Fla. hospice providers resolve Medicare fraud accusations for $2.5M | N.Y. podiatrist gets probation in Medicare fraud case | W.Va. man sentenced for defrauding VHA
May 21, 2018
NHCAA SmartBrief
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Fla. hospice providers resolve Medicare fraud accusations for $2.5M
Florida-based Hospice of the Treasure Coast, Health and Palliative Services of the Treasure Coast, and the Hospice of Martin and St. Lucie entered into a $2.5 million settlement deal to resolve allegations of defrauding Medicare and violating the False Claims Act. Court records show the organizations deliberately submitted or caused the submission of fraudulent Medicare claims from 2005 to 2011 for services rendered to patients who were not eligible to receive full or partial hospice care under Medicare rules.
Department of Justice (5/18) 
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Law Enforcement & The Courts
N.Y. podiatrist gets probation in Medicare fraud case
Perrin Edwards, a podiatrist from Columbia County, N.Y., was ordered to serve one year of probation and pay a fine of $5,000 after pleading guilty to health care fraud. Edwards admitted to improperly billing Medicare and private insurers for unprovided services or services he knew the insurance programs would not cover.
Times Union (Albany, N.Y.) (tiered subscription model) (5/18) 
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W.Va. man sentenced for defrauding VHA
Kenneth Boyles, a member of the US Army Reserve from Clarksburg, W.Va., received a six-month prison term and was ordered to pay $244,320.07 in restitution after pleading guilty to health care fraud earlier this year. Boyles admitted that he falsely reported symptoms and improperly collected benefits worth over $224,000 from the Veterans Health Administration from 2008 to 2017.
WAJR-AM/FM (Morgantown-Clarksburg, W.Va.) (5/19) 
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Calif. doctors resolve Controlled Substances Act violations for $260K
California-based physicians William Longton, Richard Shinaman and Ruben Kalra, who operate under the name Pain Medicine Consultants, collectively agreed to a $260,000 settlement deal to resolve allegations that they violated certain provisions of the Controlled Substances Act. A Drug Enforcement Administration inspection showed the doctors did not maintain sufficient records involving the receipt and distribution of controlled substances at their three California offices from Jan. 10, 2012, to Jan. 17, 2014, among other offenses.
Department of Justice (5/18) 
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Policy & Regulatory News
Tools & Technology
Nuance among health groups reporting data breaches since Dec.
Recent data breaches in the health care sector include a third party gaining unauthorized access in December to a medical transcription platform at Nuance, a speech recognition software provider in Burlington, Mass., which compromised the information of 45,000 patients. In addition, 15,552 individuals could have had their information exposed after a possible email account breach at Ohio-based USACS Management Group on March 9, and 3,453 patients at Arkansas Health Group may be affected after their information was exposed on a cloud-based file-sharing website.
Health IT Security (5/17) 
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Diabetes patients may benefit from digital health coaching programs
Researchers used a cohort of 756 adults with type 2 diabetes and found that receiving three text messages, an email message and a 10- to 15-minute phone call weekly for three months led to an A1C reduction from 8.4% to 7.4% and an average weight loss of 4.9 pounds, with similar results at 12 months. The findings, presented at the American Association of Clinical Endocrinologists annual meeting, showed that the digital health coaching program also resulted in an increased number of patients receiving eye and annual foot exams.
Healio (free registration)/Endocrine Today (5/18) 
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Medical News
Complimentary webinar hosted by LexisNexis
Join us on Wednesday, May 23, for a complimentary webinar titled "Understanding the Strengths and Risks to Payers for Electronic Visit Verification and Home and Community-based Services" sponsored by NHCAA Platinum Supporting Member, LexisNexis. Participants will learn how to identify overall plan exposure to schemes, detection methods to identify schemes and relationships between providers and patients, as well as methods to develop ratios of authorized to billed timeframes. Register today!
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Network with peers and fraud-fighting colleagues at ATC
Investigators, private sector decision-makers, law enforcement and others representing the anti-fraud community will converge at the NHCAA Annual Training Conference in Anaheim, Calif. Exchange ideas, form new business connections and renew old acquaintances during the multiple networking opportunities.
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