Kentucky leads nation in drug-fraud prosecutions and settlements

Kentucky leads the U.S. in pursuing pharmaceutical fraud, according to a report by the Washington, D.C.-based consumer group, Public Citizen. Since 1991, the state has pursued the most claims against pharmaceutical companies and reached more than 30 settlements. It pursued 17 single-state settlements, the most of any state.

The most common violation was overcharging Medicaid programs for services, mostly for drugs, Beth Musgrave of the Lexington Herald-Leader reports. The violations that netted the biggest penalties were for improper promotion of drugs. Attorney General Jack Conway oversees the Office of Medicaid Fraud and Abuse Control; his spokeswoman, Shelley Catherine Johnson, told Musgrave the agency has recovered or been awarded more than $265 million since Conway took office in January 2008. (Read more)

Kentucky leads the U.S. in pursuing pharmaceutical fraud, according to a report by the Washington, D.C.-based consumer group, Public Citizen. Since 1991, the state has pursued the most claims against pharmaceutical companies and reached more than 30 settlements. It pursued 17 single-state settlements, the most of any state.

The most common violation was overcharging Medicaid programs for services, mostly for drugs, Beth Musgrave of the Lexington Herald-Leader reports. The violations that netted the biggest penalties were for improper promotion of drugs. Attorney General Jack Conway oversees the Office of Medicaid Fraud and Abuse Control; his spokeswoman, Shelley Catherine Johnson, told Musgrave the agency has recovered or been awarded more than $265 million since Conway took office in January 2008. (Read more)

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Pill-mill bill causing problems for patients who have long-term prescriptions: expensive drug-screening tests

In July, Kentucky started making long-time holders of certain controlled-substances prescriptions submit to urine tests to determine if they were actually taking the drugs, rather than selling them. Because insurance companies don't consider the tests medically necessary, patients often have to pay for them out of pocket. It can be expensive, reports John Cheves of the Lexington Herald-Leader, citing one couple that had to pay $533.

The tests are required under emergency regulations issued to implement House Bill 1, the "pill mill bill," and Gov. Steve Beshear has said he understands the financial burden the tests can bring on those who are not abusing prescriptions. Changes could happen in January when the emergency regulations expire and are replaced with permanent rules, Cheves reports. The Kentucky Medical Licensure Board is hearing complaints, and has extended a grace period for compliance for doctors until Nov. 1.

"But critics say they warned last spring that HB 1 — intended to crack down on the illicit sale of prescription drugs — would treat everyone like a potential felon, including doctors and patients engaged in legitimate medical care," Cheves reports. Much debate about the bill has revolved around its implication on doctors, with little attention paid to patients. Cheves reports that soon may change.

Under the law, doctors are required to get an initial urine test from patients who have long-term controlled substance prescriptions. They must also get random drug tests once a year for "low-risk" patients who are most unlikely to abuse drugs based on test results, and three times a year for "high risk" patients. The amount of people requiring drug tests is "likely to be in the tens of thousands," Cheves reports. (Read more)

In July, Kentucky started making long-time holders of certain controlled-substances prescriptions submit to urine tests to determine if they were actually taking the drugs, rather than selling them. Because insurance companies don't consider the tests medically necessary, patients often have to pay for them out of pocket. It can be expensive, reports John Cheves of the Lexington Herald-Leader, citing one couple that had to pay $533.

The tests are required under emergency regulations issued to implement House Bill 1, the "pill mill bill," and Gov. Steve Beshear has said he understands the financial burden the tests can bring on those who are not abusing prescriptions. Changes could happen in January when the emergency regulations expire and are replaced with permanent rules, Cheves reports. The Kentucky Medical Licensure Board is hearing complaints, and has extended a grace period for compliance for doctors until Nov. 1.

"But critics say they warned last spring that HB 1 — intended to crack down on the illicit sale of prescription drugs — would treat everyone like a potential felon, including doctors and patients engaged in legitimate medical care," Cheves reports. Much debate about the bill has revolved around its implication on doctors, with little attention paid to patients. Cheves reports that soon may change.

Under the law, doctors are required to get an initial urine test from patients who have long-term controlled substance prescriptions. They must also get random drug tests once a year for "low-risk" patients who are most unlikely to abuse drugs based on test results, and three times a year for "high risk" patients. The amount of people requiring drug tests is "likely to be in the tens of thousands," Cheves reports. (Read more)

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Health reform's exchange won't attract many new insurers to Ky. because it's a small, sickly state, former Medicaid boss says

Kentucky is unlikely to attract many new insurance companies when it starts its Health Benefits Exchange a year from now, a former state Medicaid commissioner told Dawn Marie Yankeelov for a story in The Lane Report.

