Fla. ex-physician admits to $1.1M Medicare fraud | Former Ky. clinic manager gets 20 months for health care fraud | 4 Vt. residents sentenced for defrauding Medicaid
August 22, 2016
NHCAA SmartBrief
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Fla. ex-physician admits to $1.1M Medicare fraud
John Christensen, a former pain physician from Palm Beach County, Fla., entered a guilty plea Thursday to conspiracy to commit health care fraud over his role in a $1.1 million Medicare fraud scheme. Christensen admitted to conspiring with chiropractor Joseph Wagner to fraudulently bill Medicare and improperly prescribing narcotics that allegedly led to two patient deaths, according to authorities.
Sun-Sentinel (Fort Lauderdale, Fla.) (8/19) 
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Law Enforcement & The Courts
Former Ky. clinic manager gets 20 months for health care fraud
Kelly Lenning, former medical office manager for Louisville, Ky.-based Injury Rehab Specialists, was sentenced to a 20-month prison term after pleading guilty to health care fraud and aggravated identity theft. Lenning used the DEA numbers of formerly employed nurse practitioners to obtain hydrocodone prescriptions for personal use and instructed two people with private insurance to fill the illegal prescriptions, officials say.
U.S. Department of Justice/The Associated Press (8/19) 
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4 Vt. residents sentenced for defrauding Medicaid
Karen Tucker of Swanton, Vt., was sentenced to serve one year in jail and pay restitution of nearly $100,000 after pleading guilty to submitting false time sheets to the state Medicaid program's Children's Personal Care Program. Three other women from Vermont were also convicted over their roles in the scheme and were given suspended sentences.
WCAX-TV (Burlington, Vt.)/The Associated Press (8/19) 
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Miss. nurse faces Medicaid, prescription fraud charges
Timothy Jones, a registered nurse from Meridian, Miss., was indicted on charges including Medicaid fraud and acquiring or obtaining possession of a controlled substance by fraud. Jones allegedly stole prescription medication intended for a Medicaid beneficiary in his care at East Mississippi State Hospital, according to authorities.
WTOK-TV (Meridian, Miss.) (8/19) 
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Policy & Regulatory News
CMS proposes restricting 3rd-party insurance premium payments
The CMS is seeking comments on a proposal to limit third-party payments of health insurance premiums and out-of-pocket expenses by health care providers or associated groups. Some providers have been accused of helping pay premiums for people who would have otherwise qualified for Medicaid or Medicare in an effort to gain higher reimbursements.
Reuters (8/18) 
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Calif. senator withdraws drug bill
California state Sen. Ed Hernandez, D-West Covina, withdrew a bill that would have required health plans to report drug costs to the state and would have required drugmakers to notify payers of future price increases. A measure that would limit how much state programs can pay for drugs will be on the state ballot in November.
Los Angeles Times (tiered subscription model) (8/18) 
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Tools & Technology
Robust legal framework needed for telehealth, report says
Telehealth could improve health care quality and reduce costs, particularly in underserved areas, but it lacks a uniform legal approach that addresses risks, according to a policy brief published in Health Affairs. Areas of concern include the effects of telehealth on provider-patient relationships, quality of health information, physician licensure, reimbursements and patient privacy.
PhysiciansBriefing.com/HealthDay News (8/18) 
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La. expands ED data registry after pilot program succeeds
One year after Louisiana launched a statewide direct-to-consumer patient engagement campaign and an emergency department data registry, health IT use among at-risk patients has risen 23% and non-emergent emergency department use has declined 10.2% in a Medicaid managed care organization participating in a pilot project. Louisiana will expand the model to all Medicaid MCO plans and will allow commercial health plans and self-funded employers to join.
Healthcare IT News (8/19) 
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Medical News
Study finds gallstones may increase heart disease risk
People who have had gallstones may have a higher risk of heart disease, particularly women, according to a study in the journal Arteriosclerosis, Thrombosis and Vascular Biology. Researchers said changes in the gut microbiome and low-grade inflammation may be factors.
HealthDay News (8/18) 
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Minorities at higher risk of complications from knee replacement
A study published in the Journal of Bone and Joint Surgery found that minority groups have a higher likelihood of experiencing complications and in-hospital death after knee replacement procedures than white patients. There are over 600,000 knee replacements in the US each year, and minority patients are less likely to have the surgery than white patients.
HealthDay News (8/18) 
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Complimentary webinar sponsored by Verisk Health
Join us on Wednesday, Aug. 31, for the Spotting Wasteful or Abusive Claims Hidden in Plain Sight webinar, sponsored by NHCAA Platinum Supporting Member Verisk Health. Presenters will explore how to address all types of erroneous claims, specifically focusing on the latest examples of improper payment of clinically complex claims and the issues inherent in those complex claims. Register today!
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2016 Annual Training Conference returns to Atlanta in November
Our largest NHCAA Annual Training Conference ever, this year's program features over 60 unique sessions addressing key areas of focus for SIU teams. ATC provides expanded programming that is unmatched. There is truly something for everyone at the ATC.
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