3 N.Y. hospitals, management firm settle Medicaid fraud allegations for $8M | Former Va. rehab center operators sentenced in health care fraud | 52 defendants convicted in 4-year prescription, kickback case
August 26, 2015
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3 N.Y. hospitals, management firm settle Medicaid fraud allegations for $8M
SpecialCare Hospital Management, along with Hudson, N.Y.-based Columbia Memorial Hospital, Yonkers, N.Y.-based St. Joseph’s Medical Center and Kingston, N.Y.-based Benedictine Hospital, will pay a combined $8 million to resolve accusations of improperly billing the New York Medicaid program. The hospitals were accused of submitting claims for unlicensed and unnecessary substance abuse services from 2002 to 2005, while the Missouri-based management firm was accused of accepting kickbacks in exchange for patient referrals. The organizations agreed to the settlement without admitting wrongdoing. The Washington Times/The Associated Press (8/24), BeckersHospitalReview.com (8/24)
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Former Va. rehab center operators sentenced in health care fraud
Avi Klein of Miami Beach, Fla., and Alicia Dietrich of Lancaster, Ohio, former operators of the now-defunct Brian Center Health and Rehabilitation Center in Weber City, Va., were sentenced Monday for federal racketeering. Klein and Dietrich were accused of working with others to submit fraudulent claims to Medicare and Medicaid, as well as operating the health center without adequate staff and supplies, court records show. Klein and Dietrich were both ordered to serve five years of federal probation and pay fines, and Klein must also pay $419,050 in restitution. Kingsport Times-News (Tenn.) (8/25)
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52 defendants convicted in 4-year prescription, kickback case
A four-year prescription drug investigation has ended in the convictions of 52 out of 54 defendants. The scheme involved doctors who provided false prescriptions and patient referrals in return for kickbacks and pharmacists who provided prescription drugs including OxyContin and Xanax. MLive.com (Michigan) (free registration) (8/24)
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Vt. psychiatric hospital under probe for Medicaid fraud
The Brattleboro Retreat, a private psychiatric hospital in Vermont, is under investigation for alleged Medicaid fraud after a whistleblower complaint was filed by a former employee. The hospital is accused of failing to refund overcharges, instead altering patient accounts to reflect a zero balance when overcharges appeared, according to the whistleblower's complaint. San Francisco Chronicle (free content)/The Associated Press (8/24)
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Policy & Regulatory NewsSponsored By
Federal court stays ruling on birth control under ACA
The U.S. Court of Appeals for the 10th Circuit says the Little Sisters of the Poor and four Christian colleges in Oklahoma do not have to comply with a ruling on the Affordable Care Act's birth-control mandate until the Supreme Court determines whether to consider the matter. The institutions say their religious convictions prevent them from allowing third parties to provide birth-control coverage to their employees. The Gazette (Colorado Springs, Colo.)/The Associated Press (8/21)
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CMS offers producer training, ID acquisition through the same system this year
Health insurance producers who want to work through HealthCare.gov will be able to use the same system for training and obtaining their producer identification this year, CMS officials say. New and returning producers will be required to register once the new system is operational. Producers may instead pay approved private vendors for training. National Underwriter Life & Health (8/24)
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Tools & Technology
Health care sector struggles to put its cyberhouse in order
The $3 trillion health care industry is expected to face an onslaught of cyberthreats this year as experts scramble to address a record number of attacks attempting to steal patient data. ABI Research estimates that this is likely to push health care cybersecurity spending to $10 billion by 2020, which is roughly what the financial sector plans to spend this year. Information-Age.com (8/25)
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5 drivers of health IT priorities in 2016
Dr. John Halamka, chief information officer at Harvard Medical School, identifies five key issues affecting the priorities of stakeholders in 2016: demand is increasing for support of personal software and devices; clinicians need better data-capture tools; the demand for IT resources and tools is outstripping the supply; IT departments need time and space to focus on user's needs and not federal regulations; and the cloud is where people want to work. MedCityNews.com (8/23)
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Medical News
Pediatric imaging use shifts away from CT
There was a nearly 50% decrease in CT utilization for evaluation of children with seizures from 2004 to 2012, according to a 33-hospital study reported in Pediatrics. Overall imaging is up for nearly all of 10 clinical scenarios studied, but clinicians appear to be gravitating toward ultrasound and MRI, which do not use ionizing radiation. Experts caution that factors other than radiation should be considered, such as the possible need for sedation when using MRI, and the operator-dependent nature of ultrasound. HealthDay News (8/24)
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More elderly patients taking statins as prevention despite lack of evidence
Many patients older than 79 who do not have heart disease are being prescribed statins for the prevention of vascular disease despite a lack of evidence supporting the practice, researchers report in JAMA Internal Medicine. About 34% of very elderly patients were using a statin as primary prevention in 2011-2012, compared with nearly 9% in 1999-2000. HealthDay News (8/24)
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Join experts from Truven Health Analytics™ on Tuesday, Sept. 15, as they highlight some of their clients' success stories in fighting fraud, and reveal the secret recipes that helped find aberrant billing practices and suspicious recipient behavior. Register now.
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