12 Mass. home health agencies under probe for suspected fraudulent activity | N.Y. man admits to defrauding Medicaid program while in jail | Ga. hospital CEO, family members face prescription fraud charges
February 5, 2016
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12 Mass. home health agencies under probe for suspected fraudulent activity
Massachusetts Attorney General Maura Healey's Medicaid Fraud Division will be investigating 12 unnamed home health care agencies referred by state officials and MassHealth for possible fraud. Officials did not give any other information on the suspected fraudulent activities. MassHealth is projected to have an 82% increase in spending on home health services this fiscal year compared with two years prior, with expenditures on track to surpass $755 million. The Boston Globe (tiered subscription model) (2/3)
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Data Security and HIPAA Compliance in Mid-sized Healthcare Organizations
The 21st century is facing an uphill battle for better data security, and the healthcare industry is at the front lines. Healthcare providers deal with tremendous amounts of sensitive, legally protected data labeled protected health information (PHI), which requires certain security measures as defined by HIPAA. Learn how to ensure that all PHI is handled, transferred and stored properly.

Law Enforcement & The Courts
N.Y. man admits to defrauding Medicaid program while in jail
David Epps, who was serving a jail term in Monroe County, N.Y., for an unrelated offense, on Wednesday pleaded guilty to Medicaid fraud. Epps admitted to operating a kickback and fraud scheme from July 22 to Aug. 28 while imprisoned, causing over $5,000 worth of fraudulent Medicaid claims. Tiffany Hughes, Epps' personal care aide, submitted false timesheets for unprovided services supposedly rendered to Epps and paid him kickbacks of almost $100 per paycheck, according to the complaints. Epps was given a six-month sentence and ordered to pay restitution of $2,128. Rochester Democrat and Chronicle (N.Y.) (tiered subscription model) (2/4)
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Ga. hospital CEO, family members face prescription fraud charges
John Gowder, CEO of Blairsville, Ga.-based Union General Hospital, was arrested Thursday on charges of fraudulently obtaining a controlled substance and conspiracy to distribute in an alleged prescription fraud. Five other suspects, including Gowder’s wife, brother and sister, were arrested on similar charges, including unauthorized distribution of a controlled substance. James Heaton, a Union General Hospital board member and physician, faces 41 counts of unauthorized distribution of a controlled substance. WTOC-TV (Savannah, Ga.) (2/4)
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Fla. couple charged in alleged prescription pill mill
Tony and Katherine Duncan, both of Panama City, Fla., were charged over their alleged involvement in a prescription pill mill scheme. The couple is accused of conspiring to obtain controlled substances including alprazolam and oxycodone and working with a co-conspirators to acquire drugs to sell or trade, according to affidavits. David Flick, the Marianna, Fla.-based physician who gave the Duncans prescriptions for hundreds of pills, was also charged. Jackson County Floridan (Marianna, Fla.) (2/3)
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Policy & Regulatory News
Obama expected to request regionally tailored ACA excise tax
President Barack Obama's 2017 budget request will include a proposal to adjust the Affordable Care Act's tax on health insurance plan costs above a certain threshold. The president will propose raising the threshold in regions where health care is the most expensive, White House Council of Economic Advisers Chairman Jason Furman wrote in the New England Journal of Medicine. Reuters (2/3)
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Lawmaker proposes increased telehealth access for Medicare
A measure was introduced by Sen. Brian Schatz, D-Hawaii, on Wednesday to boost Medicare's use of remote patient monitoring and telehealth services. The Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act would remove obstacles to reimbursements for telehealth. Healthcare Informatics online (2/3)
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Tools & Technology
Study finds fitness trackers have cybervulnerabilities
A Canadian study has found that many fitness trackers emit a unique Bluetooth identifier that allows them to be tracked by outside parties. Researchers said some companion apps used with trackers can leak logins and transmit activity information in a way that could allow that information to be compromised or falsified. PCWorld/IDG News Service (2/2)
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Health Insurance Industry News
12.7M Americans signed up for coverage under ACA, Burwell says
HHS Secretary Sylvia Mathews Burwell announced Thursday that about 12.7 million Americans signed up for health care coverage through Affordable Care Act exchanges, up from last year's final tally of 11.7 million. The number fell within the range of federal estimates and included 2.7 million people ages 18 to 34. The federal exchange garnered 5.6 million return customers and almost 4 million first-time enrollees, Burwell said. Reuters (2/4), Bloomberg (2/4)
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Medical News
Study examines effect of irregular sleep schedules on women's metabolic health
Researchers evaluated data on 370 nonshift-working women ages 48 to 58 and found positive associations between insulin resistance and variability in bedtime and bedtime delay after adjusting for factors including depressive symptoms, menopausal symptoms and sleep duration. The findings, published in the journal Sleep, also showed that greater bedtime advance is associated with higher insulin resistance before adjustment. Healio (free registration)/Endocrine Today (2/3)
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Studies link smoking bans to lower CVD hospital admissions
An analysis of observational studies from 21 countries found programs that prohibit smoking at worksites and in public places to reduce exposure to secondhand smoke appear to have a positive effect on cardiovascular disease, according to a report in the Cochrane Database of Systematic Reviews 2016. Researchers said the studies linked national smoking bans to fewer hospital admissions for heart attacks and acute coronary syndrome, and several studies found nonsmokers may reap the biggest health benefits. MedPage Today (free registration) (2/3)
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Hone investigative skills at our 4-day anti-fraud boot camp
Learn the soup to nuts of health care fraud investigations at NHCAA's Investigators Boot Camp, March 8-11 in Orlando.
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Leading providers of products & services to the industry
NHCAA's Platinum and Premier 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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Whatever you think the world is withholding from you, you are withholding from the world."
-- Eckhart Tolle,
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