N.Y. chiropractor admits to defrauding Medicare | Md. medical equipment firm owner pleads guilty to fraud | N.J. physician's medical license revoked for improper prescribing
November 23, 2016
NHCAA SmartBrief
Top Story
N.Y. chiropractor admits to defrauding Medicare
Leo Kronert, a former teacher and part-time chiropractor from Frewsburg, N.Y., entered a guilty plea to a charge of health care fraud over falsely billing Medicare and private insurers. Officials say Kronert, who faces sentencing on Feb. 28, submitted about $92,000 in claims for unprovided patient visits.
The Post-Journal (Jamestown, N.Y.) (11/22) 
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Combat In-Home Healthcare Billing Fraud
Managing and monitoring mobile clinician in home healthcare is challenging, costly and integral to ensuring care is delivered. This changing paradigm, combined with a surge in billing fraud, providers are implementing Electronic Visit Verification (EVV) to prove home visits are delivered to the right patient for the prescribed amount of time. Click here to learn more.
Law Enforcement & The Courts
Md. medical equipment firm owner pleads guilty to fraud
Harry Crawford of Baltimore, the owner and president of durable medical equipment company RX Resources and Solutions, pleaded guilty to charges including conspiracy to commit health care fraud. Authorities say Crawford admitted to fraudulently billing Medicaid for unprovided medical supplies and inflating claims for unnecessary supplies, costing the program $1.2 million from 2007 to 2014.
WBFF-TV (Baltimore) (11/22) 
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N.J. physician's medical license revoked for improper prescribing
The New Jersey Board of Medical Examiners permanently revoked the medical license of Manoj Patharkar, a doctor practicing in Passaic, N.J., and Edison, N.J., for indiscriminately prescribing a potent painkiller. Patharkar pleaded guilty to charges related to his role in a $1.5 million kickback scheme to generate patient referrals to his pain clinics and faces sentencing in January.
NorthJersey.com (Woodland Park, N.J.) (free registration) (11/22) 
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The Truth about Cloud Security
72% of businesses are using the cloud. 56% said they are still figuring out exactly where they can use the cloud more. Why would so many businesses already trust these services with their own and their clients' most sensitive data? While security risks are real, the cloud is also more secure than you think. Read this eBook to learn more
NHCAA SmartBrief Poll
What area of new and emerging fraud schemes are you most interested in for 2017?
Check out the results of this poll on Dec. 14 in the NHCAA SmartBrief Best of 2016 report.
VoteMarketplace/health insurance exchange fraud
VoteGenetic testing schemes
VoteOpioid and prescription drug abuse
VoteEmerging Medicare fraud schemes
Embrace Disruptive Innovation
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Policy & Regulatory News
Ryan's ACA replacement outline might be a model for Trump
While President-elect Donald Trump has not yet provided specifics for his plans to replace the Affordable Care Act, House Speaker Paul Ryan, R-Wis., released a 37-page outline in June that might serve as a model. The proposal would lift the mandate to purchase health insurance, retain some level of tax credits to assist consumers with costs, protect people with pre-existing conditions and prioritize high-deductible plans with health savings accounts.
National Public Radio (11/21) 
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House closes in on 21st Century Cures Act
House negotiators said they are close to agreement on the 21st Century Cures Act and want to pass a bill that can also be approved in the Senate to avoid the need for a conference committee. The NIH stands to gain $4 billion to $5 billion, including $1 billion each for the Cancer Moonshot, Precision Medicine Initiative and BRAIN Initiative.
Politico (11/21) 
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Tools & Technology
How EHRs help providers work more effectively
EHRs have various capabilities, such as integrated patient education materials, documentation templates and favorites lists for dosing instructions, that allow physicians to work "smarter but not harder," writes Tony Schueth. Customized care alerts and electronic prior authorization in EHRs also help clinicians save time while improving patient care, he writes.
Health Tech Zone (11/18) 
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Health Insurance Industry News
Experts: Trump presidency unlikely to affect health care consolidation
The Trump administration probably would not reverse the US Department of Justice's current antitrust concerns over major health insurers seeking to merge, though it might offer more favorable settlement terms, experts say. Even if Trump repeals the Affordable Care Act, the pace of hospital consolidations is unlikely to slow, experts say.
The New York Times (free-article access for SmartBrief readers) (11/20) 
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Medical News
WHO ends Zika international emergency declaration
The World Health Organization has lifted its global health emergency designation for the Zika virus, prompting concerns from some public health experts that the move could stall investments in research and preparedness efforts. However, the CDC said that the WHO's declaration doesn't reduce the urgency of developing Zika vaccines and diagnostics or of understanding its health risks on fetuses and infants.
The New York Times (free-article access for SmartBrief readers) (11/18),  Reuters (11/18),  USA Today (11/18) 
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Complimentary webinar -- Dec. 6
Join Truven Health Analytics, an NHCAA Platinum Supporting Member, on Dec. 6 from 2 p.m. to 3 p.m. EST for its complimentary webinar, Addressing Evolving Threats in Fraud, Waste and Abuse -- Innovations and Insights. Attendees will discover the latest innovations Truven Health Analytics has uncovered in fighting fraud, waste and abuse in a managed care environment, including predictive analytics, algorithms, oversight and reporting. Register today!
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Membership provides you access to unparalleled education opportunities, the ability to stay on top of industry trends and current news, and exclusive access to a broad network of fellow health care anti-fraud professionals. Don’t wait, join today!
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Editor's Note
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In observance of Thanksgiving in the US, SmartBrief will not publish Thursday and Friday. Publication will resume Monday.
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