“Kentucky is not a big attractor,” said Elizabeth Ann Johnson, a lawyer with Stites and Harbison in Lexington office. “We are a small state for insurers, and we have a sicker population statistically – we see high Medicaid use. I would be surprised to see new players flood into the state.”

The exchange, required by the federal health-reform law, will be a "web-based marketplace that includes information necessary so Kentuckians can compare price and quality as they shop for health insurance," Yankeelov notes. "It also will assist employers in facilitating enrollment of their employees into health plans, enable individuals to receive insurance-premium tax credits and subsidies, and qualify small businesses for tax credits. . . . The average employer and employee in Kentucky will be able to find information on the exchange through a planned Navigators program, an outreach and education program that will be staffed by employees trained and certified to discuss the exchange."

University of Kentucky researchers have estimated that as many as 2.4 million Kentuckians may use the exchange. "The high end of this estimate includes approximately 1.4 million individuals currently receiving employer-sponsored insurance through their large employers," Yankeelov notes. Her story has other good background information on the law, the exchange and the problem of the uninsured, who make up about 15 percent of Kentucky's population. Read it here.

Kentucky is unlikely to attract many new insurance companies when it starts its Health Benefits Exchange a year from now, a former state Medicaid commissioner told Dawn Marie Yankeelov for a story in The Lane Report.

“Kentucky is not a big attractor,” said Elizabeth Ann Johnson, a lawyer with Stites and Harbison in Lexington office. “We are a small state for insurers, and we have a sicker population statistically – we see high Medicaid use. I would be surprised to see new players flood into the state.”

The exchange, required by the federal health-reform law, will be a "web-based marketplace that includes information necessary so Kentuckians can compare price and quality as they shop for health insurance," Yankeelov notes. "It also will assist employers in facilitating enrollment of their employees into health plans, enable individuals to receive insurance-premium tax credits and subsidies, and qualify small businesses for tax credits. . . . The average employer and employee in Kentucky will be able to find information on the exchange through a planned Navigators program, an outreach and education program that will be staffed by employees trained and certified to discuss the exchange."

University of Kentucky researchers have estimated that as many as 2.4 million Kentuckians may use the exchange. "The high end of this estimate includes approximately 1.4 million individuals currently receiving employer-sponsored insurance through their large employers," Yankeelov notes. Her story has other good background information on the law, the exchange and the problem of the uninsured, who make up about 15 percent of Kentucky's population. Read it here.

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Health Benefit Exchange advisory board forms panels to help draft application Kentuckians will use to obtain health insurance

At its first meeting yesterday, the Kentucky Health Benefit Exchange Advisory Board created committees: Behavioral Health, Dental/Vision, Education/Outreach, Navigator/Agent, Qualified Health Plans and Small Business, reports Jodi Mitchell of Kentucky Voices for Health. (Illustration from The Lane Report)

Exchange officials urged the Navigator, Qualified Health Plans and Small Business committees to meet immediately to provide feedback for the draft of the insurance application that must be filed with the federal government by Nov. 16. The Navigator Committee will meet Thursday, Oct. 4 at 1:30 at the exchange offices at 12 Mill Creek Park, off Millville Road near Frankfort.

Anyone interested in serving on the committees is asked to email Carrie.Banahan@ky.gov as soon as possible.  Meetings of the committees will be posted on the Cabinet for Health and Family Services open-meetings site and will soon be available on a new exchange site. The next full meeting of the Advisory Board will be Oct. 25 at 1:30 p.m. at the exchange offices.

More information on state exchanges, which will serve as marketplaces for health insurance under the federal reform law, is available here.

At its first meeting yesterday, the Kentucky Health Benefit Exchange Advisory Board created committees: Behavioral Health, Dental/Vision, Education/Outreach, Navigator/Agent, Qualified Health Plans and Small Business, reports Jodi Mitchell of Kentucky Voices for Health. (Illustration from The Lane Report)

Exchange officials urged the Navigator, Qualified Health Plans and Small Business committees to meet immediately to provide feedback for the draft of the insurance application that must be filed with the federal government by Nov. 16. The Navigator Committee will meet Thursday, Oct. 4 at 1:30 at the exchange offices at 12 Mill Creek Park, off Millville Road near Frankfort.

