June 2, 2014
NHCAA SmartBrief Special Report
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NHCAA SmartBrief Special Report:
The June NETS Program
Every day, news stories report countless fraud cases touching on virtually every aspect of health care. NHCAA's June NETS program, being held from June 10 to 12 in San Diego, will show participants how to detect fraud schemes in several medical specialties, including laboratory and diagnostic services, radiology, physical therapy and durable medical equipment. NETS faculty will provide case studies, discuss how to spot red flags and identify a wide range of fraud schemes. Look for the second part of this two-part special NHCAA SmartBrief Special Report on June 16.
  Fraud and Abuse 
 
  • Feds arrest 90 in nationwide Medicare fraud sweep
    A nationwide sweep over suspected Medicare fraud ended in the arrests of 90 people, including 27 physicians and nurses, who are believed to have cost the program almost $260 million in fraudulent billings. Residents from Los Angeles, Detroit, Houston, New York, Miami and Tampa, Fla., were arrested on charges of submitting claims for unprovided health services and medical equipment, federal officials said. Out of the 90 people arrested across the nation, 50 were charged in Miami alone in suspected $65.5 million worth of fraud related to home health care and mental health services and pharmacy fraud. Reuters (5/13) , The Hill (5/13) LinkedInFacebookTwitterEmail this Story
  • Calloway Labs settles fraud allegations for over $4M
    Massachusetts-based Calloway Laboratories agreed to pay the federal government $4.67 million to settle allegations of health care fraud. The clinical testing laboratory was accused of using the wrong billing code to charge Medicare and the West Virginia Medicaid program for medical reviews with urine drug screens, which are not eligible for coverage under either program, said U.S. Attorney Booth Goodwin. Calloway Laboratories agreed to the settlement without admitting any liability. Boston Herald/The Associated Press (5/21) LinkedInFacebookTwitterEmail this Story
  • Other News
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Government Regulation and Policy 
  • Medicare has lost billions to fraud, HHS tells Congress
    Medicare and Medicare Advantage lost about $50 billion combined in wrong or fraudulent payments in 2013, according to testimony before a House subcommittee by HHS Deputy Inspector General Gloria Jarmon. Improper payments constituted 10% of all payments, up from 8.5% the previous year. A separate Government Accountability Office report cited improved monitoring and collections efforts, but said the CMS must better identify the underlying causes of fraud through post-payment reviews. USA Today (4/30) LinkedInFacebookTwitterEmail this Story
  • CMS leadership on Medicare fraud is needed, House panel says
    Rep. Kevin Brady, R-Texas, chairman of the House Ways and Means Health subcommittee, spoke to the Centers for Medicare and Medicaid Services' director of the Center for Program Integrity about the need for the agency to be more proactive in dealing with Medicare fraud and identity theft. Social Security numbers printed on Medicare cards can lead to identity theft and should be removed, Brady said. Medicare and Medicaid also need to explore data sharing to identify and block potential system abusers, lawmakers said. The Hill (4/30) LinkedInFacebookTwitterEmail this Story
  • Payment-model changes could help lower costs, reduce fraud
    Health experts proposed changing the payment method for Medicare from fee-for-service payments to bundled or lump-sum payment plans to help reduce overpayments and prevent fraud. "[The Congressional Budget Office] projects that applying bundled payment models like Bay State's nationally could save Medicare about $46.6 billion over the next seven years," said Sen. Elizabeth Warren, D-Mass., citing the success of Massachusetts' Bay State Health demonstration project, which saved $2,000 per Medicare patient. Experts also suggested switching to accountable care organizations or paying doctors the same amount regardless of the prescribed drug or treatment. USA Today (5/19) LinkedInFacebookTwitterEmail this Story
  • Other News
Technology Tools 
  • Other News
NHCAA News 
  • 2014 Annual Training Conference comes to Dallas in November
    Our largest ATC ever, this year's program features more than 70 unique workshops spanning eight different educational tracks providing a breadth of health care fraud education that is unmatched. There is truly something for everyone at the ATC. LinkedInFacebookTwitterEmail this Story
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