S.C. physician practice accused of falsely billing Medicare $9M | Pa. doctor accused of defrauding $2.5M from insurers | Accounting firm for Vt. school settles Medicaid fraud allegations
May 20, 2016
NHCAA SmartBrief
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S.C. physician practice accused of falsely billing Medicare $9M
Family Medicine Centers of South Carolina, based in Columbia, S.C., is accused in a civil fraud lawsuit of overbilling Medicare. The group practice is suspected of inflating its Medicare billings with unnecessary charges for blood and liver tests, which cost the program more than $9 million in improper reimbursements, according to the lawsuit. Stephen Serbin, medical director of the practice, said the practice denies the allegations.
The State (Columbia, S.C.) (5/19) 
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Law Enforcement & The Courts
Pa. doctor accused of defrauding $2.5M from insurers
Samirkumar Shah, a cardiologist from Kittanning, Pa., was indicted on two counts of health care fraud on allegations of operating a scheme to defraud $2.5 million from federal and private insurers. Shah is accused of falsely advertising and offering free external counterpulsation therapy for conditions other than its intended use as an angina treatment, and falsely claiming treated patients were diagnosed with angina, prosecutors say. The alleged scheme occurred between January 2008 and December 2014.
Pittsburgh Tribune-Review (5/19),  U.S. Department of Justice/News release (5/19) 
Accounting firm for Vt. school settles Medicaid fraud allegations
Kushi and Myers PC, a Pittsfield, Mass.-based accounting firm, has agreed to pay $51,618 to the state of Vermont and $53,382 to the Medicaid program for its role in an alleged fraud scheme involving one of its former clients. The firm and the Bennington Schools, a former boarding facility for socially and emotionally challenged students, were accused of submitting false information in reports to determine funding that was partially covered by the Medicaid program, according to the Department of Justice. Kushi and Myers agreed to the settlement without admitting liability.
Bennington Banner (Vt.) (5/16) 
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Former N.C. college football player suspected of Medicaid fraud
Eric Leak, a former North Carolina State University football player, is accused of providing improper benefits to student-athletes and defrauding the Medicaid program. Leak, along with his wife, Emily Leak, allegedly used their behavioral health counseling business to fraudulently bill $8.7 million in unprovided services to Medicaid from 2012 to 2014, according to a search warrant. The Leaks are accused of using the improper reimbursements to purchase and renovate their $1.5 million home, federal authorities say.
WRAL-TV (Raleigh, N.C.) (5/20) 
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Policy & Regulatory News
CMS to modernize Medicaid management information systems
The CMS will invest $5 billion for the development of new systems that would replace the current Medicaid management information systems used in most US states. Vendors Optum Government Solutions, TriZetto and Medecision will upgrade the functions of the existing MMIS systems.
Health Data Management (5/17) 
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ONC issues legislative proposals to support use of data analytics in health care
Several pieces of legislation to promote data standards and big data analytics for health information exchange and interoperability were unveiled by National Coordinator for Health IT Karen DeSalvo and ONC Chief Operating Officer Lisa Lewis. The legislative proposals focus on the elimination of health information blocking, interoperability of health care data between different technologies, increased health care technology transparency, and sharing of best practices to help improve patient experience, hospital safety and hospital quality.
Health IT Analytics (5/17) 
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Tools & Technology
5 telemental health resource centers to be open this summer, VA says
Five telemental health resource centers will be open this summer, with four new centers joining an existing one in West Haven, Conn., the Department of Veterans Affairs announced this week. "These mental health telehealth resource centers will provide our veterans in underserved areas the expert mental health providers they may not otherwise be able to obtain locally," said VA Under Secretary for Health David Shulkin.
Healthcare IT News (5/18) 
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Health Insurance Industry News
Most employers plan to continue offering health coverage
Most employers continue to offer employer-sponsored health insurance, despite questions about whether they would move workers to Affordable Care Act exchanges. A report from Mercer shows that only 5% of large employers said they were likely to stop offering coverage in the coming five years, while among businesses with 50 to 499 employees, 7% said they were likely to stop offering coverage, down from 21% in 2013.
Star Tribune (Minneapolis-St. Paul, Minn.) (5/17) 
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Medical News
Insurers take steps to fight opioid crisis
Health insurers are in a powerful position to help fight prescription drug abuse, says Brandeis University's Dr. Andrew Kolodny, and a number are taking steps to do so. Cigna announced this week it will take measures to help prescribers spot, monitor and appropriately treat high-risk patients, with a goal of cutting prescriptions for opioids by 25%. Blue Cross Blue Shield of Massachusetts started a similar program in 2012, eliminating 21.5 million doses of opioid medicines over three years.
CNN (5/19),  Reuters (5/19) 
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Daytime naps tied to elevated hypertension risk
A meta-analysis of nine studies with more than 112,000 participants found that adults who regularly napped during the day had a 13% increased risk of developing hypertension and studies that specifically assessed daytime napping showed a 19% increased risk of hypertension. However, the risk was reduced 21% in night-shift workers who took nighttime naps. The findings were presented at the American Society of Hypertension annual meeting.
Medscape (free registration) (5/18) 
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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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Your investigative experience deserves to be recognized
Distinguish yourself from the pack with the AHFI designation. For qualifications and to apply, view the AHFI website and FAQ.
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Ronald Osborn,
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