Anyone interested in serving on the committees is asked to email Carrie.Banahan@ky.gov as soon as possible.  Meetings of the committees will be posted on the Cabinet for Health and Family Services open-meetings site and will soon be available on a new exchange site. The next full meeting of the Advisory Board will be Oct. 25 at 1:30 p.m. at the exchange offices.

More information on state exchanges, which will serve as marketplaces for health insurance under the federal reform law, is available here.

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Federal official and expert on integrating physical and behavioral health services will speak in Louisville Wednesday morning

The integration of physical health and behavioral health services, one of the hottest topics in health care, will be the topic of a Health Enterprises Network forum in Louisville Wednesday, Oct. 3.

The speaker will be Kathleen Reynolds, director of the federal Center for Integrated Health Solutions, vice president of health integration and wellness for the National Council for Community Behavioral Healthcare and author of Raising the Bar: Moving Toward the Integration of Healthcare. She will review the landscape of integration, discuss how it will affect Kentucky, and offer ideas on how health-care organizations can accomplish it.

The forum will be held from 8 to 9:15 a.m. Oct. 3 at the University of Louisville's Clinical and Translational Research Building, 505 S. Hancock Street. The registration fee for members of the Health Enterprises Network is $45; non-members $60; full-time students $10. For more information call 502.625.0179 or email Register@HealthEnterprisesNetwork.com.

The integration of physical health and behavioral health services, one of the hottest topics in health care, will be the topic of a Health Enterprises Network forum in Louisville Wednesday, Oct. 3.

The speaker will be Kathleen Reynolds, director of the federal Center for Integrated Health Solutions, vice president of health integration and wellness for the National Council for Community Behavioral Healthcare and author of Raising the Bar: Moving Toward the Integration of Healthcare. She will review the landscape of integration, discuss how it will affect Kentucky, and offer ideas on how health-care organizations can accomplish it.

The forum will be held from 8 to 9:15 a.m. Oct. 3 at the University of Louisville's Clinical and Translational Research Building, 505 S. Hancock Street. The registration fee for members of the Health Enterprises Network is $45; non-members $60; full-time students $10. For more information call 502.625.0179 or email Register@HealthEnterprisesNetwork.com.

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Is carnitine effective for feline weight loss?

Center SA, Warner KL, Randolph JF, Sunvold GD and Vickers JR. Influence of dietary supplementation with l-carnitine on metabolic rate, fatty acid oxidation, body condition, and weight loss in overweight cats. Am J Vet Res. 2012; 73: 1002-15.
 
In the world of feline nutrition, L-carnitine is a conditionally essential nutrient that plays a pivotal role in fatty acid metabolism. The investigators in this study wanted to determine whether L-carnitine as a dietary supplement would facilitate weight loss in overweight cats fed a weight-reduction diet on an unrestricted or restricted basis. As well, they wanted to evaluate retention of lean body mass (LBM) during weight loss, and preferential treatment use of fat for energy expenditure. Thirty-two healthy adult colony cats were fattened by being fed an unrestricted, energy-dense diet for 6 months. The cats were randomly assigned to 4 groups and fed a weight reduction diet supplemented with O, 50, 100, or 150 µg of carnitine/g of diet (unrestricted for 1 month, then restricted). After weight loss, the cats were allowed unrestricted feeding of the energy-dense diet to study weight gain after feeding the test diet ceased. 

Overall, the collective findings regarding absolute weight reduction do not suggest an obvious benefit of dietary carnitine supplementation in this respect. The results did indicate though that dietary L-carnitine supplementation appeared to have a metabolic effect in overweight cats undergoing rapid weight loss that facilitated fatty acid oxidation. This might explain why observations of supplementation with L-carnitine improved the probability of survival time in cats severely affected with hepatic lipidosis. A final phase of the study demonstrated the rapid rebound weight gain that may occur after substantial weight loss upon reinstitution of unrestricted feeding of an energy-dense diet. Some cats regained all weight lost during the study within 35 days after reinstitution of the energy-dense diet. [VT]

See also: Ibrahim W, Bailey N, Sunvold G and Bruckner G. Effects of carnitine and taurine on fatty acid metabolism and lipid accumulation in the liver of cats during weight gain and weight loss. Amer J Vet Res. 2003; 64: 1265-77.

