N.Y. chiropractor pleads guilty to Medicare fraud | Conn. nurse admits to receiving illegal kickbacks | N.H. dentist resolves Medicaid fraud allegations
June 26, 2015
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N.Y. chiropractor pleads guilty to Medicare fraud
Melvin Cwibeker, a chiropractor in Woodmere, N.Y., pleaded guilty to defrauding Medicare and obstructing a federal audit. Cwibeker admitted to instructing chiropractors at his practice to not provide required care to Medicare patients, submitting $6.4 million worth of fraudulent Medicare claims and improperly collecting $4.5 million between January 2006 and March 2012, officials say. Cwibeker is scheduled for sentencing on Nov. 6 and has agreed to forfeit $500,000 and pay restitution. Herald Community Newspapers (Garden City, N.Y.)/Five Towns (6/25), U.S. Department of Justice/News release (6/24)
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Law Enforcement & The Courts
Conn. nurse admits to receiving illegal kickbacks
Heather Alfonso, a registered nurse from Connecticut, has pleaded guilty to charges of receiving kickbacks in relation to a federal health care program. Alfonso admitted to accepting $83,000 in illegal kickbacks from Insys Therapeutics in exchange for prescribing Subsys, a painkiller for cancer patients, and generating over $1 million worth of Medicare claims, prosecutors said. Alfonso will be sentenced in September and faces up to five years in prison. The New York Times (tiered subscription model) (6/25)
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N.H. dentist resolves Medicaid fraud allegations
Eyad Al Mahayni, a dentist formerly practicing in Hampton, N.H., has agreed to pay restitution and investigative costs of $13,150.25 to resolve Medicaid fraud allegations. Al Mahayni was accused of submitting false Medicaid claims from February 2008 to July 2012 for services performed by non-Medicaid providers and failing to maintain proper documentation, according to the state attorney general's office. Al Mahayni did not admit guilt in agreeing to the settlement. SeacoastOnline (Portsmouth, N.H.) (tiered subscription model) (6/25)
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Ohio resident sentenced for defrauding Ala. Medicaid program
A Cleveland man was given a four-year prison sentence for Medicaid fraud after pleading guilty on Wednesday. Darnell Nash created a fake company, Chase Farms Group, with an unidentified co-defendant and submitted fraudulent claims for unprovided services to Medicaid using an Alabama-based doctor’s Medicaid provider ID, officials say. Montgomery Advertiser (Ala.) (tiered subscription model) (6/25)
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Policy & Regulatory News
CMS unveils guide to help providers prepare for ICD-10
The CMS has released a guide designed to help providers prepare for the ICD-10 transition. The Quick Start Guide lays out five steps to readying for the new coding system and notes that it's not too late to get ready, but it's essential for practices to start now. Health Data Management (6/25)
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Tools & Technology
HHS data platform provides local health agencies with disaster readiness tool
A tool that uses a geospatial information platform has been introduced by HHS to help local emergency and health management agencies plan for disasters. The HHS emPOWER Map has ZIP code-level data about Medicare beneficiaries with electricity-dependent equipment claims to help minimize and address issues caused by power outages. Health Data Management (6/24)
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Survey examines how EHR charting affects docs' productivity, workflow
A Physicians' Alliance of America survey found that EHR use interrupts workflow and affects the productivity of clinicians. According to the report, the productivity of 46% of doctors surveyed decreased with EHR use, compared to 26% who reported an increase in their productivity since implementing EHRs. The study also found that 34% of the over 250 clinicians surveyed spend less than half an hour on charting daily, while 9% spend over 120 minutes performing the task. BeckersHospitalReview.com (6/24)
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Health Insurance Industry News
Some uninsured deliberately stay that way
Some Americans consciously refuse to buy health insurance despite being liable for tax penalties under the Affordable Care Act, choosing instead to haggle with providers, take advantage of charity care or go without. About 45% of people who are uninsured deliberately forgo coverage, according to the Congressional Budget Office. The Wall Street Journal (tiered subscription model) (6/24)
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Medical News
Report: 50% of Hispanic adults unaware of high cholesterol
A study published in the Journal of the American Heart Association of 16,000 Hispanic adults found that almost half were unaware they had elevated cholesterol levels, and the lack of awareness was higher for young adults and U.S.-born Hispanics. Researchers found that only 32% of middle-aged Hispanics and 54% of older patients sought and received treatment for high cholesterol. Reuters (6/24)
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Low memory test scores linked to Alzheimer's risk
Data on over 2,000 study participants with an average age of 73 revealed that those who had low scores on tests of memory and thinking skills were at greater likelihood of developing Alzheimer's disease. Researchers said that participants with the lowest test scores had 10 times the risk of developing Alzheimer's compared with those with the highest scores. Findings appeared in the journal Neurology. HealthDay News (6/24)
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Health care anti-fraud reference materials available
Visit NHCAA's Amazon Bookstore and enjoy the benefits and ease of Amazon while shopping for reference materials related to health care fraud investigations and SIUs. We stock coding books, medical dictionaries and books written by former ATC keynote faculty.
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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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