N.J. diagnostic firm owners admit to $4.3M fraud | 2 N.Y. men charged in alleged $1M Medicare, Medicaid fraud | Ark. woman sentenced to probation for defrauding Medicaid
November 18, 2015
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N.J. diagnostic firm owners admit to $4.3M fraud
Nita Patel and Kirtish Patel, husband-and-wife owners of Parsippany, N.J.-based Heart Solutions and Biomedical Sound Services, pleaded guilty to health care fraud charges Tuesday. The Patels admitted to falsifying physicians' signatures on interpretations of diagnostic tests and improperly collecting over $4.3 million from Medicare and private health insurers, authorities say. They will be sentenced on March 15. NJ.com (Morristown, N.J.) (11/17)
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Law Enforcement & The Courts
2 N.Y. men charged in alleged $1M Medicare, Medicaid fraud
Hassan Qufqir, a resident of East Northport, N.Y., and Jamil Siddiqui, who resides in Dix Hills, N.Y., were arraigned Monday on charges including insurance fraud, health care fraud and unauthorized practice of a profession. Qufqir and Siddiqui are accused of practicing as medical technicians without a license and performing stress tests on Medicare and Medicaid beneficiaries at two clinics, officials say. The defendants are suspected of collecting over $1 million in ineligible reimbursements from May 2013 until May 2014. Patch.com/Huntington, N.Y. (11/17)
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Ark. woman sentenced to probation for defrauding Medicaid
Martha Renshaw, a resident of Lake City, Ark., was sentenced to serve three years of probation after admitting to Medicaid fraud. Renshaw, who was arrested following an investigation into Jonesboro, Ark.-based Allcare Homecare, submitted fraudulent Medicaid claims for unprovided services, according to officials. Renshaw was also ordered to pay total restitution of $4,210.95 and $6,632.85 in fines. Arkansas Democrat-Gazette (Little Rock) (free registration) (11/17)
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N.C. optometrist convicted in drug trafficking scheme
Sam Hobbs, an optometrist practicing in Charlotte, N.C., was sentenced to serve 15 to 27 months in prison after pleading guilty to his role in a drug trafficking scheme. Hobbs and his brother, Ben Hobbs, owners and operators of Clear View Eye Care clinics, prescribed inflated doses of narcotic medication to patients and then stole the pills and replaced them with vitamins while the patients were undergoing procedures at the clinic, according to court documents. Ben Hobbs is scheduled for a hearing this week. The Charlotte Observer (N.C.) (11/16)
Policy & Regulatory News
ACA Medicaid expansion fuels shift to value-based care
Thirty states have expanded or plan to expand Medicaid programs, and many have handed administration of the expanded coverage to private plans. Last year 7.8 million more beneficiaries enrolled in private Medicaid managed care plans, and the trend is expected to grow as fee-for-service models are increasingly replaced with value-based, outcomes-linked models. Forbes (11/15)
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New CMS rule holds hospitals accountable for joint replacement quality
The CMS has announced a new rule governing payments for knee or hip replacements linking reimbursement to quality measures. It's part of an effort to reduce avoidable mistakes with such procedures and ultimately improve patient care while decreasing costs, and it will be implemented in 67 cities. In 2016, 30% of Medicare payments will fall under models like the Comprehensive Care for Joint Replacement, and that percentage will increase to 50% by 2018, according to goals set by HHS. U.S. News & World Report (11/17), The Hill (11/16)
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Tools & Technology
Ky. health system alerts patients after data breach
A data breach has been reported by Owensboro Health in Kentucky after a cyberattack on the computers of its Muhlenberg Community Hospital was detected by the FBI. The attack was carried out with a keystroke logger that collected and sent data. Compromised data included patient names, birth dates, financial information and Social Security numbers. BeckersHospitalReview.com (11/16)
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Most hospitals use mobile monitoring tools, survey finds
A Spyglass Consulting Group survey found that about two-thirds of health systems and hospitals were using remote patient monitoring technology. Of surveyed institutions using the technology, 84% had deployed tablets or other mobile devices to support patients with chronic conditions after discharge. Decision support tools and analytics were used by 79% of providers to convert raw patient information into actionable data on population health. Healthcare Informatics online (11/16)
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Medical News
Expanded use of therapeutic hypothermia may improve cardiac arrest outcomes
A study published in the journal Circulation found that patients who received therapeutic lowering of body temperature after cardiac arrest were nearly three times more likely to survive and 3.5 times more likely to have better brain function after recovery. Findings were based on data from over 500 cardiac arrest patients with "nonshockable" rhythms. Use of therapeutic hypothermia is uncommon in such cases. HealthDay News (11/16)
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Doctor-patient discussions may cut antibiotic overprescribing
Shared decision-making between primary care physicians and patients helps reduce prescriptions for antibiotics to treat respiratory infections, according to a Cochrane Library report. When patients and doctors discuss the issue, 29% are prescribed antibiotics, compared with nearly 50% of clinical encounters that did not involve shared decision-making. The findings were based on over 1,000 doctors and hundreds of thousands of patients who participated in 10 randomized controlled trials in the UK and Europe. Reuters (11/16)
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Nicholas Messuri elected as chair of NHCAA board of directors
Nicholas J. Messuri, Esq., Vice President and Deputy General Counsel for Fraud Prevention & Recovery at DentaQuest and Delta Dental of Massachusetts, was elected as NHCAA's new board chair. "Nick has served NHCAA for several years, sharing his wide-ranging experience and keen legal insights and we are delighted that he will be leading NHCAA as we enter our fourth decade of protecting and serving the public interest against health care fraud," said NHCAA CEO Louis Saccoccio. Messuri succeeds Katherine M. Leff of CareSource. PR Newswire (11/17)
Call for presentations: 2016 NETS programs. We want to hear from you!
We invite you to share your best practices, anti-fraud case studies, emerging schemes, and proven analytic solutions by submitting your ideas for review. To learn more about who should submit and how, visit the Call for Presentations webpage.
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-- William Faulkner,
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