Owner of Ohio home health business admits guilt in Medicaid fraud, tax crime | Former Mo. doctor sentenced 2nd time for health care fraud | Mich. psychologist enters guilty plea to insurance fraud
June 23, 2017
NHCAA SmartBrief
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Owner of Ohio home health business admits guilt in Medicaid fraud, tax crime
Cheryl McGrath of Guysville, Ohio, owner and operator of Athens County-based Home Health Care of Southeast Ohio, agreed to pay restitution of more than $2.2 million to Medicaid and almost $367,000 to the IRS after pleading guilty to health care fraud and willful failure to pay over tax. McGrath, who faces up to 15 years in prison, is accused of falsely billing Medicaid for unprovided nursing services between 2009 and 2015, resulting in around $2.2 million worth of improper payments.
WTAP-TV (Parkersburg, W.Va.) (6/22) 
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Law Enforcement & The Courts
Former Mo. doctor sentenced 2nd time for health care fraud
Wayne Williamson, a former physician from Kansas City, Mo., was sentenced to 15 months in prison without parole and was ordered to pay $39,155 in restitution for performing disability examinations without a medical license at the Department of Veterans Affairs at Industrial Medical Center in Independence, Mo. Williamson had surrendered his license and was sentenced to three years in prison in 2010 after admitting guilt to health care fraud and other offenses.
WGEM-TV (Quincy, Ill.)/The Associated Press (6/22) 
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Mich. psychologist enters guilty plea to insurance fraud
George Compton Jr., a psychologist from Sturgis, Mich., is facing up to 10 years in federal prison and will be ordered to pay restitution after pleading guilty to insurance fraud, which resulted in more than $250,000 worth of improper payments. Compton is accused of falsely billing insurers for unprovided counseling sessions from January 2013 to June 2016.
WOOD-TV (Grand Rapids, Mich.) (6/22) 
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Tenn. woman faces TennCare fraud charges
Melysa McDaniel, a resident of Whitwell, Tenn., was charged with four counts of TennCare fraud by doctor shopping and faces up to four years in prison. McDaniel is accused of visiting multiple physicians in a short period of time and using her TennCare benefits to obtain the painkiller hydrocodone, prosecutors say.
The Chattanoogan (Tenn.) (6/22) 
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Policy & Regulatory News
Tools & Technology
EHR-linked image database opens research opportunities
A centralized image warehouse at Mount Sinai Health Systems integrates clinical images with anonymized electronic health records for research. The system will provide opportunities for using integrated data for research, precision medicine and diagnosis in a variety of research areas, including mammography, cancer, neuro-degenerative diseases and genomics.
Health IT Analytics (6/20) 
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Calif. medical center suffers data breach
Patients whose personal information may have been compromised in a phishing attack against California-based Torrance Memorial Medical Center in April were notified by hospital officials on Monday. The incident involved an unauthorized access of two of the medical center's email accounts that contained patient names, medical record numbers, health insurance data and other diagnostic information, addresses, dates of birth, phone numbers and Social Security numbers.
Healthcare IT News (6/20) 
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Health Insurance Industry News
Premiums on popular ACA plans will rise 18% next year, analysis finds
Premiums for silver-tier plans, the most popular plan tier sold on Affordable Care Act exchanges, are expected to rise an average of 18% for next year, while the number of US counties with a single insurer offering plans will grow to 41% from 33% in 2016, according to an Avalere analysis of 2018 rate requests in eight states. Uncertainty surrounding the ACA's future, cost-sharing reduction payments, risk mitigation programs and other factors played a role in the premium hikes, according to the analysis.
Becker's Hospital Review (6/20),  Healthcare Finance News (6/20),  The Examiner (Washington, D.C.) (6/19) 
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Medical News
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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