DAILY UPDATE: Express Scripts & CVS, HHS and the Roaring Stock Markets

Posted on June 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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Express Scripts and CVS, which owns Caremark, are suing Arkansas after it instituted a law banning vertical integration between pharmacies and PBMs

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🟢 What’s up

  • Circle Internet Group, the stablecoin issuer, followed up its epic IPO day on Thursday with another banger, soaring 29.80%.
  • Coreweave closed out a roller coaster week with a 3.78% gain. The recently public AI cloud computing company is up 158% in the past month, and its tie-up with Applied Digital boosted that stock by another 8.54% today.
  • Rocket Lab (+9.34%) was one of several SpaceX competitors to receive a small boost following Elon Musk’s blowup with President Trump, which could threaten SpaceX’s contracts with the government.
  • Omada continued the strong run of recent IPOs. The virtual chronic care company jumped 21.05% in its debut on the Nasdaq today.

What’s down

  • Lululemon plunged 19.80% after cutting its full-year guidance due to the “dynamic macroenvironment” (CEO-speak for tariff uncertainty and people opting for baggier clothes than yoga pants). The company said it will increase prices on some items to offset the tariffs.
  • Docusign tanked 18.97% after warning that its billings for the year would come in lower than estimates as it transitions to an AI-driven model.
  • Broadcom failed to live up to exceedingly lofty expectations for its Q3 revenue forecast, causing shares of the giant semiconductor supplier to dip 5%.

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Stat: $16 billion. That’s how much an HHS watchdog found in health program overspending, fraudulent billing, and possible cost savings in a six-month span. (Axios)

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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FRAUD SCHEMES of [Fewer] Medical Providers

Posted on October 15, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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  1. Billing for services not rendered.
  2. Billing for a non-covered service as a covered service.
  3. Misrepresenting dates of service.
  4. Misrepresenting locations of service.
  5. Misrepresenting provider of service.
  6. Waiving of deductibles and/or co-payments.
  7. Incorrect reporting of diagnoses or procedures (includes unbundling).
  8. Overutilization of services.
  9. Corruption (kickbacks and bribery).
  10. False or unnecessary issuance of prescription drugs.

[Source]: Charles Piper; CFE CRT January/February 2013 ACFE

Related: https://medicalexecutivepost.com/2020/10/01/healthcare-fraud-and-abuse-costs-and-cases-rose-in-2019/

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Update: https://medicalexecutivepost.com/2021/04/24/fraudsters-phishing-for-physician-signatures/

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DAILY UPDATE: Mike Bloomberg, Arianna Huffington and Andreessen Horowitz as Stock Markets Tread Lightly

Posted on July 10, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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Most medical students at Johns Hopkins University won’t have to pay tuition anymore thanks to a $1 billion gift from Michael Bloomberg.

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Here’s where the major benchmarks ended:

  • The S&P 500 index®(SPX) rose 4.13 points (0.1%) to 5,576.98; the Dow Jones Industrial Average® ($DJI) fell 52.82 points (0.1%) to 39,291.97; the NASDAQ Composite® ($COMP) climbed 25.55 points (0.1%) to 18,429.9.
  • The 10-year Treasury note yield increased two basis points to 4.29%.
  • The CBOE Volatility Index® (VIX) inched up to 12.49, still near recent lows.

What’s up

  • Tesla rose 3.71%, putting the company squarely in the green year to date as investors continue to celebrate the automaker’s strong delivery numbers.
  • Corning rose yet another 3.76%, extending the glassmaker’s gains as it quickly becomes the new hot AI stock du jour.
  • Kymera Therapeutics shot 23.40% higher after its partner Sanofi gave the go-ahead for further studies of its experimental skin disease treatment.
  • Jumia Technologies soared 29.79% after Benchmark analysts initiated coverage of the African e-commerce company with a “buy” rating.
  • Sony rose 4.46% on the news that it has nothing to do with the merger of Paramount and Skydance as shareholders celebrate dodging a Paramount-shaped bullet.

What’s down

  • Albemarle dropped 8.76% after Baird analysts warned that lower lithium demand will translate to lower profits for the miner in its upcoming second quarter.
  • BP sank 4.80% after management warned of lower-than-expected profits and a writedown of its German refining facility to the tune of up to $2 billion.
  • Helios Technologies fell 10.94% on the news that the CEO of the industrial manufacturer had been placed on paid leave for potentially violating the company’s code of ethics.
  • Helen of Troy plummeted 27.73% after the Hydro Flask maker announced terrible earnings and lowered its fiscal year outlook.
  • UiPath fell 6.90% on the announcement that the software company will cut 10% of its workforce.

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OpenAI’s venture fund and Arianna Huffington’s Thrive Global are jointly funding a new startup that aims to build an AI health coach to promote healthier lifestyles.

