DOJ sues owners of Ill. home health care firm for Medicare fraud | N.J. physician admits to defrauding Medicare, private insurers | Owner of Chicago health firm accused of defrauding Medicaid
October 18, 2017
NHCAA SmartBrief
Top Story
DOJ sues owners of Ill. home health care firm for Medicare fraud
A civil lawsuit has been filed by the Department of Justice against Ajibola Ayeni and Joy Turner-Ayeni, owners of Gateway Health Systems in Matteson, Ill., over allegations that they violated the False Claims Act by falsely billing Medicare for millions worth of unprovided or medically unnecessary home health care services. The lawsuit also alleges that another firm owned by Ayeni, called Docs at the Door, falsely certified non-homebound patients for unnecessary home health services and fraudulently upcoded doctor home visits to receive higher Medicare reimbursements.
Chicago Tribune (tiered subscription model) (10/17) 
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Are you ready for machine learning?
With the advent of big data, the amount of data and our ability to process it has increased exponentially. It's an environment perfectly suited for machine learning. So how can you make it part of your analytic infrastructure? This e-book highlights the capabilities of machine learning, and best practices you can implement to take full advantage of it. Download Here.
Law Enforcement & The Courts
N.J. physician admits to defrauding Medicare, private insurers
Anthony Enrico, a physician with practices in Paterson and Passaic, N.J., is facing up to 10 years in prison and $6 million in fines after pleading guilty to health care fraud for submitting $3 million worth of false claims to Medicare and private insurers. Enrico, who must also pay $3 million in restitution as part of his plea deal, admitted that he falsely billed Medicare and other insurance providers for more than 150,000 physical therapy services performed by unlicensed and unqualified employees.
Patch (10/17) 
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Owner of Chicago health firm accused of defrauding Medicaid
Chicago resident Santila Terry, owner of Special Therapy Care Chartered in the city's Southwest Side, is facing Medicaid fraud charges over allegations that she improperly billed the program more than $909,000 for children's speech therapy services she did not provide. Terry allegedly used the personal information and Medicaid provider identification number of a former employee to execute the billing scheme from the time the employee left in September 2011 to November 2014, according to the indictment.
Daily Southtown (Tinley Park, Ill.) (10/17) 
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Nev. health business owner sentenced for improperly billing Medicaid
Shawnnyce Dawson, owner of Sankofa Behavioral Health Agency in Las Vegas, Nev., received a suspended prison term of 12 to 48 months and was ordered to pay restitution of $50,324 on allegations that she defrauded Medicaid. Authorities said Dawson used fictitious documents to substantiate fraudulent Medicaid claims for services she didn't provide from January 2013 to March 2015.
KXNT-AM/KXNT-FM (Las Vegas) (10/17) 
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Policy & Regulatory News
Tools & Technology
AMA, partners to develop integrated platform for big data analytics
The Integrated Health Model Initiative is an integrated platform for clinical informatics and big data analytics being developed by the American Medical Association and its partners, including the American Medical Informatics Association, IBM and Cerner, and is designed to offer a collaborative approach for better population health management and chronic disease care. The platform, which will use existing data standards and will be developed and launched next year, will help the health care system in the collection, exchange and organization of patient-centered data.
Health IT Analytics (10/16) 
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Proclaim DRG neurostimulator system debuted by Abbott
The Proclaim dorsal root ganglion neurostimulator system has been launched by Abbott for use in alleviating pain in patients who have complex regional pain syndrome of the lower limbs. The system, which is magnetic resonance-conditional and recharge free, is intended to be used with an Apple iPod touch as a system controller via Bluetooth connectivity.
MassDevice (Boston) (10/16) 
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Medical News
Complimentary webinar hosted by SCIO Health Analytics
On Friday, Oct. 20, at 1 p.m. ET, please join NHCAA Premier Supporting Member SCIO Health Analytics for its complimentary webinar, "Balancing Act: Promoting Home Health Services While Reducing Overpayments." During this educational webinar, experts will share their thoughts and discuss best practices related to Optimizing Home Health: Identifying policy gaps; Patient-Focus: Defining "homebound" and medical necessity reviews; Provider-Focus: Role of fraud-like SIU audits; and Future State: Trends you need to be aware of. Register today!
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Network with peers and colleagues at ATC in Orlando
Investigators, private sector decision-makers, law enforcement and others representing the anti-fraud community will converge at the NHCAA Annual Training Conference in Orlando. Exchange ideas, form new business connections and renew old acquaintances during the multiple networking opportunities.
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