La. doctors charged in Medicare fraud, kickback scheme | Pa. man gets 6 years for operating prescription drug ring | Wash. pharmaceutical exec sentenced for role in bribery scheme
February 12, 2018
NHCAA SmartBrief
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La. doctors charged in Medicare fraud, kickback scheme
Louisiana-based psychiatrists Muhammad Arshad and Padmini Nagaraj are both facing multiple counts of health care fraud and other charges on allegations of accepting illegal kickbacks from a New Orleans-based home health agency in return for referring patients for medically unnecessary services. Joseph Haynes, a marketer affiliated with the doctors, was also charged over his role in the scheme, which allowed the agency's operators to submit fraudulent claims to Medicare, authorities say.
The Times-Picayune (New Orleans) (2/10) 
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Law Enforcement & The Courts
Pa. man gets 6 years for operating prescription drug ring
Barry Dorsey of Pittsburgh received a prison sentence of more than six years plus three years of supervised release and was ordered to pay around $3,500 in fines after being convicted of aggravated identity theft and health care fraud conspiracy. Dorsey was found guilty of running a prescription drug ring that involved forging prescriptions, mostly for oxycodone and Percocet, and selling the fraudulently obtained drugs on the streets.
Tribune-Review (Pittsburgh) (2/9) 
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Wash. pharmaceutical exec sentenced for role in bribery scheme
Todd Clawson, a former executive of Westport, Conn.-based Advanced BioHealing, was ordered to serve three years of probation after pleading guilty in 2014 to health care fraud, bribery and conspiracy to commit criminal conflicts of interest. Authorities say Clawson provided kickbacks and gratuities to clinicians and podiatrists connected with the Department of Veterans Affairs in return for promoting Dermagraft, a biologic wound dressing for diabetes-related foot sores.
SeattlePI (2/9) 
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Pa. dentist accused of unlawful drug distribution
Christopher Bereznak, a dentist from Wyoming County, Pa., was charged with multiple counts of unlawful distribution and dispensing of a controlled substance over allegations that he improperly prescribed or dispensed oxycodone, carisoprodol and other medications to a woman he had a romantic relationship with between June and July 2016. Bereznak's license was suspended last year by the state Board of Dentistry pending a hearing on the case.
The Citizens' Voice (Wilkes-Barre, Pa.) (2/8) 
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Policy & Regulatory News
Tools & Technology
Algorithm predicts hypertension based on EHR data
Researchers describe in the Journal of Medical Internet Research an algorithm that accurately predicted the onset of hypertension within one year based on patients' EHR data. Risk factors associated with hypertension included type 2 diabetes, cardiovascular disease, lipid disorders, mental health issues, clinical utilization and some socioeconomic factors.
Clinical Innovation + Technology online (2/8) 
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Health Insurance Industry News
State-based exchanges saw slight gain in ACA enrollment
States that partially or fully operate their own exchanges saw a 0.2% increase in Affordable Care Act plan enrollment over the previous year, while those states that relied entirely on the federal marketplace saw signups decline by 5.3%, according to data issued by the National Academy of State Health Policy. Overall, the number of Americans who enrolled for 2018 coverage dropped 3.7% to around 11.8 million as increases in state-based exchanges failed to offset losses on the federal marketplace, suggesting that the Trump administration's decision to slash ACA outreach and end cost-sharing reduction payments hurt enrollment.
Kaiser Health News (2/7),  The Hill (2/8) 
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Medical News
Coding Clinic webinar
On Feb. 15, speakers will demonstrate how revenue-generating tests and procedures are often billed together to maximize revenue for the provider or facility. Learn specific code sets to use for data mining, along with documentation criteria for the high-risk codes using a variety of examples from specialty areas including radiology, behavioral health, chiropractic, oncology, as well as general practice. Register today!
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Review the training NHCAA is offering in 2018 to enhance your investigative skills and provide professional advancement. Registration is open!
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