Kan. business owner gets 2.5 years for defrauding Medicaid | Owner of Mo. medical firm pleads guilty in VA fraud case | 2 sentenced for roles in Ala. pill mill case
April 21, 2017
NHCAA SmartBrief
Top Story
Kan. business owner gets 2.5 years for defrauding Medicaid
Kristina Hansel of Topeka, Kan., was sentenced to serve two years and six months in federal prison and ordered to pay restitution of over $480,000 for health care fraud. Hansel, owner and operator of Achieve Services, pleaded guilty to submitting false Medicaid claims for unprovided developmental disability services and using fraudulent documentation to support the claims from January 2012 to June 2014.
The Topeka Capital-Journal (Kan.) (4/20) 
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Law Enforcement & The Courts
Owner of Mo. medical firm pleads guilty in VA fraud case
David Biersmith, owner of Kansas City, Mo.-based Industrial Medical Center, pleaded guilty Thursday to health care fraud and making a false statement to a federal agency. Biersmith allowed a former physician who lost his license to practice in another fraud cause to conduct patient disability examinations under a contract with the Department of Veterans Affairs, according to the plea.
The Kansas City Star (Mo.) (4/20) 
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2 sentenced for roles in Ala. pill mill case
Christopher Manfuso, a subcontractor employed as a workers' compensation dispensary manager, and Thomas Palmer, a nurse practitioner, were sentenced to serve three years of probation and 30 months in prison, respectively. The defendants pleaded guilty to their roles in a pill mill fraud scheme operated by Xiulu Ruan and John Patrick Couch, owners of Physicians' Pain Specialists of Alabama.
AL.com (Alabama) (4/20) 
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Calif. university accuses company of health care fraud
The University of California has filed a complaint accusing California Clinical Trials of using social media ads to target its students for fake clinical trials and fraudulent prescriptions that cost the university's student health care plan nearly $12 million. The university alleges that nine health care providers improperly prescribed medication such as pain cream to students.
Los Angeles Times (tiered subscription model) (4/20) 
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Policy & Regulatory News
Trump signs law allowing some vets to receive care outside VA
President Donald Trump signed legislation to extend the "Veterans Choice" pilot program, which lets some veterans see health care providers in their communities rather than those inside the Veterans Affairs system. The program facilitates sharing of medical records and reimbursement of non-VA providers in the wake of concerns about delays and inefficiencies inside the system.
Reuters (4/19) 
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Amendment might bring AHCA back to House floor for a vote
Amendment might bring AHCA back to House floor for a vote.
(Stefan Zaklin/Getty Images)
An amendment to the American Health Care Act proposed by Rep. Tom MacArthur, R-N.J., would retain the Affordable Care Act's essential health benefits at the federal level but allow states to request approval to replace the EHBs with their own list. States could also let insurers charge higher premiums to people with preexisting conditions if they create high-risk pools for those patients, according to the amendment, which has been billed as a tool for resurrecting the legislation for a vote the White House would like to see happen next week.
The Washington Post (tiered subscription model) (4/20) 
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Tools & Technology
Report examines EHR adoption rates among US states
Wyoming has the highest rate of EHR adoption across the US at 78.6%, followed by South Dakota, Utah, Iowa and North Dakota, according to a report from SK&A. The lowest EHR adoption rates were found in Maryland, Rhode Island, New Jersey, Louisiana and New York.
BeckersASC.com (4/19) 
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Vendor says system can locate stolen health data on dark web
Terbium Labs says that Matchlight, its fully private, fully automated data intelligence system, can locate stolen health care data on the dark web in a matter of hours. The company says Matchlight uses a one-way secure data signature to search for fingerprint matches that indicate when sensitive data appears on the dark web.
Health Data Management (4/17) 
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Health Insurance Industry News
Payers mostly in for 2018, but caution around ACA markets abounds, survey finds
Payers mostly in for 2018, but caution around ACA markets abounds, survey finds.
(Joe Raedle/Getty Images)
A survey conducted earlier this month by Oliver Wyman found 96% of payers intend to remain in the Affordable Care Act market, 75% plan to retain their existing geographic footprint and 71% have no plans to change their current offerings. However, the authors note payers could change their plans at any time, and about half said it was too early to determine whether and by how much premiums will rise.
MedCityNews.com (4/19) 
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Medical News
Study: Rx nonadherence costs the US up to $289B each year
An estimated 20% to 30% of drug prescriptions are never filled, and approximately half the drugs prescribed for chronic conditions are not taken properly, causing some 125,000 deaths per year, accounting for at least 10% of hospital admissions, and costing between $100 billion and $289 billion each year, according to a study in Annals of Internal Medicine.
The New York Times (free-article access for SmartBrief readers) (4/17) 
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Complimentary webinar -- May 16
Join LexisNexis® Health Care, an NHCAA Platinum Supporting Member, on Tuesday, May 16, from 2 p.m. to 3 p.m. ET for its complimentary webinar titled "Deciphering Social Connections That Are Costing You Millions in Improper Payments." Attendees will discover how combining the right data and algorithms allows you to prevent millions of dollars in unnecessary payments and to avoid putting your organization at risk for non-compliance with state and federal requirements. Earn 1 CPE from NHCAA. Register today!
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Exhibit at this year's ATC in Orlando
The NHCAA Anti-Fraud Expo, held in conjunction with the Annual Training Conference (ATC), is where leaders in the health care anti-fraud industry showcase their products and services. The Anti-Fraud Expo has a proven reputation of providing our sponsors and exhibitors with a targeted audience and valuable interactions with over 1,300 health care anti-fraud professionals in business, industry and law enforcement. Learn more today!
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