Psychiatrist indicted over suspected Medicare, Medicaid fraud | Physicians, chiropractor face kickback, fraud charges | Ill. resident admits to defrauding Medicaid
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October 17, 2014
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Psychiatrist indicted over suspected Medicare, Medicaid fraud
Robert Gross, a psychiatrist in San Angelo, Texas, was arrested Wednesday and charged with 52 counts of health care fraud over allegations of defrauding Medicare and the state's Medicaid program of more than $1.7 million. Gross is accused of submitting claims for unprovided services and using incorrect billing codes to get higher reimbursements, according to the indictment. Houston Chronicle (tiered subscription model)/The Associated Press (10/16)
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Law Enforcement & The Courts
Physicians, chiropractor face kickback, fraud charges
Officials have charged six doctors and a chiropractor with health care claims fraud and commercial bribery over their alleged roles in a kickback case. The medical professionals, who are from New Jersey and New York, are accused of accepting kickbacks in exchange for referring patients to New Jersey-based Diagnostic Imaging Affiliates. Among those charged is East Orange doctor Alexander Salerno, who allegedly made over $1 million worth of scan referrals to the center, according to investigators. The Star-Ledger (Newark, N.J.) (10/16)
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Ill. resident admits to defrauding Medicaid
Quincy Gamble, a resident of Cahokia, Ill., on Thursday pleaded guilty to charges of defrauding the state Medicaid program from December 2012 through March 2014. Gamble billed Medicaid for unprovided personal assistant services he claimed to have rendered to his girlfriend, court documents say. Gamble is scheduled for sentencing on Feb. 15 and faces a maximum of 10 years of imprisonment. KSDK-TV (St. Louis) (10/16)
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Policy & Regulatory News
ONC privacy panel undergoes overhaul
The ONC's Privacy and Security Tiger Team has relaunched itself as the Privacy and Security Workgroup. The panel includes new members and has plans to develop recommendations addressing legal and technical aspects of big data privacy, stage 3 meaningful use and the ONC's 10-year Interoperability Roadmap. (10/15)
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Tools & Technology
Poll finds higher EHR satisfaction among mobile users
A survey by Software Advice revealed more than 50% of clinicians who used a mobile device to access EHRs said they were "very satisfied" with the technology, compared with 28% who did not use mobile tools for access. Overall, 26% of EHR users were accessing the systems via tablet or smartphone. Healthcare Informatics online (10/16)
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E-mail hacking compromises data of patients in Calif.
A potential data breach was recently reported by the University of California, Davis, Health System after an unknown person hacked into the e-mail account of one of its providers. Compromised patient data include provider referrals and scheduled appointments. The health system confirmed that no Social Security numbers or financial data were available in the e-mail account. (10/14)
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Health Insurance Industry News
Part D subsidy boosts adherence to breast cancer drugs
Medicare Part D subscribers who are also in the Extra Help program are more likely to adhere to prescribed hormone therapy after breast cancer surgery than their peers who are not, according to a study to be presented at an American Society of Clinical Oncology meeting. Adherence rates among women in the Extra Help program were 71% for both whites and Hispanics and 67% for blacks, compared with 62% for whites and 55% for Hispanics and blacks not in the program. HealthDay News (10/15)
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Medical News
Genetic test identifies patients at risk of atrial fibrillation and stroke
Scientists have developed a test that screens for 12 genetic variants to determine risk of ischemic stroke and atrial fibrillation, according to a study in the journal Stroke. Adding the genetic score to risk models for atrial fibrillation could help correctly assess when anticoagulants are needed, particularly among patients younger than 65. Healio (free registration)/Cardiology Today (10/15)
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WHO report raises concern over increasing consumption of energy drinks
The increased consumption of energy drinks raises concerns for excess caffeine intake, particularly among children, which could lead to a serious public health problem in the future, according to a World Health Organization report published in the journal Frontiers in Public Health. "From a cautionary viewpoint, further research and policy action is necessary to minimize the risk of harm from heavy and long-term energy drink consumption," the report said. Medical News Today (10/15)
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Complimentary webinar -- Converging Data & Action to Prevent Fraud
In this 60-minute webinar, faculty with Verisk Health will explore various types of data mining, the analytics Verisk is building to leverage that data and will provide a client's perspective on using actionable data and best practices to stay ahead of the latest schemes in healthcare fraud. Register for this free Oct. 22 webinar today.
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Anti-Fraud Solutions: White papers, case studies and articles
The NHCAA Fraud Solutions Resources Web page contains information on eligibility fraud, payment policy optimization, various health care anti-fraud case studies and a deeper examination of some of the best solutions available for the industry today.
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People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in, their true beauty is revealed only if there is a light from within."
-- Elisabeth Kubler-Ross,
American psychiatrist
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