Function Health, a health tech company focused on preventive medicine, recently closed a series A round led by Andreessen Horowitz (a16z) Bio + Health along with a slew of celebrity investors.

And … made possible by the American Rescue Plan, the Biden administration is putting $27.5 million toward women’s behavioral health.

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DAILY UPDATE: Walmart, HHS and Geriatrics as Companies and Stock Market Still Rise

Posted on July 4, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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HAPPY JULY FOURTH

The S&P 500 broke above 5,500 yesterday and stayed there for the first time in market history, notching yet another all-time high for the index—its 32nd this year alone. With so much bullishness it’s understandable that investors may be wondering if we’re at the top yet, but chartists suggests gains tend to beget gains. The bulls have too much momentum to stop now—and if/when the FOMC cuts rates later this year, it seems likely that we’ll see more all-time highs in 2024? Any thoughts.

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The Biden administration has awarded $206.3 million of funding to clinician training programs across 42 universities and provider organizations to bolster the nation’s geriatrics care workforce. Programs will be able to integrate geriatrics training into primary care and will work to educate older adults’ families on their care needs. Health and Human Services, in its announcement, noted that primary care providers are a crucial source of care for much of the aging population.

As Walmart shutters its primary care clinics, the retail giant inked a deal to sell its MeMD telehealth business to health tech startup Fabric. Fabric provides a telemedicine platform for a range of customers, including provider groups, with the goal of improving the clinician and patient experience, as well as operational efficiency. The acquisition will expand its provider network, add virtual behavioral health to the company’s services and build on Fabric’s employer and payer solutions.

And…The U.S. Supreme Court has overturned the Chevron deference, stripping power from federal agencies to interpret and enforce regulations. Courts no longer have to defer to reasonable agency interpretations. One healthcare attorney told Fierce Healthcare he predicts the Centers for Medicare & Medicaid Services will be under a microscope from the courts going forward, and there will be more scrutiny towards provider reimbursement cuts, drug pricing regulation and the Inflation Reduction Act.

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Here’s where the major benchmarks ended:

  • The S&P 500 index®(SPX)rose 28.01 points (0.51%) to 5,537.02; the Dow Jones Industrial Average® ($DJI) fell 23.85 points (-0.1%) to 39,308.00; the NASDAQ Composite® ($COMP) gained 159.54 points (0.9%) to 18,188.30.
  • The 10-year Treasury note yield (TNX) dropped seven basis points to 4.36%.
  • The CBOE Volatility Index® (VIX) held steady at 12.09.

What’s up

What’s down

  • First Foundation plummeted 23.81% after the bank announced it will raise $225 million to shore up a balance sheet burdened by commercial real estate loans.
  • Constellation Brands fell 3.76% after the alcoholic beverage maker reported stronger than expected earnings but missed Wall Street’s expectations on revenue.
  • Simulations Plus slid 14.87% after it reported strong third-quarter earnings but announced it’s cutting its dividend.
  • CureVac popped then dropped 6.59% after GSK bought the rights to the smaller pharma company’s Covid-19 and flu vaccines for $1.6 billion.

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DAILY UPDATE: Pitch-Book Health Companies, SCOTUS and the Peaking Stock Markets

Posted on July 3, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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SCOTUS: Two technology company cases involving Texas and Florida laws challenging social-media companies’ content moderation were sent to lower courts. SCOTUS thus effectively granted the companies a victory. The Supreme Court isn’t willing to blow up the internet just yet.

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PitchBook released its analysis of digital health venture capital deals done in the first quarter. The first quarter saw downturns in telehealth and digital therapeutics, but opportunities exist in mental health chatbots and care search platforms.

Amedisys, a large home health provider, plans to divest a number of care centers to an affiliate of VitalCaring Group in advance of its planned merger with UnitedHealth Group later this year.

And … ACOs may soon be able to take a breath of fresh air, as CMS shared that it has no intention of punishing them for a $2 billion urinary catheter fraud scandal that rocked the industry.  

What’s up

  • Tesla rose another 10.06% today, continuing its push higher thanks to quarterly car deliveries that beat Wall Street’s expectations. Rivian Automotive rose 6.82% today after beating projections for their own deliveries as well.
  • Paramount Global rose 5.97% on a report from the New York Times that Barry Diller’s IAC may be exploring an acquisition of the embattled entertainment company. IAC fell just 0.26%.
  • Archer Aviation popped 8.92% after the air taxi manufacturer received a $55 million investment from Stellantis.
  • Oliveda International is up 19.81% today after the olive oil company announced massive quarterly revenue growth at a key subsidiary.

