Mass. hospital organization settles kickback accusations for $1.77M | N.J. physician admits to defrauding Medicare, Medicaid | Ky. doctor faces health care fraud, illegal prescribing charges
January 22, 2015
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Mass. hospital organization settles kickback accusations for $1.77M
Massachusetts-based South Shore Physician Hospital Organization will pay $1.775 million to resolve allegations that it paid kickbacks to doctors in exchange for patient referrals. The organization and its member organizations conceded that physicians who agreed to make referrals to the organization's providers were given cash recruitment grants. South Shore discontinued the practice several years ago when it realized the language describing the grant program "should have been clearer to avoid misinterpretation," the organization said in a statement. The settlement will be divided among the federal government, MassHealth and the state., MA (1/20)
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Get It Right: Pricing Strategies That Work
Many entrepreneurs hope for success by offering low prices, while in fact most world-class entrepreneurs succeed by setting higher prices. If you're not exactly sure which pricing strategy will work for your business, these 6 steps can help you set your company's prices for success. Read the exclusive article now.

Law Enforcement & The CourtsSponsored By
N.J. physician admits to defrauding Medicare, Medicaid
Benjamin Sabido, a physician from Franklin Lakes, N.J., faces a maximum of 10 years in prison after pleading guilty to health care fraud. Between at least December 2006 and April 2010, Sabido collected $237,182 from fraudulent Medicare and Medicaid claims for unprovided physical therapy or services provided by unqualified and unsupervised staff, according to prosecutors. Sentencing is scheduled for May 14. Houston Chronicle (tiered subscription model)/The Associated Press (1/21)
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Ky. doctor faces health care fraud, illegal prescribing charges
Jaime Guerrero, a Louisville, Ky.-based pain doctor and operator of the Advanced Pain Management Center, was indicted on health care fraud charges. Guerrero allegedly saw over 100 patients in three days and charged inflated rates for the visits, the indictment says. Guerrero also faces charges of illegally prescribing drugs, including oxycodone and hydrocodone, which caused five patient deaths. If convicted, Guerrero could face a life sentence in prison. The Courier-Journal (Louisville, Ky.) (tiered subscription model) (1/22)
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Ohio heart clinic under investigation by state, FBI, HHS OIG
The Ohio Institute of Cardiac Care in Springfield is being investigated by the state attorney general's health care fraud unit, the FBI and the Department of Health and Human Services' Office of the Inspector General. The clinic's two offices were closed Wednesday while boxes of files were seized by federal and state agents. Springfield News-Sun (Ohio) (free registration) (1/21)
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How SDN Makes Campus Networks Better
When should agencies adopt SDN? IDC reports that SDN provides immediate benefits for government campus networks, including modernized IT infrastructures that are more agile, cost-effective, and collaborative.
Read this new IDC paper to learn more.

Policy & Regulatory News
Justices hear oral arguments regarding low Medicaid reimbursements
Centers serving patients with developmental disabilities argued for the right to sue state governments over low Medicaid reimbursements before a clearly divided Supreme Court. Chief Justice John Roberts expressed concern that a favorable ruling could trigger a flood of lawsuits and essentially put judges in charge of state budgets, and Justice Sonia Sotomayor warned that such lawsuits may be physicians' only option in disputes over reimbursement rates. Medscape (free registration) (1/20)
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Congress promises strong oversight of VA medical centers
The chairmen of the Veterans' Affairs Committees in the House and Senate said they will keep a close eye on the Department of Veterans Affairs as officials implement the Veterans Access, Choice, and Accountability Act. The law funds the hiring of more staff at VA medical centers and allows veterans to see civilian doctors in an effort to clear a backlog of medical cases and reduce patient wait times. Members of Congress also promised to make a veteran suicide-prevention bill a top priority. The Wall Street Journal (tiered subscription model) (1/15)
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Tools & Technology
Doctors ask ONC to overhaul EHR MU program
A group of 35 medical organizations, led by the American Medical Association, is asking the Office of the National Coordinator for Health IT to implement major changes in the EHR meaningful use initiative, arguing the program in its current form could compromise patient safety. Among the coalition's recommendations are to separate the MU program from EHR certification and to take another look at software testing alternatives. The Hill (1/21)
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Health Insurance Industry News transmits information to companies to boost consumer experience is transmitting patient data -- which may include income, ZIP code and IP address -- to private advertising and data analytics firms to gauge performance and marketing, an Associated Press report revealed. The scope and manner in which the information is being used are still unclear. However, the federal government said the move was meant to ensure a better experience for consumers. The Detroit News/The Associated Press (1/20)
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Medical News
Stem cell therapy benefits patients with early multiple sclerosis, study finds
Preliminary data from a small study in the Journal of the American Medical Association has found that patients in the earlier stages of multiple sclerosis benefit from treatment with autologous nonmyeloablative hematopoietic stem cells. Half of the participants who were followed for two years had significant improvements on a standard measure of disability. San Diego Union-Tribune (1/20), HealthDay News (1/20)
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Fall rates for elderly increase, study finds
University of Michigan Medical School research found self-reported falls among adults ages 65 and older during the previous two years increased between 1998 and 2010, from approximately 28% to about 36%. The study in JAMA Internal Medicine said the increase was higher than what would be expected for this aging population. HealthDay News (1/19)
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New concurrent sessions during Boot Camp
NHCAA's Boot Camp program now features concurrent sessions allowing attendees to tailor programming to meet their investigative needs. See the agenda and read details on our March NETS web page. The program is March 17-20 in Orlando.
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NHCAA's web-based education is a perfect alternative to in-person meetings and ideal for group learning. Each Online NETS program focuses on a specific skill or scheme, providing knowledge that can be applied immediately. Learn more about our 2015 Online NETS.
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The secret of my influence has always been that it remained secret."
-- Salvador Dali,
Spanish painter
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