Extendicare nursing homes resolve Medicare fraud allegations for $38M | 3 Fla. men accused of accepting kickbacks in $23M fraud | Imprisoned doctor faces new health care fraud charge
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October 13, 2014
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Extendicare nursing homes resolve Medicare fraud allegations for $38M
Extendicare Health Services, a nationwide nursing home chain, agreed to a $38 million settlement to resolve accusations of Medicare fraud and substandard nursing services. The company's subsidiary, Progressive Step, allegedly provided poor patient care at 33 nursing homes across eight states from 2007 to 2013 and falsely billed Medicare for unprovided therapy services. Extendicare agreed to a five-year compliance arrangement with the HHS inspector general's office. The Philadelphia Inquirer (10/12)
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Law Enforcement & The Courts
3 Fla. men accused of accepting kickbacks in $23M fraud
Miami residents Guillermo Delgado, Gabriel Delgado and Emerson Carmona face conspiracy charges for allegedly receiving kickbacks in connection to a $23 million Medicare fraud. The Delgado brothers and Carmona are accused of accepting kickbacks from Jose Carlos Morales, a pharmacy owner sentenced to prison for Medicare fraud, in exchange for Medicare beneficiary information. American City Business Journals/South Florida (10/10)
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Imprisoned doctor faces new health care fraud charge
Oliver Herndon, a Pennsylvania doctor currently serving 11 years and three months in prison for prescription fraud, was charged Friday with health care fraud. Herndon, along with other Horizons Hospice employees, is accused of admitting non-terminal patients to hospice care and submitting false claims for unprovided and unnecessary services. Herndon is expected to enter a guilty plea. Pittsburgh Tribune-Review (10/10)
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Policy & Regulatory News
HealthCare.gov is ready for heavy traffic, CMS official says
The federal health insurance exchange is ready to handle even more volume than on the busiest day of open enrollment for 2014, when the site handled 125,000 users at once and 4.8 million visitors in one day, CMS official Andrew Slavitt said. A new round of end-to-end testing is underway. Reuters (10/8), The New York Times (tiered subscription model) (10/9)
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IRS issues rules for disability plan premiums
Disability insurance premiums paid by defined-contribution plans are not taxable under final Internal Revenue Service regulations if proceeds are to be paid to the plan in the event that a disability prevents the employee from working, proceeds from the policy are credited to the participant's plan account, and the payable amount under the policy is not more than the annual contributions that the participant would reasonably be expected to make or receive during the time of disability. The rules also state that premium payments made from qualified defined-contribution plans for accident, health or long-term care insurance are taxable during the year that payments toward the premium are made. BenefitsPro.com (10/8)
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Tools & Technology
ONC moves forward on roadmap for health IT safety center
The ONC has awarded a contract to RTI International to launch a roadmap to develop a center that will promote safe health IT use. A task force of stakeholders from the public and private sectors, which will include health IT vendors, providers and patient advocates, will be formed to help RTI define the functions, governance, focus and value of the new health IT center. Healthcare IT News (10/9)
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CMS supports telemedicine initiative in N.M.
A grant worth over $15 million was awarded by the CMS Innovation Center to the University of New Mexico Health Sciences Center's Department of Neurosurgery to expand its Access to Critical Cerebral Emergency Support Services telehealth program. The expansion will allow patients at 30 hospitals in the state to have virtual emergency neurological and neurosurgical consultations with UNM Hospital specialists at any time of day. Albuquerque Journal (N.M.) (free content)/The Associated Press (10/9)
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Health Insurance Industry News
Part B premiums stay the same for 3rd straight year
Most seniors will pay the same monthly premium for Medicare Part B next year that they did this year: $104.90. Deductibles for hospital coverage under Part A are rising by $44. The Washington Post (tiered subscription model)/The Associated Press (10/9)
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Medical News
Most anaphylaxis-related deaths are caused by medication use
Almost 59% of nearly 2,500 deaths from anaphylaxis in the U.S. from 1999 to 2010 were attributed to medication, according to a study published in the Journal of Allergy and Clinical Immunology. Factors such as greater medication use and improved diagnosis could be behind the almost twofold increase in the number of deaths from drug reactions seen from 1999 to 2010. HealthDay News (10/10)
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Experts ID 14 barriers to better patient health
Researchers at the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute found clinical care reflected only 20% of overall health outcomes and that nonclinical factors play a greater role in boosting patient outcomes and cutting medical expenses. Researchers identified 14 factors that serve as patient barriers -- including access, care coordination and financial status -- and said that understanding and addressing these factors could improve care and lower health costs. MedCityNews.com (10/9)
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Complimentary webinar -- Converging Data & Action to Prevent Fraud
In this 60-minute webinar, faculty with Verisk Health will explore various types of data mining, the analytics Verisk is building to leverage that data and will provide a client's perspective on using actionable data and best practices to stay ahead of the latest schemes in healthcare fraud. Register for this free Oct. 22 webinar today.
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Fulfill continuing education credit requirements at the ATC
Coders, CFEs, CPA and compliance officer can all earn necessary continuing education credit at the 2014 Annual Training Conference (ATC), November 18-21 in Dallas. For credits offered, agendas, and to register visit the ATC website.
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If you want to be successful, you must respect one rule: Never lie to yourself."
-- Paulo Coelho,
Brazilian novelist
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