, staplers, shirts and mugs to doctors. “The guidelines also reiterate the [Pharmaceutical Research and Manufacturers of America] 2002 code, which prohibited more expensive goods and services like tickets to professional sports games and junkets to resorts. And it asks companies that finance medical courses, conferences or scholarships to leave the selection of study material and scholarship recipients to outside program coordinators” (6). The new code will hopefully encourage the educational relationship between industry and doctors, and restore public confidence that doctors aren’t being persuaded to prescribe higher priced drugs.

Sources
1. http://www.fiercepharma.com/story/u-s-drug-spending-tops-globe/2008-09-25
2. http://www.drugs.com/news/cms-reports-lowest-rate-overall-growth-national-health-spending-since-1998-15491.html
3. http://blogs.wsj.com/health/2009/01/06/go-to-detox-get-free-beer/
4. http://www.newsday.com/news/local/crime/ny-lihosp065988358jan06,0,2339805.story
5. http://www.nypost.com/seven/01062009/news/regionalnews/hosp_scambusters_147432.htm
6. http://www.nytimes.com/2008/12/31/business/31drug.html?partner=permalink&exprod=permalink