Nerik Ilyayev of Queens in New York City has been sentenced to four years in prison for his role in a multimillion-dollar health care fraud scheme. Officials said that from February 2021 to March 2022, Ilyayev owned a pharmacy under the identity of another person and paid illegal kickbacks to low-income HIV patients to recruit them to fill prescriptions for HIV drugs, which Ilyayev used to fraudulently bill Medicare and Medicaid, receiving around $5.2 million in reimbursements. He then took over another pharmacy with a bogus identity to defraud around $1.2 million from no-fault auto insurance providers.

Pittsburgh resident Kelley Oliver-Hollis has been indicted on several charges related to health care fraud. From December 2016 to July 2023, Oliver-Hollis, who owned care facility SerenityCare, allegedly defrauded around $2 million from Medicaid by submitting fraudulent claims for services purportedly provided to residents with intellectual disabilities, as well as for failing to properly train direct care workers, maintaining adequate records and failing to take care of residents' homes.

Ramon Apellaniz, a resident of East Hartford, has been sentenced to eight years in prison for defrauding Medicaid of more than $900,000. Apellaniz used the identity of a licensed professional to submit fraudulent claims to Medicaid for services provided by unlicensed personnel and for services that were not rendered, authorities say.

Delaware residents Adrienne Ponzo and James Wessels, along with Georgia resident Eric Rivera, have been charged with theft of COVID-19 pandemic relief funds and laundering the money they received. The three individuals allegedly conspired with each other to fraudulently obtain around $5 million from the Paycheck Protection Program and Economic Injury Disaster Loan program, with Rivera wiring Ponzo funds for her role.

Clinical note quality across specialties improved after physicians received grades and feedback from an artificial intelligence chatbot, researchers reported in NEJM Catalyst. Clinical assessments and reasoning improved by up to 45%, and planning to address patients' future needs improved by up to 34%.

The World Health Organization's Smart AI Resource Assistant for Health, known as SARAH, has demonstrated several flaws in the two weeks since it was introduced, including providing outdated information and failing to provide answers to questions such as where to get a mammogram in Washington, D.C. The bot's information is limited to data from September 2021 and prior because it was trained on ChatGPT 3.5; it also frequently defaults to telling users to "consult with your health-care provider" or visit a WHO Website.

Research shows that a Medicare initiative, Chronic Care Management, decreased patients' emergency department and inpatient visits and reduced total health spending, but only a small proportion of eligible enrollees have participated. A number of businesses have been started to help physicians participate, but physician uptake has still been low for reasons including lack of capacity to monitor patients outside office visits, high documentation requirements and reluctance to require people to participate when they don't have a supplemental policy.

NHCAA's Platinum and Premier Supporting Members are leading providers of products and services to the health care anti-fraud industry, are valued partners who support NHCAA's mission, and have demonstrated outstanding commitment to the fight against health care fraud. Learn more about these companies on the Fraud Solutions Guide.

NHCAA's platinum, premier and supporting members are leading providers of products and services to the health care anti-fraud industry, are valued partners who support our mission and have demonstrated outstanding commitment to the fight against health care fraud. Visit our Become a Member page for more information and to apply.