Audit finds $23M in MassHealth overbillings for home health services | Nev. pharmacy owner pleads guilty to Medicaid, insurance fraud | 3 N.Y. women face charges in alleged Medicaid fraud
September 19, 2016
NHCAA SmartBrief
Top Story
Audit finds $23M in MassHealth overbillings for home health services
An audit of nine Massachusetts-based home health care companies providing services under MassHealth, the state's Medicaid program, found a total of about $23 million in improper and inflated billings over three months in 2015. Nizhoni Health Systems in Somerville, Mass., allegedly submitted about $8.7 million in improper claims while Avenue Homecare Services in Lawrence, Mass., is accused of overbilling almost $4.6 million to the program, according to audit records.
The Boston Globe (tiered subscription model) (9/18) 
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Law Enforcement & The Courts
Nev. pharmacy owner pleads guilty to Medicaid, insurance fraud
Adam Katschke pleaded guilty to one count each of insurance fraud and submitting false Medicaid claims as owner of Meadow Valley Pharmacy in Nevada. Katschke agreed to pay restitution of $1.5 million and faces a maximum of four years in state prison.
Lincoln County Record (Pioche, Nev.) (9/16) 
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3 N.Y. women face charges in alleged Medicaid fraud
Rachael Merlau, her mother, Sarah Merlau, and Toya Torrance, a family friend, all residents of Monroe County, N.Y., were charged on allegations of submitting fraudulent time sheets to Medicaid for unprovided care services. Rachael Merlau and Torrance are accused of falsifying time sheets while Sarah Merlau is accused of approving the documents, which resulted in more than $6,000 in improper Medicaid payments, according to authorities.
Rochester Democrat and Chronicle (N.Y.) (tiered subscription model) (9/16) 
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Wis. pharmacist pleads not guilty in alleged Medicare, Medicaid fraud
Mark Johnson, a pharmacist in Janesville, Wis., entered a not-guilty plea Friday to a 46-count indictment accusing him of defrauding Medicare and Medicaid. Johnson, who operated Kealey Pharmacy, allegedly improperly billed the programs for $1 million worth of prescriptions from 2008 to 2014 using the identification numbers of physicians to write the prescriptions, according to the indictment.
The Gazette (Janesville, Wis.) (9/16) 
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Policy & Regulatory News
OIG: Patients lack information when choosing hospice
A report from the HHS Office of Inspector General said data show about one-third of hospice patients did not get important information about what selecting hospice care would mean at the time they enrolled. The report follows a newspaper investigation that showed an increase in the number of patients who outlived hospice care was linked to hospices recruiting patients who were not near death.
The Washington Post (tiered subscription model) (9/15) 
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Legislation with Flint aid gains Senate OK
The Senate has approved the $9.4 billion Water Resources Development Act, including $100 million in subsidized loans, to bolster water infrastructures in Flint, Mich., and other communities. The funding package also includes $30 million for federal children's health programs aimed at addressing the effects of lead poisoning, helping pregnant women and new mothers, and creating public-education campaigns; nearly $17.5 million for establishing a lead-exposure registry of youths; and $2.5 million for an advisory panel that would examine methods to effectively reduce lead exposure.
The Detroit News (9/15) 
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Tools & Technology
American Well launches telepsychiatry service
American Well introduced telepsychiatry services in six states and intends to add more states each month. Psychiatrists can use American Well's video app to see adult patients and prescribe medications, though they are still unable to prescribe controlled substances. (9/16) 
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Health Insurance Industry News
Calif. seeks health care innovation waiver for undocumented residents
California officials are seeking permission from HHS and the Treasury Department to allow undocumented immigrants to enroll in health coverage through the state's Affordable Care Act marketplace.
The New York Times (free-article access for SmartBrief readers) (9/15) 
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Medical News
CDC reports brain cancer as top cause of pediatric cancer deaths
A report from the CDC's Center for National Health Statistics found that brain cancer was the leading cause of pediatric cancer deaths after deaths rose from 516 in 1999 to 534 in 2014, while leukemia deaths declined from 645 to 445. The findings also showed that overall cancer mortality among youths declined by 20% over the same period.
Reuters (9/16),  The Washington Post (tiered subscription model) (9/16) 
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Study ties early menopause to elevated risks of heart disease, mortality
A Dutch study in JAMA Cardiology found women who started menopause before the age of 45 had a 50% higher risk of coronary heart disease, a 20% increased risk of cardiovascular disease-related mortality and a 12% greater risk of all-cause mortality, compared with those who entered menopause at an older age. The findings were based on 32 studies involving over 300,000 women.
HealthDay News (9/15),  Reuters (9/15) 
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