Texas nurse admits to role in $5M Medicare fraud | Former Ky. dentist gets prison for illegal prescribing | Wash. resident who faked cancer sentenced for medical assistance fraud
March 21, 2017
NHCAA SmartBrief
Top Story
Texas nurse admits to role in $5M Medicare fraud
Charles Esechie, a registered nurse from Katy, Texas, entered a guilty plea to a single count of conspiracy to commit health care fraud over his involvement in scheme to defraud about $4,792,199 from Medicare. Esechie admitted to conspiring with others to fraudulently bill Medicare for home health care services he claimed he provided as an employee of Baptist Home Care Providers while he was actually working as a full-time nurse at Harris County Hospital, according to the plea.
Department of Justice/News release (3/17) 
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Law Enforcement & The Courts
Former Ky. dentist gets prison for illegal prescribing
Chris Steward, a dentist in Cave City, Ky., was sentenced to an 18-month prison term and three years of supervised release after pleading guilty in a prescription fraud case. Authorities say Steward faced charges including health care fraud and intentionally distributing and dispensing controlled substances outside the course of professional medical practice, and he pleaded guilty to seven charges related to illegally prescribing and obtaining drugs for his own use.
Glasgow Daily Times (Ky.) (3/20) 
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Wash. resident who faked cancer sentenced for medical assistance fraud
Maria Sanchez-Kountz, a resident of Washington state, was sentenced to 60 days of house arrest for falsely claiming to have ovarian cancer and improperly receiving $103,000 in public medical assistance and disability support payments. Sanchez-Kountz, who was a US Army spouse, received $20,000 worth of unneeded medical care through the Army, as well as improper Social Security payments, authorities say.
SeattlePI.com (3/20) 
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Policy & Regulatory News
GOP lawmakers debate AHCA revisions ahead of planned House vote
GOP lawmakers debate AHCA revisions ahead of planned House vote
(Brendan Hoffman/Getty Images)
The American Health Care Act will undergo some changes before a House floor vote on Thursday, said Speaker Paul Ryan, R-Wis., who said he remains confident it will ultimately pass. Republican Study Committee leaders gave their support Friday after the White House agreed to include an option for states to integrate a work requirement into Medicaid programs, add a Medicaid block grant option and offer larger tax credits for lower-income, older Americans.
Reuters (3/20),  Morning Consult (3/17),  The Hill (3/17) 
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CMS postpones next steps under bundled payment programs
The CMS has postponed expansion of the Comprehensive Care for Joint Replacement pilot and implementation of the Cardiac Rehabilitation Incentive Payment Model program from July 1 to Oct. 1, and the joint replacement final rule effective date has been pushed to May 20. Although it's possible all bundled payment implementation timelines will be pushed into next year, the announced delays will be open for comment for 30 days after publication in the Federal Register.
Modern Healthcare (tiered subscription model) (3/20) 
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Tools & Technology
Cyberattack may have exposed data of 17,634 patients at Wis. provider
A total of 17,634 patients at Metropolitan Urology Group in Wisconsin may have had their information exposed when two of the provider's servers were infected by ransomware on Nov. 28. The incident may have exposed patient information including names, account numbers, procedure codes, provider identification numbers and dates of services, as well as a handful of Social Security numbers, according to a statement from the provider.
Health IT Security (3/17) 
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Report links medication errors to CPOE, pharmacy systems
The Pennsylvania Patient Safety Authority reported that 50.4% of medication error reports from state health care facilities listed computerized prescriber order entry systems as a contributing factor, with pharmacy systems listed in 28.2% of reports and electronic medication administration record systems mentioned in 28.1%. Researchers said 69.2% of errors reached patients.
HealthLeaders Media (3/17) 
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Health Insurance Industry News
Plans take action on unpaid risk adjustment money
Blue Cross and Blue Shield plans in Alabama and Tennessee have filed a lawsuit seeking a combined $250 million in risk-corridor payments the insurers say they are owed for 2014 and 2015. A number of other insurers also have taken legal action to recover money they say they are owed by the federal government under an Affordable Care Act safety net designed to balance substantial losses and profits in the ACA exchanges' first years.
Modern Healthcare (tiered subscription model) (3/16) 
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Medical News
PCSK9 inhibitor may cut heart, stroke risks in patients with CVD
PCSK9 inhibitor may cut heart, stroke risks in patients with CVD.
(Jean-Sebastien Evrard/AFP/Getty Images)
A study in The New England Journal of Medicine showed use of the cholesterol-lowering drug Repatha, a PCSK9 inhibitor, along with statins, was associated with lower risks of heart attack, stroke, cardiovascular revascularization and extended major adverse cardiovascular events, but the drug's annual $14,523 price tag could put it out of reach for some. The study involved 27,564 adults who had experienced a heart attack or pain associated with narrowed arteries in the lower extremities.
United Press International (3/17) 
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Study examines opioid exposure among US youths
More than 188,000 opioid exposure calls for youths younger than 20 were received by US poison control centers from January 2000 through December 2015, with exposures increasing by 86% from 2000 to 2009 before declining from 2009 to 2015, researchers reported in Pediatrics. The report also showed that 60% of exposures were among children younger than 5, while intentional opioid consumption was more likely among teens.
The Washington Post (tiered subscription model) (3/20),  CNBC (3/20) 
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NHCAA releases 2016 Year in Review
NHCAA distributed the Association's 2016 Year in Review highlighting the past year's successes and accomplishments, confirming once again that the Association provides our members, partners, and the industry with a range of effective resources to improve and strengthen the fight against health care fraud.
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Need to report suspected health care fraud?
The US spends over $2.7 trillion on health care every year. Of that amount, NHCAA estimates that tens of billions of dollars are lost to health care fraud. This directly impacts patients, taxpayers and government through higher health care costs, insurance premiums and taxes and can cause patient harm. Learn about the resources available to report fraud.
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