Calif. clinic owner sentenced in $2.9M Medicare fraud | N.J. physician indicted in diagnostic lab kickback scheme | Owner of Utah prescription drug distribution firm admits to $100M fraud
January 11, 2017
NHCAA SmartBrief
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Calif. clinic owner sentenced in $2.9M Medicare fraud
Simon Hong of Brea, Calif., the owner of several rehabilitation clinics in the Los Angeles area, was sentenced Monday to serve 121 months in prison and ordered to pay restitution of almost $3 million for health care fraud, making illegal kickbacks and other offenses. Hong, also known as Seong Wook Hong, was convicted of operating a Medicare fraud scheme in which patients were recruited for acupuncture and massage treatments and the services were falsely billed to Medicare as physical therapy, costing the program about $2.9 million.
The Orange County Register (Santa Ana, Calif.) (free content) (1/10) 
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Law Enforcement & The Courts
N.J. physician indicted in diagnostic lab kickback scheme
Salvatore Conte, a physician based in Passaic County, N.J., was indicted on 10 counts, including charges of conspiring to violate and violating the Anti-Kickback Statute, over his alleged involvement in the kickback scheme operated by Parsippany, N.J.-based Biodiagnostic Laboratory Services. Prosecutors say Conte is suspected of soliciting over $130,000 in bribes in return for patient referrals, which resulted in over $525,000 worth of business for Biodiagnostic from 2009 to 2013.
The Star-Ledger (Newark, N.J.) (1/10) 
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Owner of Utah prescription drug distribution firm admits to $100M fraud
Randy Crowell of Henderson, Nev., owner and operator of a Utah-based prescription medication wholesale distributor, pleaded guilty to conspiracy to commit health care fraud and awaits sentencing on May 11. Authorities say Crowell admitted to using his company to funnel $100 million worth of prescription drugs from the black market to pharmacies across the country.
Las Vegas Review-Journal (1/10) 
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Former N.Y. physician admits to falsely prescribing controlled meds
Yusuf Siddiqui, a doctor formerly practicing in Williamsville, N.Y., entered a guilty plea Monday to obtaining controlled substances by fraud and faces sentencing on April 24. Siddiqui wrote unnecessary hydrocodone and clonazepam prescriptions for a former employee, who he had not examined and was addicted to painkillers, and took a portion of the hydrocodone pills for his own use, according to the complaint.
The Business Journals (tiered subscription model)/Buffalo, N.Y. (1/10) 
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Policy & Regulatory News
Burwell warns of chaos if Congress acts on ACA without replacement
Burwell warns of chaos if Congress acts on ACA without replacement.
Burwell (Mark Wilson/Getty Images)
Outgoing HHS Secretary Sylvia Mathews Burwell highlighted the successes of the ACA in her exit memo Friday, and in a speech on Monday she argued that while improvements may be needed, criticisms of the Affordable Care Act are overblown. Any replacement plan should maintain quality health care, keep down costs and provide as widespread health coverage as the ACA, Burwell said, warning repealing before such a plan has been established could throw markets into chaos.
Kaiser Health News (1/9),  The Wall Street Journal (tiered subscription model) (1/9) 
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Republican-sponsored amendment would delay ACA repeal to March
Republican Sens. Bill Cassidy of Louisiana, Susan Collins of Maine, Bob Corker of Tennessee, Lisa Murkowski of Alaska and Rob Portman of Ohio sponsored an amendment to the budget resolution under consideration that would push back the target date to March 3 for a bill defunding the Affordable Care Act. A number of Republicans have raised concerns about rolling back the law before a replacement is developed, and President-elect Donald Trump has indicated simultaneous action is his preference, but on Tuesday he said repeal should be immediate.
Bloomberg (1/10),  The New York Times (free-article access for SmartBrief readers) (1/10),  The Wall Street Journal (tiered subscription model) (1/9) 
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Joint Commission issues updated guidance on secure text messaging use
Health care facilities will no longer be allowed to use secure text messaging to send patient care orders, according to the Joint Commission's updated guidelines, developed in collaboration with the CMS and published in the journal Perspectives. The Joint Commission and the CMS recommend the use of a computerized provider order entry system to submit orders and advise facilities to prohibit sharing protected health information through unsecured text messaging from personal mobile devices. (1/9) 
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Tools & Technology
Ill. health care network to settle HIPAA violations for $475K
Presence Health will pay $475,000 to the HHS Office for Civil Rights to resolve HIPAA violations following a 2013 data breach incident that compromised the protected health information of 836 patients at Presence St. Joseph Medical Center in Joliet, Ill. The health care network "failed to notify, without unreasonable delay and within 60 days of discovering the breach, each of the 836 individuals affected by the breach, prominent media outlets (as required for breaches affecting 500 or more individuals), and OCR," according to findings from the agency's investigation.
Health IT Security (1/9) 
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Vt. medical center advocates for unified EHR across hospitals
The state of Vermont has received a certificate of need application from the University of Vermont Medical Center that calls for the creation of a unified EHR system across four hospitals within the University of Vermont Health Network. A unified EHR will "significantly improve patient care by having all of a patient's information available to a health care provider regardless of location whenever it is needed," according to organization officials.
Healthcare Informatics online (1/9) 
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Medical News
Indoor smoking bans tied to fewer ED visits for pediatric asthma
Researchers found that the rate of emergency department visits for children with asthma attacks dropped by 17% in 20 metropolitan areas three years after the implementation of smoking bans. The findings in the Annals of Allergy, Asthma & Immunology, based on 2000 to 2014 data from 20 hospitals in 14 states and Washington, D.C., showed no such improvement in ED visits for pediatric asthma in communities that didn't prohibit indoor smoking.
HealthDay News (1/9) 
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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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