Pfizer to pay $785M to settle Medicaid discount case | Calif. physician admits to $2.4M Medicare fraud | Idaho woman receives suspended sentence for prescription fraud
April 29, 2016
NHCAA SmartBrief
Top Story
Pfizer to pay $785M to settle Medicaid discount case
Pfizer agreed to pay nearly $785 million to settle charges that its Wyeth unit, which Pfizer acquired in 2009, did not give the same discounts to Medicaid that it gave to hospitals on two versions of its acid reflux drug Protonix.
ABC News/The Associated Press (4/27),  Boston Herald (4/27) 
Law Enforcement & The Courts
Calif. physician admits to $2.4M Medicare fraud
Gary Ordog of Valencia, Calif., a doctor who specializes in toxicology, pleaded guilty Thursday to federal health care fraud for his role in defrauding Medicare out of more than $2.4 million. Ordog admitted to fraudulently billing the program for unprovided patient visits, for services provided on patients who later died and for services allegedly provided while he was not in the country.
The Signal (Santa Clarita Valley, Calif.) (4/28) 
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Idaho woman receives suspended sentence for prescription fraud
Ashley Eagle of Bonneville County, Idaho, was sentenced to 48 days and ordered to serve two years of probation for prescription fraud after her original sentence of two years, with one year fixed and one indeterminate, was suspended. Eagle was convicted for attempting to obtain fraudulent Tramadol prescriptions, to which she had become addicted following a back injury.
Rexburg Standard Journal (Idaho) (4/28) 
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N.J. anesthesiologist accused of Medicare fraud stripped of license
Amgad Hessein, an anesthesiologist from Belmar, N.J., who is facing charges for an alleged $1.5 million Medicare fraud scheme, had his medical license revoked. Hessein's license was suspended in 2011 when he was named in an indictment for allegedly overbilling and upcoding the claims his clinic, Advanced Pain Management Specialists, submitted to Medicare. (Morristown, N.J.) (4/28) 
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Policy & Regulatory News
Lawmakers introduce bill to improve cybersecurity at HHS
House Energy and Commerce Committee members Billy Long, R-Mo., and Doris Matsui, D-Calif., have introduced the HHS Data Protection Act, which seeks to improve HHS cybersecurity. The legislation calls for the creation of the Office of the Chief Information Security Officer, which would be responsible for information security at HHS' headquarters and at its operating divisions.
Health IT Security (4/27) 
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Senator proposes cap on Medicare drug cost-sharing
The amount Medicare beneficiaries spend for prescription drugs each year would be capped under a bill proposed by Sen. Ron Wyden, D-Ore. Insurers say that limiting out-of-pocket spending does nothing to address high drug prices and only raises costs elsewhere.
Morning Consult (4/27) 
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Tools & Technology
Survey: Providers want EHRs to include electronic prior authorization
A Surescripts survey revealed that about 64% of health care providers want EHR vendors to provide integrated electronic prior authorization capabilities in their systems. The functionality, which is not yet standard, could help providers save time and improve quality of care, said Surescripts' Joe DeLisle.
EHR Intelligence (4/26) 
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Communication platform for joint replacement surgery unveiled by Stryker
The JointCOACH digital patient engagement and education platform has been introduced by Stryker. The Web-based communication platform, intended to improve patient care and experience in joint replacement surgeries, allows for communication between patients and their hospital care teams from the time of surgery to 90 days after hospital discharge. (Boston) (4/27) 
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Health Insurance Industry News
Claims data analysis shows wide variation in medical procedure prices
(Dominique Faget/AFP/Getty Images)
Prices for common medical services vary widely from state to state, according to an analysis of claims data by the Health Care Cost Institute. The difference may be especially pronounced in areas with a shortage of health care providers or a highly consolidated health care system, say HCCI Executive Director David Newman and the Kaiser Family Foundation's Cynthia Cox.
NBC News (4/27),  National Public Radio (4/27) 
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Medical News
Study links diabetes, obesity to psoriasis
Type 2 diabetes patients had a more than 50% increased risk of having psoriasis than those without diabetes, according to a study in the journal JAMA Dermatology. Danish researchers analyzed data on almost 34,000 twins, ages 20 to 71, and found that those with psoriasis were more likely to be obese, compared with those without the skin condition.
HealthDay News (4/27) 
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NAFLD may be risk factor for early CVD, death, study says
Data from a retrospective study published in the Journal of Hepatology suggested nonalcoholic fatty liver disease may be a risk factor for early cardiovascular disease and mortality. Experts writing an accompanying editorial said the data were not surprising because NAFLD usually is found in a "milieu of disturbed metabolism, including increased total body adiposity, insulin resistance, impaired glucose tolerance and dyslipidemia."
Healio (free registration) (4/26) 
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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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Ralph Waldo Emerson,
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