Mo. physician, practice settle Medicare fraud allegations for $300K | Mo. woman gets 30-year term for prescription fraud | Neb. woman arrested on allegations of Medicaid fraud
May 23, 2017
NHCAA SmartBrief
Top Story
Mo. physician, practice settle Medicare fraud allegations for $300K
Sherry Ma, a Ladue, Mo.-based physician, and her employer, Aima Neurology, have agreed to pay $291,288 as part of a civil settlement to resolve accusations of fraudulently billing the Medicare program. Ma was accused of submitting false Medicare claims for new vials of Botox and Myobloc when she actually used unfinished vials obtained at no cost for procedures on privately insured patients, authorities say.
The Business Journals (tiered subscription model)/St. Louis (5/22) 
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Law Enforcement & The Courts
Mo. woman gets 30-year term for prescription fraud
Anne Marie Coke of Marshall, Mo., was sentenced to 30 years in prison after pleading guilty to 36 felony charges, including 33 counts of fraudulently attempting to obtain a controlled substance. Coke, who entered a plea deal in return for 109 other charges being dropped, stole pre-signed prescription forms from the dental office where she worked and filled out fraudulent oxycodone prescriptions for herself and others, according to testimony.
Marshall Democrat-News (Mo.) (5/22) 
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Neb. woman arrested on allegations of Medicaid fraud
Tammy Bolles, a personal assistant services provider from Lincoln, Neb., was arrested and charged with theft by unlawful taking in an alleged Medicaid fraud. According to a court document, Bolles was overpaid $9,596.32 by Nebraska Medical Assistance after falsely claiming that she spent over 400 hours with two patients over a two-year period while she was actually working at a department store.
Lincoln Journal Star (Neb.) (tiered subscription model) (5/22),  KTIV-TV (Sioux City, Iowa)/The Associated Press (5/22) 
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Woman suspected of TennCare fraud by doctor shopping
Shana Clay, a resident of Chattanooga, Tenn., was charged with three counts of TennCare fraud by doctor shopping. Clay is accused of visiting multiple physicians and using her TennCare benefits to obtain prescriptions of hydrocodone and Tramadol, authorities say.
The Chattanoogan (Tenn.) (5/22) 
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Policy & Regulatory News
Trump's proposed budget to include Medicaid cuts, SNAP changes
President Donald Trump's budget plan, to be unveiled Tuesday, reportedly will include major cuts to Medicaid and changes to the Supplemental Nutrition Assistance Program, among others. The administration will also call to allow states more flexibility in setting work requirements for anti-poverty programs.
The Washington Post (tiered subscription model) (5/21) 
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Senate Republicans continue work on ACA replacement
Senate Republicans continue to work on legislation dismantling the Affordable Care Act despite unified Democratic opposition to repeal. Proposals include changing the law's tax credits, relaxing coverage rules and cutting funds for Medicaid expansion.
ABC News/The Associated Press (5/22) 
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Tools & Technology
Report: Government initiatives to drive global EHR market growth
The worldwide electronic health record market is expected to hit $33.41 billion by 2025, driven by government initiatives in multiple countries that support EHR adoption, according to a Research and Markets report. Among the key players in the market are Allscripts, Cerner, Epic Systems, GE Healthcare and McKesson.
Becker's Hospital Review (5/19) 
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HHS releases 3rd update for health care cybersecurity guidance
HHS' third update of its "International Cyber Threat to Healthcare Organizations" guidance details how health IT personnel can receive intelligence from InfraGard, an FBI-affiliated nonprofit group, and contains links to other resources on cybersecurity. The guidance also reiterates how health care organizations can obtain a scan of their public IP address from the National Cybersecurity Assessment & Technical Services.
Becker's Hospital Review (5/17) 
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Medical News
CDC reports increasing diarrhea outbreaks from US swimming pools
The number of diarrhea outbreaks related to cryptosporidium in US swimming pools rose from 16 in 2014 to at least 32 in 2016, CDC researchers reported in the agency's Morbidity and Mortality Weekly Report. The CDC urged parents to restrict swimming for children with diarrhea and discourage swallowing of pool water, while patients with cryptosporidiosis should not swim until two weeks after being diarrhea-free.
TIME online (5/19),  Reuters (5/18) 
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Study: Overweight boys have higher colon cancer risk in adulthood
Boys who were overweight at age 7 and in young adulthood were two times more likely to develop colon cancer as adults than those who weren't overweight, Danish researchers reported at the European Congress on Obesity. However, the findings, based on data involving more than 61,000 Danish males born from 1939 to 1959 followed for 25 years on average, showed no higher colon cancer risk among those who were overweight as children but were a normal weight in young adulthood.
The Indian Express online (India)/Indo-Asian News Service (5/20),  HealthDay News (5/19) 
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Complimentary webinar hosted by SAS
On June 13 at 2 p.m. ET, join NHCAA Platinum Supporting Member SAS for its complimentary webinar, Using Analytics to Drive Payment Integrity and Reduce Fraud. The session will look at a payment integrity approach that delivers results, sharing case studies to show how you can use analytics to create measurable financial impact for both government and commercial payers and providers. Attendees will earn 1 CPE.
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Excellence in SIU Leadership
Join NHCAA July 18-19 in Baltimore for the inaugural Excellence in SIU Leadership Program. Sponsored by General Dynamics Health Solutions, the Excellence in SIU Leadership Program will be a highly interactive program providing dynamic sessions to enable participates to become rising stars in their special investigations unit. Register today!
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