Report: $3.3B recovered from federal health care fraud cases in fiscal 2014 | Adventist Health settles Medicare, Tricare fraud allegations for $5.4M | Business owner, physician face health care fraud charges

March 20, 2015
NHCAA SmartBrief

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Report: $3.3B recovered from federal health care fraud cases in fiscal 2014
A total of $3.3 billion worth of fraudulent health care payments were recovered in fiscal 2014, according to the Department of Justice and HHS. The report, released Thursday, shows that an average of $7.70 was recovered for every dollar spent on health care fraud investigation expenses over the past three years. A total of 924 new criminal health care fraud investigations were opened by the Department of Justice in fiscal 2014, and 734 individuals were convicted of crimes related to health care fraud, the report says. The Wall Street Journal (tiered subscription model) (3/19), Modern Healthcare (tiered subscription model) (3/19)
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10 ways to inspire creativity in your staff.
Fostering creative business practices isn't as hard as it seems and can lead to smart solutions. Use these ten techniques to help inspire and encourage creativity in your staff. Read the article and learn 10 ways to get the creative juices flowing.

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Adventist Health settles Medicare, Tricare fraud allegations for $5.4M
Adventist Health System, the parent company of Florida Hospital, has agreed to pay the federal government $5.4 million to resolve allegations of defrauding Medicare and Tricare. The company was accused of not providing proper supervision by qualified clinicians during radiation-oncology services at eight Florida Hospital locations between January 2010 and December 2013, according to the government. No determination of liability was made. Orlando Sentinel (Fla.) (tiered subscription model) (3/19)
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Business owner, physician face health care fraud charges
James Hatzimbes, owner of DME Plus, and Richard Rydze, a former physician for the Pittsburgh Steelers, were indicted on 16 counts of health care fraud. Hatzimbes allegedly used his business to recruit Rydze and other physicians and chiropractors to write false prescriptions for nerve stimulation machines, according to the indictment. The scheme targeted beneficiaries of Highmark and UPMC insurance and netted almost $4 million between 2007 and 2012 from Highmark alone. Pittsburgh Post-Gazette (3/19)
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La. woman accused of falsely billing Medicaid
Diana Brownlee of Tangipahoa Parish, La., was arrested Tuesday on suspicion of billing Medicaid for unprovided services. Brownlee, a direct service worker, submitted fraudulent time sheets for hours she claimed to have worked simultaneously at two separate personal care agencies from March 2012 to June 2014, according to investigators. She was charged with felony Medicaid fraud. The Washington Times/Associated Press (3/19), WAFB-TV (Baton Rouge, La.) (3/18)
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How to Achieve IT Agility: A Survival Guide for IT Decision Makers
When business teams add new apps and services to already-strained networks, IT departments are accountable for making everything work. Is your team ready for this challenge? Read this eGuide to learn how IT teams are automating their networks, why they're utilizing Ethernet fabrics and SDN, and what success looks like as they regain network control and business relevance.

Policy & Regulatory News
Bipartisan legislation seeks to repeal SGR formula
More than 750 medical groups signed a letter to Congress urging repeal of the sustainable growth rate formula. Congressional leaders on Thursday announced a bipartisan plan that repeals the SGR and introduced bills in the House and Senate that would provide for a 0.5% payment update each year for five years. (3/17), Modern Healthcare (tiered subscription model) (3/19), CNN (3/19)
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Budget plans call for Medicare cuts
A Senate Republican budget proposal includes greater cost reductions for Medicare than a House plan released Tuesday but would not convert the program into a voucher-like system for future retirees. The Senate plan would cut $431 billion from Medicare over a 10-year period. PBS/The Associated Press (3/18)
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Tools & Technology
Phishing attack compromises data of 14,000 patients
A data breach affecting as many as 14,000 people has been reported by Florida-based Sacred Heart Health System after its billing vendor was subject to a phishing attack, resulting in unauthorized access to an employee's e-mail account. Compromised data included patient names, physician names, diagnosis and procedure information, as well as at least 40 people's Social Security numbers. The Huntsville Times (Ala.) (3/18)
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Google files patent for wristband that could attack Parkinson's, cancer cells
A patent for a wristband that could be used to help patients with cancer and Parkinson's disease was recently filed by Google with the World Intellectual Property Organization. According to the patent, a magnet will be used to supply energy to the wearable device that will target and change or eliminate cells and proteins that cause the diseases. The company has not yet developed or tested the device. (3/19), International Business Times (3/18)
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Medical News
Study: Routine imaging for back pain does not benefit seniors
A study in the Journal of the American Medical Association found that early diagnostic imaging, including magnetic resonance imaging and computed tomography scans, for back pain among seniors was not associated with improved pain and function outcomes after one year. The study included data on more than 5,200 U.S. adults older than 65. HealthDay News (3/17)
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Early habits influence heart health in adulthood
Approximately 90% of nearly 9,000 children had healthy blood pressure levels, but fewer than 1% were eating a healthy diet and 40% had poor cholesterol levels, according to a study based on the 2003-2010 National Health and Nutrition Examination Survey. Although children started with good BP levels, poor diet can trigger greater body mass index and cholesterol levels, lead researcher Donald Lloyd-Jones said. The findings appear in the journal Circulation: Cardiovascular Quality and Outcomes. HealthDay News (3/17), (3/17)
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For updates related to NHCAA educational opportunities, news related to health care fraud and more, follow @NHCAA on Twitter or Facebook.
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Find new job opportunities with NHCAA Career Connection
If you're looking for a new challenge in your current field, or are interested in exploring something different, it can't hurt to take a look at the wide variety of positions posted on NHCAA Career Connection. You'll never know until you look.
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