5 health professionals sentenced for roles in Ala. pill-mill case | N.Y. orthodontics chain to pay $9M to settle Medicaid fraud accusations | Sentencing delayed for Ind. doctor who admitted to fraud, drug charges
January 18, 2019
NHCAA SmartBrief
Top Story
5 health professionals sentenced for roles in Ala. pill-mill case
Former doctors Julio Delgado and Willie Chester Jr. and former nurse practitioners Steven Cox and Elizabeth Cronier were ordered to serve probation for their roles in a pill-mill scheme involving Montgomery, Ala.-based clinic Family Practice and its owner, Gilberto Sanchez. Johnnie Sanders, a licensed counselor who ran an office out of Sanchez's medical practice, received a seven-month federal prison term after entering a guilty plea to health care fraud.
Montgomery Advertiser (Ala.) (tiered subscription model) (1/17) 
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Law Enforcement & The Courts
N.Y. orthodontics chain to pay $9M to settle Medicaid fraud accusations
Dentist Oleg Drut and the 19-office Diamond Braces chain agreed to pay $9 million to settle allegations that uncertified practitioners performed orthodontic procedures that were billed to Medicaid. The company must hire an independent monitor, pay $4.5 million to Medicaid and pay $4.5 million in penalties, according to New York Attorney General Letitia James.
Patch/Prospect Heights-Crown Heights, N.Y. (1/15) 
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Sentencing delayed for Ind. doctor who admitted to fraud, drug charges
Sentencing for Michael Cash, a former doctor from Indiana who pleaded guilty to health care fraud, conspiracy and dispensing and distributing controlled substances, was postponed to May 15. Cash, who was originally scheduled to be sentenced this month, admitted to unlawfully dispensing the opioid drug Subutex and then submitting fraudulent claims to Medicare to cover the costs of the medications.
The Tribune-Democrat (Johnstown, Pa.) (1/17) 
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Kan. nurse sentenced for defrauding Medicaid in 3 counties
Kathleen Kleuskens, a nurse from Ogden, Kan., was sentenced to prison in three Kansas counties for defrauding Medicaid and related charges. Kleuskens, who received 21-month prison terms in Geary County and Pottawatomie County and a 20-month sentence in Clay County, forged opioid prescriptions, changed medical records and committed other offenses while she was employed at nursing facilities in the counties.
St. Joseph News-Press (Mo.) (tiered subscription model)/The Associated Press (1/17) 
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Policy & Regulatory News
Tools & Technology
Wearable device studied for detection of pediatric anxiety, depression
Researchers used a common wearable movement sensor to measure physiological responses of 63 children ages 3 to 7 to a 90-second mood induction task with the goal of detecting internalizing disorders, including depression and anxiety. The study, published in PLOS ONE, found that performing a machine learning algorithm-based analysis of just 20 seconds of movement data had an 81% accuracy rate in identifying children with internalizing disorders.
Mashable (1/17),  New Atlas (1/17) 
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Health Insurance Industry News
Medicare Advantage enrollment up 6.8% from last year
Medicare Advantage enrollment up 6.8% from last year
(Spencer Platt/Getty Images)
The latest federal data showed the number of people enrolled in Medicare Advantage plans reached 22.4 million as of January 2019, up by 6.8% from January 2018. Enrollment increased at a slower rate compared with 2016 and 2017, but many insurers saw significant enrollment growth.
Modern Healthcare (tiered subscription model) (1/16) 
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Medical News
Need to report suspected health care fraud?
The United States spends over $2.7 trillion on health care every year. Of that amount, NHCAA estimates that tens of billions of dollars are lost to health care fraud. This directly affects patients, taxpayers and government through higher health care costs, insurance premiums and taxes and can cause patient harm. Learn about the resources available to report fraud.
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Advance your career -- earn an AHFI®
The best way to add value to your career prospects by getting the most out of your health care fraud-fighting experience. Distinguish yourself from the pack with the AHFI® designation. For information about testing, qualifications and to apply, view the AHFI website and FAQ.
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I liked being half-educated; you were so much more surprised at everything when you were ignorant.
Gerald Durrell,
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