Texas nurse found guilty in $8M scheme to defraud Medicare | Pa. sports broadcaster admits guilt in $3.6M health care fraud scheme | Owner of N.Y. nonprofit accused in $5M Medicaid fraud
July 20, 2016
NHCAA SmartBrief
Top Story
Texas nurse found guilty in $8M scheme to defraud Medicare
Ann Anyanwu, a registered nurse from Houston, was found guilty Tuesday by a federal jury for her involvement in a scheme to defraud $8 million from Medicare. Anyanwu was convicted of fraudulently billing Medicare for services allegedly provided through Medpsych Home Health Care.
The Bryan-College Station Eagle (Texas)/The Associated Press (7/19) 
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Law Enforcement & The Courts
Pa. sports broadcaster admits guilt in $3.6M health care fraud scheme
Peter Pappas, a resident of Drexel Hill, Pa., and a professional soccer broadcaster, pleaded guilty Tuesday to conspiracy to commit health care fraud over his role in a kickback scheme that cost federal and private insurers $3.69 million or more. Pappas admitted to accepting $481,773 in kickbacks in exchange for filling unnecessary compounded prescriptions for himself and recruiting others, including Tricare beneficiaries, into the scheme, prosecutors say.
The Philadelphia Inquirer/The Associated Press (7/20),  American City Business Journals/Philadelphia (7/20) 
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Owner of N.Y. nonprofit accused in $5M Medicaid fraud
Joseph Wright, a resident of Middletown, N.Y., was indicted Tuesday on a second-degree insurance fraud charge. Wright, owner and operator of nonprofit Assistance By Improv II in Bronx, N.Y., and his staff of eight physicians allegedly ordered clients to undergo unnecessary medical tests that were falsely billed to Medicaid, costing the program over $5 million in improper reimbursements, according to prosecutors.
Times Herald-Record (Middletown, N.Y.) (tiered subscription model) (7/19) 
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Conn. doctor faces Medicaid fraud charges
Sheikh Ahmed, a pediatric and family physician based in Rocky Hill, Conn., on Tuesday was indicted on charges including health insurance fraud and identity theft. Ahmed, operator of Meriden Health Care Center, is accused of submitting around $25,000 in false claims to Medicaid from April 2013 to April 2015 using other medical providers' information after he was banned from participating in the program, authorities say.
Record-Journal (Meriden, Conn.) (7/19) 
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Policy & Regulatory News
Republican Party releases health care platform
Delegates to the Republican Party convention will vote on a platform that promises to repeal the Affordable Care Act, turn Medicaid into a capped state block-grant program, transform Medicare into a "premium support model," and give people younger than 55 years old an "income-adjusted contribution toward a plan of their choice, with catastrophic protection." The platform also promises to roll back state insurance benefit mandates, limit non-economic damages for medical malpractice, allow health insurance to be sold across state lines and expand health savings accounts.
Modern Healthcare (tiered subscription model) (7/18) 
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Bill seeks to cut health IT costs for clinicians in rural areas
A bill that aims to help rural hospitals and physicians reduce their operating costs when implementing health IT within their organizations has been introduced by Sen. Al Franken, D-Minn. The legislation would increase the broadband-related discounts given to rural providers by the Federal Communications Commission from 65% to 85%, require the FCC to improve the rural discount program's application process and allow it "to further reduce cost sharing for health care providers in tribal areas," according to a news release.
Modern Healthcare (tiered subscription model) (7/18) 
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Tools & Technology
Report shows health care industry's lack of cyberdefenses
(Sean Gallup/Getty Images)
A Ponemon Institute study showed that health care is one of the least prepared industries in the event of a cyberattack, with only 16% of IT and IT security professionals reporting having a formal process to monitor the internet and social media, compared with 26% in the financial services sector. Security experts from the health care and other sectors cited the lack of staff expertise and technology as key reasons organizations fail to detect cyberattacks.
Healthcare IT News (7/18) 
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Technology helps small, rural hospitals meet operational challenges
Small, rural hospitals in Wisconsin face staffing, training and other challenges not seen in urban facilities, but they continue to get high quality and patient satisfaction ratings. Technology is important to the success of smaller facilities, such as St. Clare Hospital, which has a telehealth program allowing physicians in St. Louis to help care for patients in the ICU.
The Eagle (Sauk City/Prairie du Sac, Wis.) (7/18) 
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Medical News
Women still need bone mineral density tests after osteoporosis therapy
Canadian researchers followed over 6,600 women who were prescribed drugs for osteoporosis and found that 19% experienced decreases in hip bone mineral density after starting medication, while about 30% had increases in density. The study in the Annals of Internal Medicine, which also found a higher fracture risk among women who had a decrease in hip bone mineral density, suggests the need for women to undergo bone density screenings even if they are on osteoporosis therapy.
Reuters (7/18) 
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Maternal smoking during pregnancy may reduce sons' fertility
Men born to women who smoked during pregnancy had 19% lower sperm production, compared with those whose mothers didn't smoke, according to a study in the Journal of Clinical Endocrinology & Metabolism. The findings, based on data involving 404 men in their 20s whose mothers were part of a two-decade infant and maternal health study, also showed lower testosterone levels among those born preterm.
International Business Times (7/18) 
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NHCAA education & training heats up this summer
Make time in your summer schedule for two outstanding in-person trainings. Join us in Dallas July 26-28 for the Skills & Schemes for the Health Care Fraud Investigator where you will obtain the investigative skills necessary to conduct successful health care fraud investigations. Then join us August 23-25 in Nashville for three unique programs, Pharmacy & Part D Fraud Issues, Emerging Schemes and Interviewing Techniques.
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Missed the March Boot Camp? Register for September!
NHCAA is hosting a second Health Care Fraud Investigators Boot Camp in 2016. Join us September 20-23 in Chandler, Ariz., to acquire an understanding of the core competencies necessary to combat health care fraud at our intense, three-day Boot Camp program. Register today!
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