Pfizer settles false claims accusations for $23.85M | Texas fitness trainer convicted in $3.9M-plus health care fraud | Conn. social services agency exec sentenced in $1.6M Medicaid fraud
May 25, 2018
NHCAA SmartBrief
Top Story
Pfizer settles false claims accusations for $23.85M
Pfizer entered into a $23.85 million settlement deal to resolve accusations that it violated the False Claims Act by improperly using a foundation as a conduit to cover copayments of patients taking three of the firm's prescription kidney cancer and heart drugs. Authorities said the scheme, which ran between 2012 and 2016, allowed Pfizer to increase its revenue and raise drug prices.
Reuters (5/24) 
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Law Enforcement & The Courts
Texas fitness trainer convicted in $3.9M-plus health care fraud
David Williams, a fitness trainer from Fort Worth, Texas, and owner of Kinesiology Specialists, could face up to 40 years in prison after being convicted of four counts of health care fraud. Trial evidence showed Williams, who provided fitness and exercise training services, falsely certified himself as a health care provider and improperly billed private insurers for medical services, allowing him to collect more than $3.9 million worth of improper payments from November 2012 to August 2017.
Department of Justice (5/24) 
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Conn. social services agency exec sentenced in $1.6M Medicaid fraud
Maurice Sharpe, co-founder and manager of Torrington, Conn.-based social services agency Family First Community Support Services, was ordered to serve five years of probation and pay $211,131 in restitution after pleading guilty to health care fraud for his role in a Medicaid fraud scheme. Sharpe admitted to fraudulently billing Medicaid for unprovided psychotherapy services or services rendered by unlicensed individuals using the Medicaid provider number of a licensed social worker, which resulted in about $1.6 million worth of improper payments from Medicaid.
The Register Citizen (Torrington, Conn.) (5/24) 
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Doctor, ambulance firm execs suspended from Calif. workers' comp system
Mauran Ambulance Service co-owner Toros Yeranosian and the company's manager, Aharon Krkasharyan, both California residents who were convicted of conspiracy to commit health care fraud last year over their involvement in a $1 million-plus Medicare fraud scheme, were recently suspended from participating in California's workers' compensation program. The California Division of Workers' Compensation also suspended Los Angeles-based doctor Ronald Grusd from participating in the program after being convicted last year for his role in a $20 million-plus kickback and fraud scheme.
Insurance Journal (5/24) 
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Policy & Regulatory News
Tools & Technology
Scientists create bacteria-on-a-chip device for diagnosis of GI problems
An ingestible device bearing genetically modified bacteria may one day enable diagnosis of gastrointestinal problems by converting the bacterial response to the human gut into a smartphone-readable wireless signal. The "bacteria-on-a-chip" technology was tested in mice and pigs, and it was found to correctly detect the presence of blood in the stomach, researchers reported in the journal Science.
Xinhua News Agency (China) (5/25),  Wired (tiered subscription model) (5/24) 
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Mauna Kea's Cellvizio cleared by FDA for neurosurgical use
Mauna Kea Technologies has secured 510(k) clearance from the FDA for its laser endomicroscope Cellvizio 100 series F400 and F800 with the CranioFlex, a new Confocal Miniprobe, for use in neurosurgery.
Seeking Alpha (5/24) 
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Medical News
Register for the 2018 Rising Trends conference
NHCAA's Rising Trends program, scheduled June 19-21 in Baltimore, consists of three one-day programs on trending issues in health care: Outpatient Facility Fraud, Examining Emerging Trends, and Abusive Pharmaceutical Practices. Travel to one location and participate in three unique, intense training programs. Registration is open!
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2018 Annual Training Conference goes to California in October
Join your colleagues at NHCAA's Annual Training Conference. This year's program once again features unique sessions addressing key areas of focus for SIU teams. ATC provides expanded programming that is unmatched. There is truly something for everyone at the ATC.
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