Mass. nursing home operator, exec settle allegations of Medicare fraud | Okla. behavioral therapist admits to defrauding Medicaid | Texas physician accused of improper prescribing
October 14, 2016
NHCAA SmartBrief
Top Story
Mass. nursing home operator, exec settle allegations of Medicare fraud
Whittier Health Network, a skilled nursing home operator in Haverhill, Mass., and Leo Curtin, its director of long-term care, agreed to resolve Medicare overbilling accusations through a $2.5 million settlement. The defendants were accused of failing to properly oversee Massachusetts-based Therapy Resources Management and prevent it from submitting fraudulent and inflated claims for unprovided therapy services at Whittier facilities, according to authorities.
U.S. Department of Justice/News release (10/13) 
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Law Enforcement & The Courts
Okla. behavioral therapist admits to defrauding Medicaid
Damon Wells of Oklahoma City pleaded guilty to charges of Medicaid fraud and identity theft over using the identities of pediatric patients to falsely bill Medicaid. Wells, a former behavioral health rehabilitation specialist at Pennington Creek Life House, conspired with a parent of four children to submit fraudulent claims for unprovided counseling services, officials say.
KFOR-TV (Oklahoma City) (10/13) 
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Texas physician accused of improper prescribing
William Elder-Quintana, a doctor practicing in El Paso, Texas, on Thursday was charged with 35 counts including conspiracy to commit health care fraud and payment of illegal remuneration. Elder-Quintana is accused of prescribing compound medications without obtaining information to adequately justify the prescriptions, some of which were written for patients residing in other states, authorities say.
El Paso Times (Texas) (10/13) 
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Calif. man admits to fraudulently obtaining prescription drug
Jalin Russell-Halfacre, a resident of Sacramento, Calif., pleaded guilty Wednesday to obtaining controlled substances by fraud and will be sentenced on Jan. 10. Russell-Halfacre admitted to using fraudulent codeine cough syrup prescriptions in Boise, Idaho, in February 2015, and authorities found evidence that he was reselling the medication to others, according to court information.
U.S. Department of Justice/News release (10/13) 
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Policy & Regulatory News
Home care groups dispute CMS pre-claims data from Ill. pilot
Illinois home health agencies report high rejection rates for claims submitted under the CMS Pre-Claim Review Demonstration project and inconsistent explanations for denial. Industry groups are disputing new CMS data that counter those claims, with the agency reporting 66% of pre-claim review requests have been provisionally afforded or partially affirmed and that the time it takes to complete submission of paperwork has decreased from an average of 12 minutes to 9 minutes.
Home Health Care News (10/12) 
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Tools & Technology
Pentagon pushes initial EHR rollout to Feb.
Citing compatibility and technical issues, Pentagon officials have postponed activation of the $4.3 billion MHS GENESIS EHR system until early next year, with the initial rollout planned for a single base. The system will go live in February at Fairchild Air Force Base in Washington state, and additional locations will be connected to the system in June.
Military Times (tiered subscription model) (10/11),  Federal Computer Week (10/11) 
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Pa. health system helps employees meet personalized BP goals
The Employee Hypertension Program at the University of Pennsylvania Health System uses a cloud-based platform to help workers with uncontrolled high blood pressure get screening, a treatment plan and follow-up that includes a tracking app. Health coach and registered nurse Nicole McHenry sets employees up with the app and then follows them over time to help them lower their blood pressure and achieve goals that are important to them. (10/12) 
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Health Insurance Industry News
Many count on Medicare to cover dental costs
Medicare does not pay for dental checkups and certain oral health procedures, but 51% of people surveyed by the Washington Dental Service Foundation thought preventive dental services were covered or were unsure. Some Medicare Advantage plans do cover such care, but oral surgeon Nick Freuen recommends patients plan for future dental care costs in retirement, regardless of whether they have insurance that covers some dental care.
The Oregonian (Portland)/The Associated Press (10/9) 
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Medical News
Study: Benefits of widespread mammography may be exaggerated
Over half of newly diagnosed breast cancers are unlikely to progress to become deadly, according to a new report in The New England Journal of Medicine, yet many women undergo aggressive, stressful and expensive follow-up and treatment. The study found little difference in the rate of serious breast tumors discovered on mammograms from 1975 to 2010, while discovery of smaller, harmless lumps has risen with advancing technology and widespread screening, accounting for 67% of mammography abnormalities in 2010.
Los Angeles Times (tiered subscription model) (10/12) 
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High spending to handle surgery complications may not benefit patients
A study published in JAMA Surgery found that patients treated for surgery complications at hospitals with the highest "cost of rescue," which refers to spending used to keep people from dying, were no more likely to survive than patients at low-cost facilities. Adjusted rates of serious complications were higher at the highest-cost hospitals, and costs varied substantially, with elective abdominal aortic aneurysm repair costing $60,000 at the most-expensive hospitals, compared with $23,000 at hospitals with the lowest cost of rescue.
HealthDay News (10/12) 
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Specialty-focused coding & compliance courses
The NHCAA Online Training Center, in conjunction with Coding Strategies, Inc., offers over 50 courses approved by a variety of coding-focused groups, as well as NHCAA. Take courses at your own pace and build a clinic foundation in a variety of specialty areas.
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The ATC -- you can't afford to miss it
You can't afford to miss this year's NHCAA Annual Training Conference. Each year NHCAA designs educational content designed to advance your investigation skills, four pre-conference programs offering deeper drill-downs on topics of critical importance, and the largest Anti-Fraud Expo floor yet.
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If you would be a real seeker after truth, it is necessary that at least once in your life you doubt, as far as possible, all things.
Rene Descartes,
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