Outpatient Facility Fees To Be More Transparent With New Law

Patients billed for a facility fee for outpatient hospital services will get a clearer explanation of the charge, under legislation taking effect Friday. Connecticut has taken various steps to educate patients about the fees. The latest changes, passed this year as part of a broader health care bill, put further mandates on institutions that charge the fees. Patients have complained they were blindsided by the fees on their medical bills, and patient advocates say the fees are difficult to understand. A facility fee is charged by a hospital or health system for outpatient services provided in a hospital facility, intended specifically to compensate the facility for operational expenses.

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Southington Dentist Will Pay Settlement In Medicaid Fraud Case

A dentist will pay $55,000 to settle claims he defrauded the state’s Medicaid program, Attorney General George Jepsen announced Monday. Dr. Thomas DeRienzo, a licensed practicing dentist in Southington, will pay the money to settle civil healthcare fraud allegations that he submitted fake claims for Medicaid payments. Jepsen alleged that DeRienzo carried out a “long-term scheme” in which he submitted claims to the state Department of Social Services, which administers Connecticut’s Medicaid program, for dental services he did not provide to patients enrolled in the Connecticut Medical Assistance Program (CMAP).  CMAP, run by DSS, includes family, children’s and low-income Husky programs.

Jepsen accused DeRienzo of submitting claims to DSS for resin-based composite fillings that he never gave to CMAP patients. In addition to agreeing to pay $55,000 to resolve those allegations, DeRienzo has entered a separate agreement with DSS in which he is permanently barred from participating as a dentist in the CMAP, according to Jepsen.

Reached at his practice Monday, DeRienzo denied any wrongdoing.

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Feds Issue Rules To Protect Seniors Enrolled In Medicare Advantage Plans

UnitedHealthcare’s decision last fall to drop thousands of doctors from its Medicare Advantage plans in Connecticut and across the country has spurred Medicare officials to improve protections for seniors who lose their doctors. The new measures were announced late Monday along with a slight increase in next year’s payment rates to Medicare Advantage insurers who provide policies as an alternative to the traditional government-run Medicare program. Nearly 16 million older Americans have enrolled in a Medicare Advantage plan, including more than 147,000 in Connecticut, which requires members to get treatment only from a network of health care providers. They cannot change plans during the year if their doctor leaves their network. The new rules require insurers to provide at least 90 days advance notice of significant changes in their provider networks and allow members to switch plans under certain circumstances.

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CT Joins $1.2 Billion Settlement With Johnson & Johnson, Janssen

Connecticut will receive more than $10 million in one of the largest pharmaceutical fraud settlements in history, as Johnson & Johnson and its subsidiary, Janssen Pharmaceuticals, Inc., resolve allegations of unlawfully marketing two antipsychotic drugs, including Risperdal, heavily used among nursing-home patients. Johnson & Johnson has agreed to pay a total of $2.2 billion to states and the federal government to end civil and criminal investigations into off-label marketing of Risperdal and Invega, both antipsychotics, as well as the heart drug Natrecor, for uses not approved by the U.S. Food and Drug Administration. The company allegedly paid kickbacks to physicians and pharmacists to promote the drugs for unapproved uses. In documents filed Monday, federal officials said that Johnson & Johnson, through Janssen, marketed Risperdal to doctors for use in elderly dementia patients, even though the drug was approved only for schizophrenia. Connecticut’s rate of antipsychotic use in nursing homes remains in the top 20 nationally, but has dropped in recent years, a recent C-HIT analysis found.

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State Orders Clean-Up Of English Station In New Haven

Two decades after New Haven’s English Station power plant stopped producing energy for United Illuminating, state officials have ordered the owners to conduct a massive clean-up of the property, which is contaminated with hazardous PCBs, or polychlorinated biphenyls. “English Station has been a potential source of pollution to Fair Haven and the waters of the state for too long.  It must be cleaned up by all those responsible for its present condition,’’ said Attorney General George Jepsen, whose office is working with the state Department of Energy and Environmental Protection (DEEP). The administrative order announced Thursday requires that the current and previous owners of the plant make a full investigation of the contamination on, and emanating from, the site; submit a remediation plan for DEEP approval that is in compliance with federal and state laws and regulations; and then remediate the site in accordance with the approved plan. The property, on the Mill River, contains the former electric-generating plant and a warehouse.  The parties named in the order include the current owners, Asnat Realty, LLC of Bayside, N.Y. and Evergreen Power, LLC, of Wilmington, Md., as well as Quinnipiac Energy, LLC; Grant Mackay Demolition; and the United Illuminating Company, which previously owned the site. The plant is shut down, and access to the property has been limited, pending submission of a formal plan to clean up extensive contamination by PCBs, a known carcinogen, as well as heavy metals and other contaminants.

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CT Joins $90 Million Settlement with GlaxoSmithKline

The state will receive $1.6 million as part of a $90 million multi-state settlement with the drug maker GlaxoSmithKline to resolve allegations that the company unlawfully promoted its diabetes drug, Avandia. Thirty-seven other states are participating in the settlement, following claims that GlaxoSmithKline (GSK) engaged in unfair and deceptive practices by misrepresenting Avandia’s potential cardiovascular risks and by promoting the drug to physicians and other healthcare professionals with false and misleading representations about Avandia’s safety profile. The settlement resolves the state’s claim against the company under the Connecticut Unfair Trade Practices Act. Connecticut’s share of the settlement is $1,668,482, of which $100,000 will be allocated to the Department of Consumer Protection to support the Prescription Drug Monitoring Program and the agency’s Consumer Fund. Another $100,000 will go to the Attorney General’s Consumer Fund.

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