Fla. home health firm owner sentenced in $32M Medicare fraud | Texas woman admits guilt in alleged $374M Medicare, Medicaid fraud | Calif. physician faces charges over suspected $6.5M Medicare fraud

April 17, 2015
NHCAA SmartBrief

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Fla. home health firm owner sentenced in $32M Medicare fraud
Felix Gonzalez, an owner of Miami-based AA Advanced Care, was sentenced Thursday to a 113-month prison term and ordered to pay restitution of $21.4 million for his role in a $32 million Medicare fraud scheme. Gonzalez pleaded guilty to conspiracy to commit health care fraud in January, and admitted to operating the home health care firm with others specifically to submit fraudulent Medicare claims for unprovided and unnecessary services. Gonzalez and his co-conspirators received almost $22 million in false reimbursements between January 2006 and March 2009. U.S. Department of Justice/News release (4/16)
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Law Enforcement & The Courts
Texas woman admits guilt in alleged $374M Medicare, Medicaid fraud
Teri Sivils, a former office manager at Texas-based Medistat, pleaded guilty to conspiracy to commit health care fraud for her involvement in an alleged $374 million Medicare and Medicaid fraud scheme. Sivils was accused of using her position at Medistat to provide a doctor's signature on documents necessary for certification of home health care services in exchange for kickbacks, according to the government. Sivils faces probation in accordance with her plea deal and will be sentenced on Sept. 21. Modern Healthcare (tiered subscription model) (4/16)
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Calif. physician faces charges over suspected $6.5M Medicare fraud
Gary Ordog, a doctor from Valencia, Calif., was charged with nine counts of health care fraud over allegations of defrauding Medicare. Ordog is accused of submitting $6.5 million worth of claims for unprovided services, sometimes under the names of deceased Medicare beneficiaries, between January 2009 and February 2015, according to the Department of Justice. Ordog improperly collected $2.5 million from the Medicare program, according to the indictment. The Signal (Santa Clarita Valley, Calif.) (4/16)
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N.H. medical transport provider resolves allegations of Medicaid fraud
The operator of Bath, N.H.-based North Country Medi-Van agreed to a $75,885 settlement deal with the state Medicaid Fraud Control Unit to resolve fraud allegations. Jeffrey Gould and his company were accused of submitting unsupported Medicaid claims for wheelchair van services, according to Attorney General Joseph Foster. The Union Leader (Manchester, N.H.) (4/16)
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Policy & Regulatory News
Medicare reimbursement change signed into law
President Barack Obama has signed a measure that he said strengthens Medicare "because it starts encouraging payments based on quality, not the number of tests that are provided or the number of procedures that are applied but whether or not people actually start feeling better." The bill also eliminates the 21% cut in Medicare payments that was due to take effect this month. The Washington Post (tiered subscription model)/The Associated Press (4/16), Reuters (4/16)
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Backers of Calif. vaccination bill withdraw measure
A bill that would prevent parents in California from opting out of school immunizations because of personal beliefs was withdrawn by its supporters before it came to a vote Wednesday. Backers of the bill hope to return the measure to the state Legislature later this month after soliciting enough support. Reuters (4/16)
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Tools & Technology
HHS offers grants to support health data sharing program
HHS has up to $1 million in grant money to distribute to as many as 10 groups that will participate in the Community Interoperability Health Information Exchange Program. The program was launched to encourage organizations to use health IT to integrate resources and improve health data sharing at the community level to promote better care. Among the providers that will be eligible to receive the data exchange services are safety net providers, emergency medical services and behavioral health providers. Healio (free registration) (4/14)
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How mobile health can help cut medical costs, expand access
Medical professionals should consider mobile health and telehealth as critical weapons in efforts to reduce costs, improve patient satisfaction and provide broader access to quality care. These are the common themes being touted this week at a health care conference where a survey of 330 organizations showed nearly 50% have installed a strategy focusing on mHealth or telehealth as a means of engaging with patients. mHealthIntelligence.com (4/14)
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Health Insurance Industry News
Report: ACA program cut Medicare spending 1.2%
The Affordable Care Act's Pioneer program, which seeks efficiencies by managing care for patients with chronic diseases, saved 1.2% on Medicare spending in its first year, according to a paper published by the New England Journal of Medicine. Bloomberg (4/15)
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Medical News
Unneeded tests may be common before cataract surgery
An analysis of data on almost 441,000 Medicare patients who underwent cataract surgery in 2011 found that 53% of them were subjected to at least one preoperative test, despite ophthalmology guidelines that recommend against routine presurgical testing. The study in the New England Journal of Medicine also found that about a third of ophthalmologists ordered these tests for almost all of their patients. HealthDay News (4/15)
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Obesity may elevate prostate cancer risk among black men
Black men were nearly 60% more likely than white men to develop prostate cancer overall, but obesity increased the risk further among black men, according to a study in JAMA Oncology. The likelihood of prostate cancer was 103% and 28% higher among obese and normal-weight black men, respectively, compared with white men. Reuters (4/16)
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For updates related to NHCAA educational opportunities, news related to health care fraud and more, follow @NHCAA on Twitter or Facebook.
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