Medical research firm resolves Medicare fraud allegations for $343K | Ga. lab owner pleads guilty to health care fraud charges | Trial begins for former hospital owner accused of Medicare fraud
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July 24, 2014
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Medical research firm resolves Medicare fraud allegations for $343K
Virginia-based American International Biotechnology finalized on Tuesday a settlement agreement to resolve allegations of Medicare fraud and improper referrals for over $343,000. A former contract sales agent for the firm, Jason Hoover, is accused of improperly obtaining patient consent for cheek swabs and billing health insurers for genetic tests that resulted in payments of up to $4,000 per Medicare beneficiary, the Justice Department said. The company denied any liability and said it "had no knowledge of the alleged actions of the contract sales agent." Pittsburgh Post-Gazette (7/22)
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Law Enforcement & The Courts
Ga. lab owner pleads guilty to health care fraud charges
R. Jackson Garth, owner of Polaris Allergy Labs in Georgia, admitted on Tuesday to falsifying blood-test results after ordering a lab technician not to test the samples. Garth submitted claims to health care benefit programs for the unprovided blood-test services while providing doctors with fraudulent results from September 2012 to February 2014, said the U.S. attorney's office. Garth's sentencing has yet to be scheduled. Houston Chronicle (tiered subscription model)/The Associated Press (7/22)
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Trial begins for former hospital owner accused of Medicare fraud
The trial for Tariq Mahmood, a Dallas-based doctor and former owner of six rural hospitals in Texas accused of defrauding Medicare, began on Monday. Prosecutors aim to use billing audits in the trial, which they say would prove "the existence of the defendant's scheme to defraud Medicare." Mahmood faces 15 counts of fraud charges and accusations of submitting over $1.1 million in fraudulent claims, according to indictments. The Dallas Morning News (free content) (7/21)
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Policy & Regulatory News
Feds ready contraceptive coverage opt-out alternative
The Obama administration is creating an alternative to the existing form religious organizations may use to inform HHS that they have an objection to offering employees health insurance that covers some or all forms of contraception. The policy is in response to a Supreme Court ruling in favor of Wheaton College in Illinois, which objected to the form. Reuters (7/23)
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Supreme Court likely to hear yet another ACA case
Two federal court panels issued opposing rulings on whether tax credits for health insurance plans bought through the federally run marketplace are legal under the Affordable Care Act. Unless the full U.S. Court of Appeals for the District of Columbia Circuit overturns the three-judge panel's ruling and agrees with the 4th U.S. Circuit Court of Appeals' ruling, the cases are likely to go to the Supreme Court, experts say. Bloomberg (7/23), The New York Times (tiered subscription model) (7/23)
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Tools & Technology
Groups weigh in on proposed changes to MU program
The American Medical Association has expressed concern about proposed changes to the EHR Incentive Programs, arguing the program's inflexibility, lack of quality alignment with the Physician Quality Reporting System and other issues pose challenges to physicians. The Medical Group Management Association also weighed in, questioning the viability of the program. EHR Intelligence (7/23)
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Tech challenge aims to boost use of government behavioral health data
HHS is incentivizing software developers, public health experts and others to analyze and make the CDC's Behavioral Risk Factor Surveillance System data easier for the public to understand and use. The VizRisk challenge, which will run from July 28 to Oct. 28, will offer winners cash prizes totaling $15,000. Health Data Management (7/22)
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Health Insurance Industry News
More than 10M Americans gain coverage under ACA
Following the full implementation of the Affordable Care Act last year, approximately 10.3 million Americans gained health care coverage, according to a report in the New England Journal of Medicine. The uninsured rate dropped from 21% prior to the first open enrollment period for insurance plans to 16.3% in April. The number of those finding coverage was particularly higher in states with expanded Medicaid as well as for Hispanics, blacks and young adults. The Hill (7/23), Modern Healthcare (subscription required) (7/23)
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Medical News
Probiotics may offer protection against hypertension, study finds
An analysis of data from nine studies involving 543 adults found that regular consumption of probiotics was associated with lower blood pressure readings. The findings, published in the journal Hypertension, showed those who regularly took probiotics saw their systolic BP drop an average of about 3.6 mm Hg and their diastolic BP drop about 2.4 mm Hg on average compared with nonusers. HealthDay News (7/21)
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High sodium intake raises heart risk in diabetes
Type 2 diabetes patients in the highest quartile of sodium intake were more than twice as likely than those in the lowest quartile to develop cardiovascular disease, according to a study in the Journal of Clinical Endocrinology & Metabolism. However, the results did not show a causal relationship between the conditions. MedPage Today (free registration) (7/22)
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Internet profiling and intelligence gathering
Come to NHCAA’s August Skills & Schemes program in Phoenix to learn step-by-step in-depth researching techniques utilizing online and open-source databases located on the Web. Additional programming includes an investigator and law enforcement track. Visit the August webpage for more information.
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Earn extra CPE credits at the ATC with pre-conference programs
Extend your ATC investment and attend one of our 4 pre-conference programs. Program topics cover Evaluation & Management (E/M) Coding Schemes, Emerging Schemes, Provider Interviewing Techniques and the popular AHFI® prep course. View descriptions now.
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-- Norman Cousins,
American journalist
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