Walgreens settles case of prescription drug overcharging for $5.5M | Conn. counseling business owner sentenced in Medicaid fraud case | Former Steelers physician gets 10 years in illegal drug distribution case
March 21, 2018
NHCAA SmartBrief
Top Story
Walgreens settles case of prescription drug overcharging for $5.5M
Pharmacy chain Walgreens has agreed to pay $5.5 million to settle allegations pharmacies in New Bedford, Springfield and Worcester, Mass., as well as Boston, overcharged employees for prescription drugs covered by the state workers' compensation insurance system, state Attorney General Maura Healey says. The overcharging allegedly happened from 2008 to 2017, but Walgreens has not admitted wrongdoing.
The Republican (Springfield, Mass.) (3/20) 
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Authenticate and verify the accuracy of enrollment data
Member, Provider, or Broker fraud? The solution: LexisNexis® InstantID® for Healthcare. Our unique approach to data and identity analytics provides significantly more insight into enrollees by going well beyond the basic review process to verify and correct layers of information. Learn more.
Law Enforcement & The Courts
Conn. counseling business owner sentenced in Medicaid fraud case
Andrea Prenez, owner of Sweet Counseling Services in Thomaston, Conn., received a 10-year prison term suspended after 67 months plus three years of probation and was ordered to pay $661,000 in restitution to Medicaid after pleading guilty to identity theft and larceny by defrauding a public community. Prenez admitted to using the identity and credentials of a relative to submit over $661,000 worth of fraudulent claims to Medicaid for unprovided services or services she could not legally render.
Patch (3/20) 
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Former Steelers physician gets 10 years in illegal drug distribution case
Richard Rydze, owner of Optimal Health Center in Pittsburgh and a former physician for the Pittsburgh Steelers, received a 10-year prison term and was ordered to pay $50,690 in restitution and special assessments after being convicted of 180 counts, including charges of illegal distribution of controlled substances, human growth hormones and anabolic steroids. Authorities say Rydze prescribed anabolic steroids for unauthorized uses and conspired with others to illegally distribute opioid drugs including Vicodin and oxycodone, among other offenses.
Patch (3/20) 
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Va. psychiatrist accused of health fraud, illegal drug distribution
Alfredo Cervantes, a psychiatrist from Abingdon, Va., was indicted on charges of health care fraud, unlawfully distributing a Schedule IV controlled substance, and wire fraud. Cervantes is accused of improperly prescribed controlled substances to a patient with whom he had personal relations and caused Virginia Medicaid and other insurers to reimburse claims for unnecessary prescription drugs and psychotherapy treatments, the indictment says.
Bristol Herald Courier (Va.) (3/20) 
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Policy & Regulatory News
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Tools & Technology
Deep neural network, EHR data-based risk model predict CV mortality
A study presented at the American College of Cardiology annual conference showed that applying deep neural networks and natural language learning to a mortality risk model that quantifies frailty by using EHR data resulted in higher accuracy levels in predicting mortality after major cardiac procedures, compared with modern support vector machine models. Researchers used a cohort of 21,355 US veterans whose first major cardiac surgery was in 2014.
Cardiovascular Business online (3/16) 
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Study shows positive results for Medtronic's cryoballoon
A study presented at the European Heart Rhythm Association's annual meeting showed use of Medtronic's Arctic Front Advance cryoballoon for treating atrial fibrillation demonstrated a 60.7% rate of freedom from atrial arrhythmias of at least 30 seconds, meeting the primary outcome of single-procedure success at one year. The device also showed a procedure-related complication rate of 4% for the 130-patient trial's secondary outcome, acute procedural success.
MassDevice (Boston) (3/19) 
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Medical News
Complimentary webinar hosted by SAS
On Wednesday, April 4, at 2 p.m. ET, please join NHCAA Platinum Supporting Member SAS for their complimentary webinar: Operationalize Analytics to Improve Health Care Costs and Performance. Participants will learn to manage and transform vast amounts of data into a repository for reporting and analysis, quickly find patterns of abnormalities in claims and behavior of payers, patients and providers, govern workflow from alert to investigation to resolution using intelligent case management, implement and manage new pay-for-performance service delivery models, and improve Medicaid programmatic performance and costs. Register today!
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Complimentary webinar -- 2018 Algorithms
Join Truven Health Analytics, now a part of IBM Watson Health, on Tuesday, March 27, at 2 p.m. ET as its expert analysts reveal this year's set of key fraud-fighting algorithms that have yielded excellent results for its customers over the past year. In addition, experts will introduce some useful new ideas for algorithms and the latest trends in aberrant billing practices and suspicious recipient behavior. Register today.
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