Former Texas hospital administrator gets prison sentence in $116M Medicare fraud | HHS uncovers questionable Medicaid dental claims in Calif. | Wis. business owner admits to $1.5M Medicaid fraud
May 22, 2015
NHCAA SmartBrief

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Former Texas hospital administrator gets prison sentence in $116M Medicare fraud
Mohammad Khan, former assistant administrator of Houston-based Riverside General Hospital, was sentenced Thursday to a 40-year prison term for conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks and paying illegal kickbacks. Khan admitted his involvement in the hospital's submission of over $116 million worth of fraudulent Medicare claims for unnecessary or unprovided services supposedly rendered to recruited patients. Khan was also ordered to pay $31,321,200 in restitution. Federal Bureau of Investigation/News release (5/21)
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Law Enforcement & The Courts
HHS uncovers questionable Medicaid dental claims in Calif.
Six orthodontists and 329 dentists billed California's Medicaid program for $118 million worth of pediatric dental services in 2012 that raised questions, HHS auditors say. Many dentists billed for an unusually large number of services per day, some received exceptionally high per-patient payments and at least one billed for potentially inappropriate treatment. San Jose Mercury News (Calif.) (free registration)/The Associated Press (5/17)
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Wis. business owner admits to $1.5M Medicaid fraud
Carleen Larson of Kenosha, Wis., pleaded guilty Wednesday to medical assistance fraud and forgery. Larson, owner of The Caring Heart, admitted to submitting fraudulent Medicaid claims for 94,987 hours of unprovided services, resulting in over $1.5 million in improper reimbursements, court records show. Larson is scheduled for sentencing on Aug. 13. Kenosha News (Wis.) (5/21)
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N.J. man sentenced to prison for role in defrauding Medicare
Vijay Patel, owner of Mobile Diagnostic Testing in Parsippany, N.J., was sentenced Thursday to serve one year in prison for health care fraud. Patel admitted to helping a physician avoid Medicare prepayment review by filing claims for services rendered by the doctor and paying part of the reimbursements to him, according to officials. Patel was also ordered to serve two years of supervised release. The Star-Ledger (Newark, N.J.) (5/21)
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Policy & Regulatory News
House panel OKs 21st Century Cures measure
The 21st Century Cures bill passed the House Energy and Commerce Committee in a 51-0 vote Thursday. The bill would speed up drug approval by requiring the FDA to improve its drug review process, look at more flexible forms of clinical studies and include patient experience in the decision-making process. The full House is expected to vote on the measure in June. The Hill (5/21), Reuters (5/21)
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Advocates urge Minn. to boost Medicaid dental reimbursement rates
A coalition called Help Minnesota Smile, made up of dental care providers and payers, is urging the state Legislature to increase reimbursement rates for dental care under Medicaid to the median national rate. Minnesota has the lowest reimbursement rates in the nation for pediatric dental services and has the fourth-lowest reimbursement rates for adult care. Many dentists say they cannot afford to treat people covered under Medicaid. St. Cloud Times (Minn.) (tiered subscription model) (5/14)
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Tools & Technology
App to boost L.A. patients' access to imaging data
Children's Hospital Los Angeles will provide its patients with a free imaging application to enable them to view their imaging data such as X-rays, ultrasounds and MRI files. With the use of NexGenic's ImageInbox, parents of CHLA patients can access the records and transmit them to other providers securely. The app is also expected to cut down on unnecessary imaging tests, which will also cut children's unnecessary exposure to radiation. (5/20)
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Large practices have smaller EHR pool than small practices, survey finds
An AmericanEHR Partners survey found that physician practices with at least 26 clinicians choose from a narrower pool of EHR systems than practices with one to three clinicians. The survey showed that 51% of small practices are using an EHR product from one of the vendors listed in the top 10 by AmericanEHR Partners, compared with around 60% of large physician practices that are using one of those systems. (5/20)
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Medical News
Researchers link childhood bullying to health problems in adulthood
A British study published in the journal Psychological Medicine found that adults who experienced bullying when they were ages 7 and 11 were more likely to become obese, overweight and have blood inflammation later in life, compared with those who were never bullied. The study involved over 7,100 people born in England, Scotland and Wales. HealthDay News (5/20)
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Metabolic syndrome increases mortality risk from CVD
Adults with metabolic syndrome had about a twofold increased likelihood of dying of cardiovascular disease, compared with those without the syndrome, according to a Korean study in The Journal of Clinical Endocrinology & Metabolism. Higher mortality risk was observed among women with metabolic syndrome and people with diabetes and high blood pressure, researchers said. (5/21)
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-- Peter Drucker,
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