More on cat health:
Winn Feline Foundation Library
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Center SA, Warner KL, Randolph JF, Sunvold GD and Vickers JR. Influence of dietary supplementation with l-carnitine on metabolic rate, fatty acid oxidation, body condition, and weight loss in overweight cats. Am J Vet Res. 2012; 73: 1002-15.
 
In the world of feline nutrition, L-carnitine is a conditionally essential nutrient that plays a pivotal role in fatty acid metabolism. The investigators in this study wanted to determine whether L-carnitine as a dietary supplement would facilitate weight loss in overweight cats fed a weight-reduction diet on an unrestricted or restricted basis. As well, they wanted to evaluate retention of lean body mass (LBM) during weight loss, and preferential treatment use of fat for energy expenditure. Thirty-two healthy adult colony cats were fattened by being fed an unrestricted, energy-dense diet for 6 months. The cats were randomly assigned to 4 groups and fed a weight reduction diet supplemented with O, 50, 100, or 150 µg of carnitine/g of diet (unrestricted for 1 month, then restricted). After weight loss, the cats were allowed unrestricted feeding of the energy-dense diet to study weight gain after feeding the test diet ceased. 

Overall, the collective findings regarding absolute weight reduction do not suggest an obvious benefit of dietary carnitine supplementation in this respect. The results did indicate though that dietary L-carnitine supplementation appeared to have a metabolic effect in overweight cats undergoing rapid weight loss that facilitated fatty acid oxidation. This might explain why observations of supplementation with L-carnitine improved the probability of survival time in cats severely affected with hepatic lipidosis. A final phase of the study demonstrated the rapid rebound weight gain that may occur after substantial weight loss upon reinstitution of unrestricted feeding of an energy-dense diet. Some cats regained all weight lost during the study within 35 days after reinstitution of the energy-dense diet. [VT]

See also: Ibrahim W, Bailey N, Sunvold G and Bruckner G. Effects of carnitine and taurine on fatty acid metabolism and lipid accumulation in the liver of cats during weight gain and weight loss. Amer J Vet Res. 2003; 64: 1265-77.

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

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Mayfield named state's top doctor, as head of health department

Dr. Stephanie Mayfield

Dr. Stephanie Mayfield has been appointed as the commissioner for the state Department for Public Health, making her the first woman and first African American to hold the position, which has typically been held by a physician. The appointment was made by Audrey Haynes, secretary of health and family services.

The department is the largest health-care provider in the state, with an annual budget this year of almost $400 million. It includes 59 county and district health departments, many of which are "financially struggling," notes Beth Musgrave of the Lexington Herald-Leader. "The health departments have seen their budgets cut in recent years, leading to some lay offs and furloughs." (Read more)

Mayfield has been director of Kentucky’s public health laboratory since 2005. According to the Cabinet for Health and Family Services, Mayfield and the state lab team have been instrumental in speeding up tuberculosis detection and in testing the state's newborns for a wide array of problems. In addition to overseeing the state lab, Mayfield has also served as a lecturer on rotation at the University of Kentucky School of Medicine’s Preventive and Occupational Medicine Residencies and the University of Louisville School of Medicine’s Department of Pathology.

Dr. Steve Davis, who as deputy commissioner has run the department for more than a year, tells Kentucky Health News that he will remain in the agency.

Dr. Stephanie Mayfield

Dr. Stephanie Mayfield has been appointed as the commissioner for the state Department for Public Health, making her the first woman and first African American to hold the position, which has typically been held by a physician. The appointment was made by Audrey Haynes, secretary of health and family services.

The department is the largest health-care provider in the state, with an annual budget this year of almost $400 million. It includes 59 county and district health departments, many of which are "financially struggling," notes Beth Musgrave of the Lexington Herald-Leader. "The health departments have seen their budgets cut in recent years, leading to some lay offs and furloughs." (Read more)

Mayfield has been director of Kentucky’s public health laboratory since 2005. According to the Cabinet for Health and Family Services, Mayfield and the state lab team have been instrumental in speeding up tuberculosis detection and in testing the state's newborns for a wide array of problems. In addition to overseeing the state lab, Mayfield has also served as a lecturer on rotation at the University of Kentucky School of Medicine’s Preventive and Occupational Medicine Residencies and the University of Louisville School of Medicine’s Department of Pathology.

Dr. Steve Davis, who as deputy commissioner has run the department for more than a year, tells Kentucky Health News that he will remain in the agency.

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