Former DME company operator sentenced to prison for fraud | Mich. physician gets 2-year sentence for defrauding Medicare, Medicaid | Retired Kan. doctor accused of Medicaid fraud
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August 25, 2014
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Former DME company operator sentenced to prison for fraud
Lawrence Tyler, a former durable medical equipment company operator, was sentenced Friday to serve six years in prison for a $2.4 million health care fraud. The Humble, Texas, man was convicted of submitting claims to Medicare and Medicaid for undelivered medical equipment from 2007 to 2008 and improperly collecting approximately $1.2 million in federal reimbursements, prosecutors said. Tyler was also ordered to pay restitution of $1.24 million. San Antonio Express-News/The Associated Press (8/22)
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Law Enforcement & The Courts
Mich. physician gets 2-year sentence for defrauding Medicare, Medicaid
Okemos, Mich.-based doctor Shannon Wiggins received a two-year prison sentence on Friday for accepting kickbacks and conspiring with her husband to defraud public and private health insurers. Wiggins and her husband, Mohamad Abduljaber, referred patients to a physical therapist for unneeded tests in exchange for $100 per referral, documents show. The court also ordered Wiggins to forfeit $550,000 and pay restitution of almost $286,000 to Medicaid and the IRS. (Michigan) (free registration) (8/23)
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Retired Kan. doctor accused of Medicaid fraud
Adnan Ashkar, a retired physician from Leavenworth, Kan., was charged with 12 felony counts, including submitting a false claim to Medicaid, destroying or concealing records and obstructing a Medicaid investigation. Ashkar is suspected of committing most of the crimes from 2012 to 2013, court documents indicate. He was released on $5,000 bond with supervision requirements and is scheduled to appear in court Sept. 19. Leavenworth Times (Kan.) (8/22)
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Policy & Regulatory News
AHRQ releases guide to help improve Medicaid care
The Agency for Healthcare Research and Quality has released a resource designed to support efforts to cut readmissions under Medicaid. The guide is intended to assist acute-care providers in complying with CMS standards and establishing partnerships. (8/22)
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Hospital Compare's fall info update restricted to 2 metrics
The October update of the CMS' Hospital Compare website will be limited to two areas of information -- Medicare Spending per Beneficiary and aggregate payment data -- due to system upgrades, the agency stated. Additional metrics will be updated in December, including data on hospital-associated infections and rates of surgical complications following hip and knee procedures. (8/21)
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Tools & Technology
Premier calls for use of open APIs to boost EHR interoperability
Premier has asked the Senate Committee on Finance to mandate that EHR vendors design open application programming interfaces to boost interoperability and aid providers in enhancing patient care while cutting care costs. In a letter sent to Sens. Chuck Grassley, R-Iowa, and Ron Wyden, D-Ore., Premier suggested that the ONC lead the reform to reduce health care data fragmentation and promote real-time sharing of the information available in EMR/EHR platforms. (8/20)
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Medical Body Area Network rules set by FCC
The rules for Medical Body Area Networks have been finalized by the Federal Communications Commission to boost clinician access to extensive real-time information. The rules cover the process involved in choosing a Medical Body Area Network coordinator who will oversee MBAN frequency use and eliminate RF interference between wireless platforms that could affect hospital operations and put patients at risk. Health Data Management (8/22)
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Health Insurance Industry News
Helping seniors find the best plan can keep Part D strong
Medicare Part D has reduced out-of-pocket costs and boosted adherence in America's senior population, but high drug prices and the recession have eroded some gains, University of Massachusetts and Harvard University researchers report in the journal Health Affairs. Many low-income seniors are unaware that they may qualify for Medicare's Extra Help subsidy, and many need help choosing a plan that would make drugs more affordable, the researchers said. The New York Times (tiered subscription model)/New Old Age blog (8/21)
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Medical News
Minor infections may raise short-term risk of stroke in children
Children who suffered an ischemic stroke were significantly more likely to have visited a doctor for a minor infection in the previous three days than peers who did not have a stroke, according to a study in the journal Neurology. "Infections trigger activation of platelets [blood cells responsible for clotting], making them more prone to clotting," an expert said. HealthDay News (8/20)
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Diabetes patients who lose weight show lower kidney risk
Data published in The Lancet Diabetes & Endocrinology revealed about 35% of U.S. adults with diabetes exhibited some degree of kidney disease. However, patients who lost weight through diet and exercise had a 31% reduced odds of developing very high risk chronic kidney disease. Chicago Tribune (tiered subscription model)/Reuters (8/21)
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Last chance to earn your AFHI® in 2014
Take the next step in your professional development; attend the November AHFI® Prep Course and get a high-level refresher on all things concerning health care fraud. Those who wish to test immediately after the program can apply to test.
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Budget adequately for 2015 trainings
Make sure to budget adequate travel dollars for training and travel to take advantage of NHCAA's educational programs. Start your 2015 planning.
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Don't be afraid to give up the good to go for the great."
-- John D. Rockefeller,
American industrialist
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