Study: EHR use does not increase Medicare fraud | Cosmetic surgery center employees accused of falsely billing insurers | Pharmacy owner sentenced for role in "pill mill" scheme
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July 17, 2014
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Study: EHR use does not increase Medicare fraud
A study by the University of Michigan School of Information and the Harvard School of Public Health examined data from hospitals that adopted EHRs and those that did not to determine if EHR adoption would lead to increases in fraudulent Medicare coding and billing. The study, which appears in the July issue of Health Affairs, found no difference in the increases in Medicare billing between the two groups. The study also suggested that an efficient use of EHRs to reduce costs, and not policies to reduce fraud, would be the best way to reduce health care spending. Health Data Management (7/14)
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Address Longstanding Losses Due to E/M Overpayments
Claim overpayments can be a payer's financial Achilles heel; E/M upcoding is one of the prominent pain points. These widespread, low dollar claim overpayments often go undetected or un- prioritized over larger per claim cases. Until now. MultiPayer analytics and education can help reduce losses to overpayments. Click here, scroll down to downloads.
Law Enforcement & The Courts
Cosmetic surgery center employees accused of falsely billing insurers
Three employees of Empire Surgery in Orange, Calif., were indicted Wednesday on charges of falsely billing health insurers in excess of $50 million. Vi Nguyen and Theresa Fisher, consultants for the surgery center, and Lindsey Hardgraves, a marketer for the company, are accused of promising "free or discounted cosmetic surgeries" to patients who underwent unnecessary medical procedures, officials say. The surgery center, which also went by the names Vista Surgical and Princess Cosmetic Surgery, billed the procedures to various health insurers. The Orange County Register (Santa Ana, Calif.) (free content) (7/16)
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Pharmacy owner sentenced for role in "pill mill" scheme
Lisa Hollier, a pharmacist and owner of the Urban Independent Pharmacy in Dallas, was sentenced on Tuesday to five years in prison for her involvement in an illegal drug-distribution scheme. Hollier filled false prescriptions for hydrocodone and alprazolam pills that were then sold to recruited patients and dealers for $250 or $185, according to the indictment and federal officials. Nicolas Alfonso Padron, the doctor who operated the scheme, and a number of other defendants connected to the scheme have already pleaded guilty. D Healthcare Daily (Dallas) (7/16)
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Policy & Regulatory News
Changes planned for sites to simplify ratings
The CMS plans to add a rating system using stars to its Home Health Compare, Dialysis Facility Compare and Hospital Compare websites to make it easier for consumers to understand the ratings. The additions will be made throughout the rest of this year and into 2015, CMS deputy administrator for innovation and quality and CMO Patrick Conway wrote in a blog post. The websites are all part of (7/15)
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HHS tells court 340B discounts can continue for orphan drugs
Hospitals may continue to apply 340B program drug discounts for orphan drugs used to treat non-orphan diseases, according to HHS and the Health Resources and Services Administration. HHS said in a federal court filing in response to a motion from the Pharmaceutical Research and Manufacturers of America that it has the authority to maintain the discounts and that HRSA will provide guidance on the issue. AHA News Now (7/15)
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Tools & Technology
Health care law sparks investment in IT
The Affordable Care Act has stimulated investment in health care IT, which has benefited firms in Massachusetts, according to Steve Kraus, a partner at Bessemer Venture Partners. Figures from the National Venture Capital Association show Massachusetts second only to California for investment in health care last year. American City Business Journals/Boston/Health Care Inc. blog (7/14)
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Device shows promise for early detection of Alzheimer's
A device being commercialized by NeuroVision Imaging has been shown in a 40-patient study to have the ability to accurately detect Alzheimer's disease. Designed to identify beta-amyloid plaque buildup in the retina, the device eliminates the need to collect samples from the nervous system and could be used to detect Alzheimer's as early as two decades prior to a clinical diagnosis, according to researchers. (7/15)
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Health Insurance Industry News
Poll finds fewer adults get health insurance through employer, union
The percentage of adults who said they had insurance coverage through an employer or union, or through an individual plan, increased from 63.9% last autumn to 66.7% percent this spring, a Gallup poll found. Over the same period, the percentage of adults saying they had an employer-sponsored health plan fell from 44.4% to 43.5%, and the percentage with coverage through a union fell from 2.8% to 2.5%. National Underwriter Life & Health (7/11)
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Medical News
U.S. sees decline in stroke rate in past 2 decades
The overall first-time stroke rate among Americans dropped 24% from 1987 to 2011, with a greater drop seen among people aged 65 and older, according to an analysis in the Journal of the American Medical Association. Researchers found a 20% overall decline in stroke-related deaths per decade. HealthDay News (7/15), (7/15)
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Experts tie family history to higher cerebral palsy risk in youths
Children who had a twin, sibling or parent with cerebral palsy had significantly higher odds of developing the condition compared with those who did not, a study indicated. The findings warrant further research, which "should consider the possibility of genetic causes as well as genetic susceptibility to environmental causes," researchers wrote in BMJ. (7/15)
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Legal & Ethics webinar -- next week
On July 24 NHCAA will host a webinar on laws that frequently impact investigations such as HIPAA and ERISA, as well as discuss ethical challenges faced by investigators in areas of evidence, interviewing, professional and business activities, and privacy.
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The ATC -- big things will happen here
NHCAA's Annual Training Conference offers more than 70 unique workshops spanning eight different educational tracks, providing nearly 1,200 attendees with health care fraud education that is unmatched. Register by September 15 and save.
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Be brave enough to start a conversation that matters."
-- Margaret Wheatley,
American writer
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