Fla. pharmacy owner admits guilt in $1.8M Medicare fraud | Former Ala. CFO accused of fraud faces additional drug charge | Miss. nurse accused of Medicaid fraud
July 24, 2015
NHCAA SmartBrief

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Fla. pharmacy owner admits guilt in $1.8M Medicare fraud
Evelio Penaranda, owner of Miami-based Naranja Pharmacy, pleaded guilty Thursday to one count of health care fraud for his involvement in a $1.8 million scheme to defraud Medicare. Penaranda admitted to using the pharmacy to file fraudulent Medicare claims for unprescribed, unnecessary and unprovided prescription drugs from May 2013 to March 2014, according to his plea. He faces sentencing on Oct. 8. U.S. Department of Justice/News release (7/23)
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Crunching the Numbers
Your passion may have led you into business, but tracking cash flow and other key numbers will help keep your company up and running. Read Boomtown: Think Like a Startup

Law Enforcement & The Courts
Former Ala. CFO accused of fraud faces additional drug charge
Terri Mollica, former chief financial officer for Birmingham Health Care and Central Alabama Comprehensive Health, pleaded guilty to an additional felony drug charge. Mollica admitted to using a re-mailing business to send prescription drugs such as Valium, Adderall and Ritalin to co-defendants, court records show. The guilty plea could add up to 14 more years to her prison sentence, in addition to the maximum of 12 years she faces after pleading guilty in an $11 million health care fraud case. The Huntsville Times (Ala.) (7/23)
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Miss. nurse accused of Medicaid fraud
Sarah Lepard, a licensed practical nurse based in Ripley, Miss., was arrested Wednesday and indicted on charges of Medicaid fraud and fraudulently acquiring or obtaining possession of a controlled substance. Lepard is accused of signing out prescription drugs, including oxycodone and hydrocodone, but not giving them to the nursing home patients who should have received them, officials say. The Sun Herald (Biloxi-Gulfport, Miss.)/The Associated Press (7/23)
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Ore. woman charged with health care fraud, theft
Debra Berg, a resident of Roseburg, Ore., was indicted Tuesday on 50 counts, including multiple charges of making false health care claims and theft by deception. Berg is accused of medical fraud that began in 2009 and was revealed in December 2014, the indictment says. Berg is scheduled to appear in court on Aug. 24. Albany Democrat-Herald (Ore.) (7/23)
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Policy & Regulatory News
Senate Finance Committee to support stage 3 MU delay
Lamar Alexander, R-Tenn.
Lamar Alexander, R-Tenn. (Alex Wong/Getty Images)
Senate Finance Committee Chairman Lamar Alexander, R-Tenn., said Thursday that his committee will advocate delaying the implementation of stage 3 of the meaningful use program. As it currently stands, stage 3 would be enforced by the CMS beginning in 2017. Provider groups including the American Medical Association have been seeking a delay, and Alexander says that in spite of a possible delay, his committee supports full implementation of EHR adoption. Modern Healthcare (tiered subscription model) (7/23)
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Medicare trustees predict hospital trust fund to last to 2030
Medicare trustees said the program's trust fund that pays for hospital care is expected to run out of money in 2030, the same time frame as their previous estimate. While Medicare still faces a shortfall, a slowdown in health care spending narrowed the funding gap and put the program in better financial position for the long term, the trustees said. However, the report found that 30% of Medicare beneficiaries could see a 52% increase in their Part B monthly premiums come January. Kaiser Health News (7/23), Reuters (7/22)
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Tools & Technology
Survey examines consumer awareness, willingness to use telemedicine
A HealthMine survey found that 41% of 1,200 consumers queried said they have never heard of telehealth services. The study also revealed that a person's age might affect his or her willingness to use telemedicine, as 58% of respondents ages 25 to 34 were interested in using telemedicine compared with 37% of participants ages 55 to 64. Health Data Management (7/23)
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Health Insurance Industry News
States could look to hospitals to fund Medicaid expansion
State legislators could raise or institute hospital assessment fees to help pay their share of Medicaid expansion starting in 2017. Arizona, Colorado, Indiana and Ohio have plans in place for assessments to fund the states' share of the program. Modern Healthcare (tiered subscription model) (7/21)
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Medical News
CT scans can cause DNA damage, cell death, study finds
A study published in the Journal of American College of Cardiology: Cardiovascular Imaging found that computed tomography scans are associated with DNA damage, although cells also initiate repair mechanisms, and sometimes cellular death. The findings come from 67 patients who had heart CT scans. The team found that scans using the lowest radiation dose did not adversely affect the cells of healthy patients, and they recommend practitioners minimize use of radiation when possible. HealthDay News (7/22)
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Survey tracks trends in substance use among U.S. teens
There was an increase in marijuana use, but a significant decline in cigarette and alcohol use among almost 600,000 high-school seniors surveyed between 1976 and 2013, according to a study in the Journal of Adolescent Health. Black teens were more likely to choose marijuana over cigarettes since 1993, while white teens became more likely to choose marijuana over cigarettes in 2011. Alcohol drinking has declined since the mid-1970s, but white teens continue to use it more than any other substance. HealthDay News (7/22)
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Respond to provider defenses
The biller did it! Some providers, when confronted with allegations of fraud, have a bag of tricks to reduce repayment or legal action potential. This August NETS program will show attendees how to respond to and anticipate the defenses providers use to create solid cases for negotiation or legal proceedings.
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There is no passion to be found playing small -- in settling for a life that is less than the one you are capable of living."
-- Nelson Mandela,
political activist and president of South Africa
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