Mo. hospitals agree to resolve Medicare fraud accusations for $34M | Mich. physician sentenced to 19 years for health care fraud | N.Y. resident gets probation for defrauding Medicaid
May 22, 2017
NHCAA SmartBrief
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Mo. hospitals agree to resolve Medicare fraud accusations for $34M
Mercy Hospital Springfield in Chesterfield, Mo., and its Mercy Clinic Springfield affiliate have agreed to pay a $34 million settlement to resolve allegations of submitting false Medicare claims. The hospital, which said it made a regulatory mistake, was accused of falsely billing Medicare from 2009 to 2014 for chemotherapy services provided to patients referred by oncologists who received financial rewards for the referrals, authorities say.
Modern Healthcare (tiered subscription model) (5/19) 
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Law Enforcement & The Courts
Mich. physician sentenced to 19 years for health care fraud
Adelfo Pamatmat, a physician practicing in Farmington Hills, Mich., was sentenced to serve 19 years in prison after being convicted of conspiracy to commit health care fraud and conspiracy to illegally distribute prescription drugs. Officials say Pamatmat, a former employee of a fraudulent visiting physicians' practice, improperly prescribed several million dosage units of controlled substances including oxycodone and hydrocodone, resulting in a health care fraud valued at more than $4 million.
WDIV-TV (Detroit) (5/19) 
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N.Y. resident gets probation for defrauding Medicaid
Tina Gabel of Poughkeepsie, N.Y., was sentenced to serve five years of probation and ordered to pay restitution of $113,584 after pleading guilty to grand larceny in a Medicaid fraud case. Authorities say Gabel submitted fraudulent timesheets to AccentCare of New York, an intermediary for Medicaid's Consumer Directed Personal Assistance Program, for unprovided home care services supposedly rendered by two relatives.
Poughkeepsie Journal (N.Y.) (5/19) 
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N.M. company probed on Medicaid fraud allegations
Albuquerque, N.M.-based Angel Touch Personal Care is being investigated on suspicion of defrauding the Medicaid program since 2012. The company is accused of falsely billing Medicaid for unprovided or unnecessary personal care services rendered under the names of deceased patients, hospitalized patients, fake patients and patients who were married to their caregivers, according to the attorney general's office.
KRQE-TV (Albuquerque, N.M.) (5/20) 
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Policy & Regulatory News
Senators float more generous tax credits for low-income Americans, seniors
Sen. John Thune, R-S.D., is crafting a proposal that would modify the American Health Care Act's approach to health insurance tax credits by boosting support for older Americans, linking credits to income and cutting off eligibility sooner. "We clearly want to drive more of the benefit of the tax credit to people on the lower-income part of the scale and the elderly," Thune said.
The Hill (5/17) 
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States file motion to intervene in CSR case
Attorneys general in 15 states and the District of Columbia filed a motion to intervene in the Republican case against the Affordable Care Act's cost-sharing reduction payments. Insurers have repeatedly asked the administration for reassurance on the subsidy payments to help stabilize markets and mitigate premium hikes.
Reuters (5/18),  Los Angeles Times (tiered subscription model) (5/18) 
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Senate bill designed to improve Medicare chronic disease care
Senate bill designed to improve Medicare chronic disease care.
(Sean Gallup/Getty Images)
Bipartisan legislation designed to improve care while reducing costs for Medicare beneficiaries with chronic medical conditions was unanimously passed by the Senate Finance Committee. The bill would promote care coordination, expand telehealth reimbursement eligibility beyond rural areas and let Medicare Advantage plans tailor benefits to chronically ill members.
Morning Consult (5/18) 
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Tools & Technology
Siemens, Relaymed partner to send POC test results to EHRs
An agreement has been reached by Siemens Healthineers and Relaymed to integrate Relaymed's cloud services with Siemens DCA Vantage analyzer and Clinitek Status point-of-care instruments. The integration will enable automatic delivery of test results from point-of-care instruments to EHRs in the physician's office, eliminating the need for manual input and lowering the risk for errors.
MassDevice (Boston) (5/18) 
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Medical News
Researchers find lowest cancer screening rates among uninsured
A report from the American Cancer Society found that uninsured Americans have the lowest screening rates for breast cancer, cervical cancer and colon cancer. Another report found that more cancers have been caught at early stages since the introduction of the Affordable Care Act, with many of those who benefited covered by Medicaid.
HealthDay News (5/18),  Philly (Philadelphia)/HealthDay News (5/18) 
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Survival rates for women with advanced breast cancer increasing, study finds
Women with advanced breast cancer are surviving longer in the US, according to a new study published online in Cancer Epidemiology, Biomarkers & Prevention. Researchers say the longer survival rates may be the result of better treatments developed over the years.
The Washington Post (tiered subscription model) (5/18) 
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NHCAA Launches Inaugural Leadership Program
NHCAA is launching the Excellence in SIU Leadership Program July 18-19 at the Kimpton Hotel Monaco in Baltimore. This highly interactive program is ideal for the rising stars in the special investigations unit (SIU). Dynamic sessions will enable participants to engage in meaningful conversations and share experiences with peers from across the country. Register today!
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Missed the March Boot Camp? Register for September!
NHCAA is hosting a second Health Care Fraud Investigators Boot Camp in 2017. Join us Sept. 12-15 in Scottsdale, 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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