N.J. physician suspected of falsely billing Medicare, Medicaid | Mich. doctor convicted of fraud gets license suspended | Wyo. man gets three-year probation for Medicare fraud
February 24, 2015
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N.J. physician suspected of falsely billing Medicare, Medicaid
Albert Ades, a doctor practicing in Cresskill and Little Falls, N.J., faces one count of health care fraud and 35 counts of making false statements relating to health care matters. Ades allegedly submitted fraudulent claims to Medicare, Medicaid and private health insurers for unprovided physician visits from 2005 to 2014, according to the U.S. Attorney's Office. Ades is also accused of falsifying patient records to bill prescription refills as office visits, officials say. NorthJersey.com (Woodland Park, N.J.) (free registration) (2/23)
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Law Enforcement & The Courts
Mich. doctor convicted of fraud gets license suspended
The Michigan Department of Licensing and Regulatory Affairs suspended the license of Paul Petre, a doctor from Shelby Township, Mich., following a fraud conviction. Petre was sentenced to a three-year prison term and three years of supervised release after being convicted of health care fraud conspiracy and conspiracy to distribute controlled substances. Petre is also required to pay restitution of $950,000 along with co-defendants in the case. The Detroit News (2/23)
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Wyo. man gets three-year probation for Medicare fraud
Brian Jimenez of Cheyenne, Wyo., was sentenced Monday to serve three years of probation after he pleaded guilty to one count of health care fraud. Jimenez used his company, Indulge, to improperly bill Medicare for $269,501.02 worth of physical therapy services that were either unprovided or provided by physical therapy assistants who were not supervised by a licensed physical therapist, records show. Jimenez was also ordered to pay restitution of $83,497.31. KTWO-AM (Casper, Wyo.)/K2 Radio (Wyoming) (2/23)
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N.J. woman faces Medicaid fraud, theft charges
Doris Litle of Deptford, N.J., was charged with Medicaid fraud and theft by deception over allegedly stealing a relative's savings and improperly applying for Medicaid. Litle, who acted as power of attorney for her cousin, is accused of spending the savings on lottery tickets instead of nursing home care for her cousin, according to the state Attorney General's Office. Unexplained transfers worth $214,450 resulted in a 27-month Medicaid ineligibility for Litle's cousin. NJ.com (Morristown, N.J.) (2/23)
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Get It Right: Pricing Strategies That Work
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Policy & Regulatory NewsSponsored By
Government delays enforcement of HRA rule
The government will now wait until July before it begins enforcing a rule that fines small businesses that offer their employees health reimbursement arrangements. HRAs do not meet insurance standards set by the Affordable Care Act, guidance released in 2013 states. The Washington Post (tiered subscription model) (2/19)
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Tax mistake affects 800K HealthCare.gov users
About 800,000 people enrolled in a health insurance plan through the federally run exchange received incorrect information regarding subsidies and have been asked to postpone filing their tax returns until they receive correct information. The Washington Post (tiered subscription model)/Wonkblog (2/20), The New York Times (tiered subscription model) (2/21)
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Building Workplace Trust 2015
Interaction Associates' 6th annual research study tracking trust on the job, Building Workplace Trust, is out, and more than half of employees surveyed give their organizations low marks for trust and leadership. Yet this year's findings again point to how high trust leads to better outcomes and financial results — and even boosts innovation.

Tools & TechnologySponsored By
U.S. sees growth in medical identity theft
A study by the Ponemon Institute revealed the incidence of medical identity theft in the U.S. grew 21.7% between 2013 and 2014. Data also showed nearly 50% of consumers said they would consider switching health care providers if their medical data were stolen, while almost all respondents said that clinicians should reimburse consumers who experienced theft. Healthcare Informatics online (2/23)
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Carpathia seeks HIPAA-covered entities to join cloud service beta testing
HIPAA-covered entities willing to serve as beta sites for the Healthcare Community Cloud Service are being sought by Carpathia, a cloud computing vendor. The platform, designed using VMware and EMC technology, allows users to leverage the same platforms they have for internal clouds and easily move their workflows to the HCCS cloud. The service is expected to be launched in late spring. Health Data Management (2/20)
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The IDC Market Spotlight on Network Automation and Agility
The arrival of virtualization, cloud computing, and mobility has strained data center networks—and IT staff—like never before. This Market Spotlight explains how data center network fabrics provide a foundation for automated provisioning, configuration, and management of network-based services in a new era of IT agility. Download now.

Medical News
Influenza wanes, but additional pediatric deaths reported
Influenza cases in the U.S. declined for the third consecutive week, according to the CDC. However, six more children died of the illness, bringing the pediatric death toll to 86, while the pneumonia- and influenza-related death rate "was above the epidemic threshold," officials noted. NBC News (2/20)
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Study shows formula-fed infants have elevated arsenic exposure
Researchers at Dartmouth College found urinary arsenic levels were higher among formula-fed babies than those who were breast-fed. The authors said arsenic in the water and the powder used to make formula may be to blame. Researcher Kathryn Cottingham said parents should have their water tested if they are using it to make formula. The findings were reported in Environmental Health Perspectives. Reuters (2/23)
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Don't be scammed by health care fraud
NHCAA has developed a few simple tips for consumers in order to avoid becoming a victim of a health insurance scam or fraud.
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Health care anti-fraud career opportunities
The only career center dedicated to the health care anti-fraud industry is hosted by NHCAA. Complimentary for job-seekers and moderately priced for employers, it's the central repository for the best available positions in the industry. Visit NHCAA Career Connection to explore the options -- it might be time for a fresh start.
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-- Bob Moawad,
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