It’s Time To Stop Segregating Reproductive Rights

Now is the time to repeal a 40-year-old law that perpetuates inequality among women. The Hyde Amendment, which bans the use of federal funds to pay for abortions except in certain circumstances, is unfair. The amendment targets women who rely on Medicaid for their health care coverage. According to the federal Centers for Medicare and Medicaid Services, roughly two out of three adult women enrolled in Medicaid are between the ages of 19 and 44—the reproductive years. Abortions can run upward of $1,000, which places the (legal) procedure out of reach for most women living in poverty.

As Smoking Rates Drop, Medicaid Recipients Twice As Likely To Smoke

People who are uninsured or on Medicaid are more than twice as likely to smoke tobacco compared to those covered by other insurance, according to a national study by the Centers for Disease Control and Prevention. About 28 percent of uninsured adults and 29 percent of adults on Medicaid smoke nationwide, according to the Centers for Disease Control and Prevention (CDC), compared with just 13 percent of adults on private insurance plans and 12.5 percent on Medicare. The CDC, which examined data from the 2014 National Health Interview Survey, published the findings in November. The CDC found that cigarette-smoking rates were higher among people who live below the poverty level (26.3 percent) and people with a GED certificate (40 percent). Overall, the prevalence of cigarette smoking among adults declined from 20.9 percent to 16.8 percent from 2005 to 2014, according to the CDC.

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.

Access Health Enrollment Starts Sunday; Uninsured To Face Steeper Fines

Open enrollment for consumers to buy health insurance through the Access Health CT marketplace begins Sunday, and 2016 will bring considerably steeper fines for consumers who lack insurance. Access Health CT (AHCT), now in its third year, enrolled close to 100,000 individuals in private insurance plans in its first two years, according to Andrea Ravitz, director of marketing. About 500,000 enrolled in Medicaid through AHCT, during the first two years. The marketplace aims to enroll between 105,000 and 115,000 in private plans by the end of open enrollment, Ravitz said. AHCT concentrated on attracting new enrollees its first two years but this year it has been focusing on retaining enrollees, she added.

Podiatrist Pleads Guilty To Submitting False Medicare Claims

A Stamford-based podiatrist faces hefty fines and prison time after she pleaded guilty this week to submitting fraudulent Medicare claims.

Amira Mantoura pleaded guilty Monday in Hartford federal court to one count of making a false statement to Medicare after she billed the government program for foot surgeries when she merely clipped patients’ toenails, according to Deirdre M. Daly, U.S. Attorney for the District of Connecticut. Mantoura, 53, lives in Greenwich and has a practice at 95 Morgan St., Stamford. In her guilty plea, she admitted that she submitted false claims to not only Medicare, but Medicaid and private insurance companies as well, Daly said. Reached by phone at her practice Tuesday, Mantoura declined to comment. According to court documents, between January 2009 and August 2013, Mantoura “knowingly submitted materially false claims” seeking payment for nail avulsions, which are surgical treatments for ingrown toenails.

Drug Company Tied To Connecticut Nurse Settles Kickback Case In Oregon

The company alleged to have paid kickbacks to a Derby nurse in exchange for her prescribing of a potent pain medication has agreed to pay $1.1 million to settle a case brought by the state of Oregon, which accused the firm of deceptive marketing and kickback payments involving the same drug. In a notice of unlawful trade practices filed against the Arizona-based drug maker Insys, the Oregon attorney general’s office charged that the company used an “unconscionable tactic by making payments to doctors that you intended to be a kickback to incentivize the doctor to prescribe Subsys.” The attorney general also charged Insys with using “unconscionable, false and deceptive sales tactics” designed to increase the “off-label” use of Subsys, which is approved only to treat breakthrough cancer pain. The case in Oregon comes as Connecticut nurse practitioner Heather Alfonso, formerly with the Comprehensive Pain and Headache Treatment Center in Derby, awaits sentencing on charges she received $83,000 in kickbacks from Insys from 2013 to 2015. In pleading guilty, Alfonso, 42, admitted that the money she was paid for attending “dinner programs” as a speaker — many of them sham dinners, with just an Insys sales representative or her friends or co-workers — influenced her prescribing of the drug, according to the U.S. Attorney’s Office for Connecticut. The charge of receipt of kickbacks in relation to a federal healthcare program carries a maximum term of imprisonment of five years and a fine of up to $250,000.

Derby Pain Clinic Terminated From Medicaid Program

The state has barred practitioners at a Derby pain clinic, including a high-prescribing nurse, from participating in the Medicaid program because of improprieties in treatment and oversight. Documents from the Department of Social Services (DSS) show the physician heading the clinic, Dr. Mark Thimineur, and four nurses and assistants were notified in July that their participation in the Connecticut Medical Assistance Program, which includes Medicaid, is being terminated on Aug. 30. Those terminations came after Heather Alfonso, an advanced practice registered nurse (APRN) at the privately run Comprehensive Pain & Headache Treatment Centers, was removed from the Medicaid program in May, DSS officials said. Alfonso was identified in a February story by C-HIT as among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 — Schedule II drugs, which have a high potential for addiction and abuse.