Mylan agrees to pay $465M to settle EpiPen misclassification claims | Owner of Texas home health clinics gets 40 years in $17.2M fraud scheme | Owner of Ill. podiatry practice sentenced to 7 years for Medicare fraud
August 18, 2017
NHCAA SmartBrief
Top Story
Mylan agrees to pay $465M to settle EpiPen misclassification claims
Mylan agrees to pay $465M to settle EpiPen misclassification claims
(Joe Raedle/Getty Images)
EpiPen maker Mylan agreed to pay $465 million as part of a final settlement deal with the Justice Department, resolving claims that the firm overcharged the US government by misclassifying the epinephrine auto-injector as a generic product under Medicaid's Drug Rebate Program while it was being marketed and priced as a branded treatment. The settlement, which requires Mylan to reclassify EpiPen and pay rebates applicable to its new classification effective April 1, was criticized by several lawmakers who believe the settlement is too low.
Reuters (8/17),  The Hill (8/17) 
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Law Enforcement & The Courts
Owner of Texas home health clinics gets 40 years in $17.2M fraud scheme
Godwin Oriakhi, owner and operator of five home health care clinics in Houston, received a 40-year prison term for his involvement in a $17.2 million scheme to defraud Medicare and Medicaid. Oriakhi pleaded guilty earlier this year to charges including conspiracy to commit healthcare fraud on allegations that he and co-conspirators submitted $17.2 million worth of false claims for unprovided or unnecessary services from 2009 to 2016, receiving almost $16.2 million in reimbursements.
Houston Chronicle (tiered subscription model) (8/17) 
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Owner of Ill. podiatry practice sentenced to 7 years for Medicare fraud
Yev Gray, a podiatrist and owner of Aggeus Healthcare in Chicago, received a prison sentence of more than seven years and was ordered to pay restitution of almost $7 million after pleading guilty to health care fraud charges. Gray was accused of falsifying patient records and pressuring physicians in his practice to provide unnecessary services, allowing the company to collect millions of dollars in fraudulent Medicare claims, prosecutors say.
KTVI-TV (St. Louis)/The Associated Press (8/16) 
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N.J. doctor faces health care fraud charges
Subramaniam Khanthan, a pain management doctor with several practices in New Jersey, was charged with three counts of health care claims fraud by the state Attorney General's office on allegations of submitting fraudulent claims to an insurer from May 22 to July 17, officials announced. According to the complaint, the claims submitted by Khanthan contained false, fictitious, misleading or fraudulent statements concerning the treatment or evaluation of patients.
The Jersey Journal (Jersey City, N.J.) (8/18) 
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Policy & Regulatory News
Tools & Technology
Study: Telemedicine may lead to more office visits
Study: Telemedicine may lead to more office visits
(Carsten Koall/Getty Images)
Researchers from the University of Wisconsin found a 6% increase in office visits among providers that have adopted electronic visit programs because many doctors feel the need to see telemedicine patients in person, causing them to spend an additional 45 minutes on those visits. The study, based on health care encounters between 90 providers and more than 140,000 patients over five years, said e-visit programs also reduced the number of new patients seen by providers each month by 15% and did not contribute any "observable improvement in patient health" between users and nonusers.
Healthcare IT News (8/16) 
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Many providers can open 3 or more EHR records at once, study finds
A study in the Journal of the American Medical Informatics Association showed that 44.3% of inpatient and outpatient facilities have EHR systems that allow providers to open three or more patient records at a time, while 38.3% allow only one record to be open at a time and 17.4% allow two records to be open. Researchers suggested that hospitals may reduce the risk of documentation errors by limiting the number of patient records that providers can open at once.
Becker's Hospital Review (8/15) 
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Medical News
Complimentary webinar hosted by Truven Health Analytics
On Wednesday, Sept. 20, at 2 p.m. ET, please join NHCAA Platinum Supporting Member Truven Health Analytics for its complimentary webinar: Ensuring Program Integrity in a Managed Care Environment -- Insights from Iowa Medicaid Enterprise. In this webinar, experts will share their insights on efforts to ensure program integrity in their state, including best practices on encounter data validation work, navigating managed care contractual provisions, eligibility analysis and analytics to turn identified fraud, waste and abuse into actual recoveries.
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NHCAA Webinar: Internet Search Strategies for Effective Investigations
Join NHCAA on Wednesday, Aug. 30, to learn how to appraise a website to efficiently ascertain if useful information is present. Attendees will be trained to properly review government, medical, association, and social media websites that can be effective for investigations. Finally, this webinar demonstrates how internet information can be incorporated into a case and presented to internal and external stakeholders through case studies. Register today!
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