What’s down

  • Chewy fell yet another 2.24% as fallout from Roaring Kitty’s stake in the company continues to rattle investors.
  • Pure Storage plunged 4.15% after UBS analysts downgraded the stock to “sell,” citing its high valuation and overhyped AI potential.
  • Home builders took a beating after Citi analysts downgraded Lennar and D.R. Horton from “neutral” to “sell,” noting the housing market will remain soft in the second half of the year. Lennar dropped 1.61%, and D.R. Horton fell 1.35%.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 33.92 points (0.62%) to 5,509.01; the Dow Jones Industrial Average® ($DJI) climbed 162.33 points (0.41%) to 39,331.85; the NASDAQ Composite® ($COMP) rallied 149.46 points (0.84%) to 18,028.76.
  • The 10-year Treasury note yield (TNX) dipped four basis points to 4.43%.
  • The CBOE Volatility Index® (VIX) dropped to 12.03 after earlier trading at its lowest intraday level since late May.

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SCOTUS: Health policy leaders say patients, providers, and health systems should brace for more uncertainty and less stability in the healthcare system. Even routine government functions such as deciding the rate to pay doctors for treating Medicare beneficiaries could become embroiled in long legal battles that disrupt patient care or strain providers to adapt.

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DAILY UPDATE: Walgreens, Healthcare Fraud and Opioids as Stock Markets Hurt

Posted on June 29, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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In an interview with the Wall Street Journal, CEO Tim Wentworth said the pharmacy chain Walgreens will shutter a significant share of its 8,600 locations in the US. The closures are part of a broader attempt to boost the ailing company, which also includes reducing its stake in the primary care business VillageMD. Wentworth said the company can reassign most employees instead of conducting layoffs. Shares cratered yesterday after Walgreens whiffed on Wall Street’s earnings projections due to weak consumer spending.

And, read how some counties reduced opioid overdose deaths during the pandemic. (Politico)

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What’s up

  • Oliveda International, which makes beauty products from olive oil, rose 38.33% for no apparent reason. Maybe people just really like the feel of extra virgin olive oil on their skin?
  • Infinera popped 16.38% after Nokia announced it would acquire the telecommunications hardware manufacturer for $2.3 billion.
  • Synchrony Financial rose 6.17% after a Baird analyst initiated coverage of the financial services company with an outperform rating.
  • Regional banking stocks rose on the hopes that a good PCE reading means a better chance of the Fed cutting rates soon. Regions Financial rose 3.83%, while Citizens Financial Group rose 3.16%.

What’s down

A late round of selling in the Treasury market sent yields to fresh highs as the day ended so here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) dipped 22.39 points (0.41%) to 5,460.48; the Dow Jones Industrial Average® ($DJI) fell 45.20 points (0.12%) to 39,118.86; the NASDAQ Composite® ($COMP) lost 126.08 points (0.71%) to 17,732.6.
  • The 10-year Treasury note yield climbed nine basis points to 4.38%.
  • The CBOE Volatility Index® (VIX) moved up slightly to 12.43.

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Nearly 200 people have been charged for their roles in various health care fraud schemes across the U.S. that federal authorities say amounted to over $2.7 billion in intended losses, the Justice Department announced. Attorney General Merrick Garland said charges against 193 people, including 76 doctors, nurse practitioners, and other licensed medical professionals in 32 different federal districts. The defendants were charged over a two-week sweep involving numerous law enforcement agencies nationwide, resulting in the seizure of more than “$231 million in cash, luxury vehicles, gold, and other assets,” according to Garland.

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PODCAST: The Principal-Agent Problem in Healthcare!

Posted on August 1, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

By Eric Bricker MD

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Healthcare Fraud and Abuse Costs and Cases Rose in 2019

Posted on October 1, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

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Combating Healthcare Fraud?

Posted on May 3, 2017 by Dr. David Edward Marcinko MBA MEd CMP™

By http://www.MCOL.com

In Healthcare Plans and Accounts

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Connecting Healthcare Fraud Schemes with Fraudsters

Posted on August 14, 2016 by Dr. David Edward Marcinko MBA MEd CMP™

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On the FBI’s Medicare Fraud Strike Forces

Posted on March 20, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

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$6.5 Billion in Cash

Edward Bukstel

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FBI’s Medicare Fraud Strike Forces Strikes $6.5 Billion in Cash.

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Miami based Home Health Agency owner guilty of Medicare fraud,  The Medicare Fraud Strike Force since its inception in March 2007, is now operating in nine cities across the country, has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion.

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 In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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Become a Whistle Blower in the Healthcare Industrial Complex

Posted on May 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Have You Ever Worked in the Medical Profession?

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Tell the Medical Executive-Post about your work conditions, doctors or nurses, management shenanigans, or the politics and your observations of what is happening at your healthcare organization. Gossip, insider information, knowledge, personal opinion, insight or related hearsay – both positive and negative – is sought.

The clinical, financial, legal, insurance, pharma or administrative scenes are all fertile grounds for exposure and transparency. You may remain an anonymous tipster, or we will publish your identity upon request for additional credibility.

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