Weis Markets to host lifestyle expos for seniors
SUNBURY, Pa. Weis Markets on Tuesday announced it will host two senior health and lifestyle expos — the first in Williamsport, Pa., on Oct. 19, and the second in Bloomsburg, Pa., on April 19, 2011. The expos will feature exhibits from dozens of local and regional companies that provide products and services for adults ages 50 years and older.
“The information offered at the expo will be of special interest to folks 50-plus that have different needs as they age,” stated Deborah Verderame, show coordinator. “The exhibitor mix is excellent,” she said. The mix will include representatives from healthcare organizations, hospitals, insurance companies, home care suppliers and mobility product companies, among others.
Aspecial feature of the expos will be a free “Early Bird Breakfast” prepared by Weis Markets and served 8 a.m. to 10 a.m.
Courtney Thomas, Miss Pennsylvania 2010, will serve as the official expo hostess. Thomas will visit the booths of the expo sponsors for photo opportunites with guests and exhibit staff. Exhibitors also will provide door prizes and have prize drawings that visitors may enter at each booth.
Medicare anti-fraud efforts re-ignite indy feud
WASHINGTON —A new push to crack down on the massive and costly fraud and abuse that plagues Medicare and Medicaid is drawing praise from the pharmacy benefit management industry. But it also drew another volley against PBM practices by the independent pharmacy lobby.
Both Congress and the White House are targeting fraud, waste and improper billing in federal healthcare outlays. The Centers for Medicare and Medicaid Services has proposed new regulations to help prevent what the agency said is $55 billion in annual improper payments to providers and health plans. In a related development, the House Energy and Commerce Subcommittee on Health is looking at ways to attack the problem, and held a hearing Sept. 22 titled, “Cutting Fraud, Waste and Abuse in Medicare and Medicaid.”
The National Community Pharmacists Association quickly weighed in on the issue. Speaking on behalf of independent pharmacy owners, the NCPA submitted a statement at the hearing that accused the pharmacy benefit management industry of responsibility, directly or indirectly, for much of the abuse and unnecessary outlays by Medicare and Medicaid.
Reform of the Medicare and Medicaid payment system, NCPA told the congressional panel, should include “targeting PBMs by examining their past record of alleged systematic chicanery. From 2004 to 2008, the three major PBMs…faced six major federal or multidistrict cases over allegations of fraud; misrepresentation to plans, patients and providers; improper therapeutic solutions; unjust enrichment through secret kickback schemes; and failure to meet ethical and safety standards,” the pharmacy group asserted. What’s more, the NCPA charged in its testimony, “PBMs are virtually unregulated at the state or federal level, even though they manage numerous prescription drug plans funded by billions of taxpayer dollars.”
The group urged Congress to pass legislation “to rein in the waste being generated by the business practices of pharmacy benefit managers under Medicare and Medicaid” and to increase the transparency of PBM audit practices. In its strongly worded statement, the NCPA also asked the panel to “address through oversight or legislation CMS’ failure, in certain circumstances, to assert its authority to fight fraud, waste and abuse.”
Not surprisingly, the PBM industry has a very different take on payment-reform efforts. Responding to new proposed regulations from CMS to combat fraud and abuse, Pharmaceutical Care Management Association president and CEO Mark Merritt said the government’s focus should be on preventing abuse rather than on pursuing wrongdoers after the fact for fraudulent billing practices.
“Pharmacy benefit managers agree that prevention, not ‘pay and chase,’ is the key to fighting fraud,” Merritt noted. “That’s why PBMs use a variety of state-of-the-art techniques to detect and prevent fraud, waste and abuse before it happens. Unfortunately, some public policies undermine the fight against fraud by requiring payers to include pharmacies in their networks that have been banned from federal programs [known as ‘any-willing pharmacy’ policies],” Merritt added. The potential for abuse, he went on, also is exacerbated by other policies that “grant pharmacies that commit fraud a long waiting period before removing them from networks, [and] grant pharmacies an advanced-notice ‘heads up’ before performing audits.”
Merritt also took the opportunity to reiterate the PBM industry’s intense opposition to the “promptpay” requirements long sought by chain and independent pharmacies, which historically have been plagued with slow reimbursements for drugs dispensed to public and private third-party payers. Policies that require payers to “accelerate payments,” PCMA’s leader charged, leave “less time to detect and prevent fraudulent Medicare claims before payments are made”—so-called “prompt pay.”
Skin cancer proves to be color blind
NEW YORK —While studies have indicated that anyone can get melanoma, minorities often are less likely to be diagnosed when skin cancer is in its earlier stages, according to Marcy Street, the nation’s first African-American female to complete a fellowship in Mohs micrographic surgery, a specialized form of skin cancer removal and treatment.
One recent study of 41,072 melanoma patients in Florida found advanced cases in 12% of whites, 18% of Hispanics and 26% of African-Americans.
“There is a fairly common misconception among African-Americans and Hispanics that we do not get skin cancer. Nothing could be further from the truth,” stated Street, a board-certified, Mayo Clinic-trained dermatologist. “Everyone, regardless of ethnicity, needs to get checked and often, especially if there is an abnormality of the skin.”
Abnormalities of the skin may include any changing moles, a growth on the skin that does not heal, or a “rash” that won’t go away with lotion.
Street also is the founder of the Doctor’s Approach skin care line, which includes acne-fighting products, anti-aging facial products and other specialty skin care items.