Texas pharmacy chain settles improper billing allegations for almost $64M | Miss. regional health center pays $6.93M to resolve fraud accusations | Ohio doctor sentenced to prison for Medicaid fraud, drug trafficking
December 15, 2017
NHCAA SmartBrief
Top Story
Texas pharmacy chain settles improper billing allegations for almost $64M
DaVita Rx, a pharmacy chain based in Coppell, Texas, agreed to a nearly $64 million settlement deal to resolve allegations that it improperly billed federal health care programs for unprovided prescription drugs. Prosecutors said the payment also settles accusations that the company paid illegal kickbacks or offered unwarranted discounts to program beneficiaries.
The Dallas Morning News (tiered subscription model) (12/14) 
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Law Enforcement & The Courts
Miss. regional health center pays $6.93M to resolve fraud accusations
Mississippi-based Region 8 Mental Health Services, a community health center covering several counties in the state, reached a settlement deal worth over $6.93 million with the federal government resolving accusations that it violated the False Claims Act by submitting fraudulent claims from 2004 to 2010 for day treatment services that were not provided or were rendered by unqualified employees. The settlement is thought to be the biggest health care False Claims Act settlement in the state's history, according to the US attorney's office.
The Daily Leader (Brookhaven, Miss.) (12/14) 
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Ohio doctor sentenced to prison for Medicaid fraud, drug trafficking
Robert Reeves, a doctor from Norwalk, Ohio, received a 47-month prison term and was ordered to pay $69,078 in restitution and $5,000 in fines after pleading guilty to charges of Medicaid fraud, drug trafficking and illegal processing of drug documents. Reeves, who agreed to surrender his medical license as part of his plea deal, distributed scheduled II and III drugs between December 2014 and May 2016 without performing medical examinations, according to prosecutors.
Norwalk Reflector (Ohio) (12/14) 
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Ex-administrator accused of stealing from Mo. ambulance district
William Gum, former administrator of the Washington County Ambulance District in eastern Missouri, and his wife, Charlena Gum, a former employee of the district, are each facing multiple charges on allegations that they stole thousands of dollars from the district's fund. Authorities say William Gum gave himself a higher salary than the board of directors authorized from 2012 to 2016 and used the district's money to pay for his dependents' health insurance without proper approval, while Charlena Gum allegedly used the district's credit cards to buy personal items.
U.S. News & World Report/The Associated Press (12/14) 
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Policy & Regulatory News
Tools & Technology
Free tool can help health plans, providers assess population health
HHS issued a tool in 2000 for assessing quality of life in patient populations, and though the tool is freely available, it is seldom used, David Nash writes. Humana used the Healthy Days survey tool to measure progress toward its goal of improving health in the communities it serves by 20% by 2020, and the tool showed the company achieved a decrease in the number of unhealthy days among members, Nash notes.
MedPage Today (free registration) (12/11) 
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Report shows medical identity theft trends across US
The World Privacy Forum's "The Geography of Medical Identity Theft" report showed that the high number of medical identity theft complaints in states such as California, Texas, Florida and New York could be due to higher populations there. The report also found trends of aggressive debt collection and a regional medical identity theft hotspot including a number of Southeastern states.
Becker's Hospital Review (12/13) 
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Health Insurance Industry News
Federal exchange enrollment hits nearly 4.7M in 6 weeks
The CMS announced that 4.68 million people chose Affordable Care Act plans through the federal exchange in the first six weeks of open enrollment this year, with over 1 million Americans signing up in the week ending Dec. 9, up from 823,000 in the previous week. Open enrollment ends Dec. 15 for most states, and overall signups are expected to fall short of last year's total HealthCare.gov enrollment of 9.2 million due to the shorter enrollment period.
Reuters (12/13),  Modern Healthcare (tiered subscription model) (12/13),  The Hill (12/13) 
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Medical News
Health care anti-fraud reference materials available
Visit NHCAA's Amazon Bookstore and enjoy the benefits and ease of Amazon while shopping for reference materials related to health care fraud investigations and SIUs. We stock coding books, medical dictionaries and books written by former ATC keynote faculty.
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Need to report suspected health care fraud?
The US spends over $2.7 trillion on health care every year. Of that amount, NHCAA estimates that tens of billions of dollars are lost to health care fraud. This directly impacts patients, taxpayers and government through higher health care costs, insurance premiums and taxes and can cause patient harm. Learn about the resources available to report fraud.
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