Former hospital exec pleads guilty to role in $67M Medicare fraud | Tenn. physician pleads guilty in $7.5M Medicare fraud | Former union official sentenced to prison for role in health care fraud
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November 19, 2014
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Former hospital exec pleads guilty to role in $67M Medicare fraud
Christopher Gabel, former chief operating officer of Florida-based psychiatric hospital Hollywood Pavilion, pleaded guilty Tuesday to conspiracy to commit health care fraud and conspiracy to defraud the U.S. and receive and pay kickbacks. Gabel admitted that Pavilion staff members turned in fraudulent Medicare claims for unnecessary or unprovided treatment from 2003 to 2012. The hospital submitted $67 million in false claims and received $40 million in reimbursements, authorities said. Gabel faces up to 15 years in prison. Sun-Sentinel (Fort Lauderdale, Fla.) (11/18)
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Law Enforcement & The Courts
Tenn. physician pleads guilty in $7.5M Medicare fraud
Raymond Brown, a physical medicine and rehabilitation physician from Cleveland, Tenn., pleaded guilty to defrauding Medicare of almost $7.5 million. Brown admitted to purchasing 254 vials of Botox but billing Medicare for 17,766 vials between 2008 and 2012, according to prosecutors. Brown, who will be sentenced March 5, faces up to three years in prison and as much as $250,000 in fines. Chattanooga Times Free Press (Tenn.) (11/19)
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Former union official sentenced to prison for role in health care fraud
Reginald Guy, a former representative for the United Auto Workers at a Lear plant in Arlington, Texas, has been sentenced to a 13-year prison term and ordered to pay restitution of $2.4 million for his role in defrauding Blue Cross Blue Shield of Texas. Guy, who pleaded not guilty, was accused of using his position as a union official to refer co-workers to a chiropractor who billed the insurer for unprovided treatment, according to the U.S. Attorney's Office. Guy, along with clinic employee Abbas Zahedi, was convicted of 10 fraud charges in June, court documents say. Fort Worth Star-Telegram (Texas) (11/18)
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Policy & Regulatory News
"Critical weaknesses" hinder Medicare websites, GAO audit says
Missing data, confusing language and problematic design are "critical weaknesses" of five patient-focused websites run by the CMS, an audit by the Government Accountability Office says. The websites are intended to offer Medicare patients information about providers and treatments. The Hill (11/18)
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Mont. governor will propose expanding Medicaid, budget director says
Montana Gov. Steve Bullock's two-year budget proposal will include a plan to expand Medicaid eligibility, according to Bullock's budget director, Dan Villa. The Montana Standard (Butte) (11/16)
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Tools & Technology
Community Health Centers recognized for successful EHR use
HIMSS has awarded Community Health Centers in central Florida a 2014 Community Health Organization HIMSS Davies Award of Excellence for its outstanding adoption of EHRs. The federally qualified community health center uses its EHR system to enhance patient engagement, boost care coordination, adjust workflow and improve patient outcomes. The center's use of an EHR system helped boost the percentage of its hypertension patients who have blood pressure below 140/90. Health Data Management (11/18)
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App designed to monitor health progress of patients with hypertension
A mobile application that can create a personalized health plan for patients with hypertension as well as enhance patient-doctor communication has been developed by Twine Health. The app, being piloted at six facilities including Massachusetts General Hospital, is expected to help hospitals save money by allowing physicians to monitor their patients' daily activity logs and remind them when needed to follow their treatment plans. BetaBoston (11/16)
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Health Insurance Industry News
Heavy traffic leaves HealthCare.gov visitors lined up
More than 1 million people visited the federally run health insurance exchange on the first weekend of open enrollment for 2015 plans, the Obama administration said. But some customers with established accounts on HealthCare.gov were unable to open their accounts Monday amid heavy traffic and technical problems. Some messages directed customers to wait and others suggested trying again later. Yahoo/The Associated Press (11/17)
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Medical News
Painkillers linked to bleeding risk for atrial fibrillation patients, study finds
Nonsteroidal anti-inflammatory drugs are associated with increased risk of blood clots and bleeding among patients with atrial fibrillation, according to a study in the Annals of Internal Medicine. The risk is greater for patients also being treated with an anticoagulant. HealthDay News (11/17)
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Study: Head trauma causes severe, lifelong disability for young children
A study in Pediatrics revealed half of children who suffered severe abusive head trauma before age 5 will not survive past age 21, while those who do will have a much lower quality of life. HealthDay News (11/17)
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NHCAA News
NHCAA welcomes new Chair
At NHCAA's Annual Membership Forum meeting, the association's members met to approve the 2015 Board of Directors and elected Katherine Leff, Director of the Special Investigations Unit for CareSource Management Group, as the new Chair. Leff succeeds Ralph Carpenter, Senior Director, Special Investigations Unit of Aetna.
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Hone investigative skills at our four-day anti-fraud boot camp
Learn the soup to nuts of health care fraud investigations at NHCAA's Investigators Boot Camp, March 11-14 in Baltimore.
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SmartQuote
It is always our own self that we find at the end of the journey. The sooner we face that self, the better."
-- Ella Maillart,
Swiss travel writer
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