OIG: 33 Calif. hospitals received over $5M in Medicare overpayments | Ark. care aide, mother deny Medicaid fraud allegations | Okla. physician faces preliminary hearing on Medicaid fraud, pill mill charges
March 22, 2017
NHCAA SmartBrief
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OIG: 33 Calif. hospitals received over $5M in Medicare overpayments
A report from the HHS Office of Inspector General found that Medicare made about $5.3 million in overpayments to 33 hospitals in San Francisco due to inaccurate wage information reported by Alta Bates Medical Center. Alta Bates mistakenly overstated its adjusted hourly wage by $5.78 and failed to report some work hours, salaries and severance payments and misclassified certain salaries, according to the OIG.
Healthcare Finance News (3/21) 
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Legislation requirements to eliminate billing fraud
The 114Th Congress passes the CURES Act directing states to require the use of Electronic Visit Verification (EVV) for personal and home healthcare services. Find out more on state mandated requirements and how healthcare organizations can proactively simplify billing to combat fraud. Click here to learn more.
Law Enforcement & The Courts
Ark. care aide, mother deny Medicaid fraud allegations
Juanita Rowden of Greenbrier, Ark., and her daughter Vonita Herbert of Conway, Ark., a personal care aide employed by Absolute Care Management Corporation, have entered not guilty pleas to charges of Medicaid fraud and abuse of an endangered or impaired person. The defendants are suspected of submitting $2,639.70 worth of Medicaid claims for unprovided care and living assistance services, according to the affidavit.
Log Cabin Democrat (Conway, Ark.) (3/21) 
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Okla. physician faces preliminary hearing on Medicaid fraud, pill mill charges
Harvey Jenkins, a physician in Oklahoma charged with Medicaid fraud and drug-related offenses, appeared in court Monday for a preliminary hearing. Jenkins, operator of Aria Orthopedics, is accused of improperly prescribing narcotics to as many as 90 patients per day, practicing without a license and writing narcotic prescriptions using the identity of another physician, prosecutors say.
KOCO-TV (Oklahoma City) (3/21) 
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Policy & Regulatory News
GOP reworks health care legislation to gain support
Congressional Republicans have made changes to the American Health Care Act in an effort to win more support for the legislation within their own party. The proposed amendments would boost tax credits for older people, end most Affordable Care Act taxes in 2017 rather than 2018, and give states more flexibility on Medicaid administration.
Reuters (3/22),  USA Today (3/21) 
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Lawmakers revive national association health plan idea
Later this week, Republican lawmakers will debate the Small Business Health Fairness Act, which would permit the creation of national association health plans for trade groups, business associations and similar groups to offer coverage to small employers. The idea is to give buyers greater bargaining power and access to lower rates for their members, and the measure also paves the way for sidestepping Affordable Care Act small-group requirements and would lift most state regulation of such plans.
Kaiser Health News (3/21) 
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Tools & Technology
Insiders account for 58% of health care data breaches in Feb., report finds
A Protenus Breach Barometer report said 58% of the total hacking incidents within the health care industry in February were caused by insiders, affecting 146,162 patient records. Nine of the 18 insider incidents, which compromised 133,418 patient records, resulted from insider error, while eight were from insider wrongdoing that affected 12,020 patient records, according to the report.
Healthcare Informatics online (3/20) 
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How one N.M. health system steers patients away from the ED
Presbyterian Healthcare Services President and CEO Dale Maxwell said his organization's patient navigation model uses medical screenings when patients arrive at the emergency department to determine whether the ED is the appropriate place to meet their needs, with an eye toward reducing costs and improving care coordination, and patient satisfaction has improved as a result. The organization has also prioritized data sharing and telehealth programs to reach more rural areas of New Mexico with critical health services, recognizing that health care is local but some lessons should be widely adopted.
Hospitals & Health Networks Magazine (3/20) 
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Health Insurance Industry News
Antitrust legislation raises concern among insurers
Legislation that would impose higher levels of antitrust scrutiny in the health insurance industry is expected to be put to vote in the House this week. Industry groups, including America's Health Insurance Plans, have opposed the measure, saying it would create unnecessary liability risks while failing to boost competition.
Bloomberg BNA (free content) (3/20) 
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Medical News
Teen exposure to secondhand e-cigarette vapors examined
More than 24% of US teens said they were exposed to secondhand e-cigarette vapors within the last month, CDC researchers reported in JAMA Pediatrics. The findings, based on 2015 National Youth Tobacco Survey data involving middle- and high-school students, also showed higher odds of secondhand vapor exposure among girls and whites, with significantly increased exposure risk among those exposed to secondhand tobacco smoke and current e-cigarette users.
HealthDay News (3/20) 
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Study ties pre-hospitalization opioid use to elevated pneumonia risk
A study presented at the annual American Academy of Pain Medicine meeting found use of prescription opioids, such as fentanyl, codeine or morphine, in the 100 days prior to hospital admission was associated with a higher risk of hospital-acquired pneumonia, compared with no exposure to the drugs. The findings were based on 40,403 patients aged 18 to 70 years admitted to the Kaiser Permanente health system over four years.
Medscape (free registration) (3/20) 
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Leading providers of products and services to the industry
NHCAA's Platinum, Premier and Supporting Members are leading providers of products and services to the health care anti-fraud industry, are valued partners who support NHCAA's mission, and have demonstrated outstanding commitment to the fight against health care fraud. Learn more about these companies on the Fraud Solutions Index.
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Find new job opportunities with NHCAA Career Connection
If you're looking for a new challenge in your current field, or are interested in exploring something different, it can't hurt to take a look at the wide variety of positions posted on NHCAA Career Connection. You'll never know until you look.
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