Tenn. physicians admit involvement in $65M Tricare fraud case | Mo. health care firm settles Medicare fraud accusations for $525K | Texas physician accused of unlawful drug distribution
April 12, 2018
NHCAA SmartBrief
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Tenn. physicians admit involvement in $65M Tricare fraud case
Cleveland, Tenn.-based physicians Carl Lindblad and Susan Vergot pleaded guilty to conspiracy to commit health care fraud over their involvement in a $65 million Tricare fraud scheme. Authorities accused Lindblad and Vergot of receiving kickbacks in exchange for prescribing thousands of expensive compounded drugs to Tricare beneficiaries from December 2014 to May 2015 without conducting medical exams, which allowed pharmacies run by co-conspirators to submit $65,679,512 worth of fraudulent claims to Tricare.
The Tennessean (Nashville) (tiered subscription model) (4/11) 
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Case Study: Claims Intelligence helps identify and prevent prescription fraud.
The health plan saw something suspicious in one doctor's prescribing patterns. Their fraud investigators used LexisNexis® Intelligent Investigator to analyze medical and pharmacy claims to get the precise intelligence they needed. Download the case study to learn more.
Law Enforcement & The Courts
Mo. health care firm settles Medicare fraud accusations for $525K
Gamma Healthcare, a Poplar Bluff, Mo.-based firm offering laboratory and other services to physicians and nursing homes, and the company's owners, Jerrod and Jerry Murphy, agreed to pay $525,000 to resolve accusations of defrauding Medicare. Authorities accused Gamma of submitting inflated claims to Medicare for mileage fees related to specimen pick-ups.
St. Louis Post-Dispatch (4/11) 
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Texas physician accused of unlawful drug distribution
Thomas Easter, a doctor from El Paso, Texas, could face a maximum five-year prison term after being charged with conspiracy to distribute Xanax and other drugs outside the medical field. Easter and his co-defendant, Elizabeth Lightfoot, are accused of selling prescription drugs including Xanax to individuals who were not their patients, authorities say.
KFOX-TV (El Paso, Texas) (4/11) 
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Woman suspected of TennCare fraud, illegal sale of hydrocodone
Betty Russell, a resident of McMinn County, Tenn., was recently arrested and charged with TennCare fraud, conspiracy to sell and deliver a schedule II controlled substance, and sale and delivery of a schedule II controlled substance. Russell fraudulently obtained hydrocodone using her TennCare benefits, then sold some of the drugs to an undercover officer, authorities say.
The Daily Post-Athenian (Athens, Tenn.) (4/11) 
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Policy & Regulatory News
Tools & Technology
CVS tool alerts pharmacists when cheaper medications are available
CVS tool alerts pharmacists when cheaper medications are available
(Joe Raedle/Getty Images)
CVS Health has developed a new tool to alert pharmacists when more affordable drug options are available to patients as they fill prescriptions. CVS Pharmacy's Rx Savings Finder flags less costly therapeutic equivalents, and pharmacists who see an alert then ask patients for permission to talk with prescribers about switching to the cheaper medication.
The Washington Post (tiered subscription model) (4/11) 
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Privacy concerns hinder patients' access to online medical records
The ONC evaluated National Cancer Institute survey data and found that although 52% of US individuals were given access to their online medical records in 2017, only 53% of them accessed their records once or more in the past year, and 25% did not access their records because of concerns about security or privacy. Respondents also cited not needing to use their online records, preferring to speak directly with their clinician, and lack of access to the website as reasons for not accessing their records.
Health IT Security (4/9) 
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Medical News
Webinar: Intensive outpatient therapy
On April 19, discuss how intensive outpatient therapy schemes operate, detection methods and red flags, investigative strategies, and steps to prevent fraud in this area. Speakers will utilize case study examples to help participants recognize these schemes in their own cases. Register today.
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Register for the 2018 Rising Trends conference
NHCAA's Rising Trends program, scheduled June 19-21 in Baltimore, consists of three one-day programs on trending issues in health care: Outpatient Facility Fraud, Examining Emerging Trends, and Abusive Pharmaceutical Practices. Travel to one location and participate in three unique, intense training programs. Registration is open!
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