October 27, 2021
NHCAA SmartBrief
Top Story
Calif. duo sentenced for selling fake pregnancy insurance
Jose Hernandez and Melissa Torres, a couple from Chula Vista, Calif., were sentenced to 40 months and 33 months in prison, respectively, and were ordered to forfeit $424,500 and pay over $1.5 million in restitution after both pleading guilty to charges related to a health care fraud scheme. Court documents showed the defendants sold fake insurance to pregnant women, causing over $1 million in losses to California's Medi-Cal Access Program.
Full Story: Department of Justice (10/26) 
LinkedIn Twitter Facebook Email
Seeing tomorrow, today.
Codoxo is leading a movement to reimagine healthcare cost containment through our innate ability to see what the future looks like tomorrow, and get there today. Our mission is to help make healthcare more affordable and effective and is driven by the belief that change is possible, and the time is now to disrupt the status quo. Read the blog.
Law Enforcement & The Courts
Emilio Navarro, a family physician from Pennsylvania, entered a guilty plea to one count of health care fraud and one count of unlawful distribution of oxycodone. According to the plea, Navarro illegally distributed oxycodone and oxymorphone that were medically unnecessary to patients in exchange for sexual favors, and then submitted fraudulent claims to Medicaid for the prescriptions.
Full Story: Department of Justice (10/26) 
LinkedIn Twitter Facebook Email
Novartis said it received a subpoena from the Department of Justice last month requesting documents involving the pricing and marketing of its heart failure drug Entresto. The Justice Department also requested records of remuneration offered to health care professionals as part of a "civil investigative demand."
Full Story: FiercePharma (10/26) 
LinkedIn Twitter Facebook Email
Judge: Eli Lilly must pay 2% insulin sales to Ariz. firm
A federal judge has ordered Eli Lilly to pay 2% of its insulin sales to Arizona firm Research Corp. Technologies because they signed a royalty deal in 1992 that allowed Lilly to use a specific yeast strain to make its insulin products. "Lilly breached its reporting and royalty payment obligations by failing to pay the 2% royalty owed for the net sales value of the diabetes drugs, so RCT is entitled to judgment as a matter of law as to liability," District Judge Scott Rash argued in his ruling.
Full Story: FDAnews (10/26) 
LinkedIn Twitter Facebook Email
A proven approach to preventing E&M over-coding
Over-coding of both professional and facility Evaluation and Management (E&M) claims causes significant losses for payers every year. Cotiviti's chief medical officer explains a proven approach to preventing E&M over-coding that has saved organizations tens of millions of dollars per year—and without increasing provider abrasion. Read the white paper.
Policy & Regulatory News
Free eBooks and Resources
Free eBooks and resources brought to you by our partners
Tools & Technology
Facial recognition technology has a number of potential health care and research applications, including appointment check-in, diagnosis of certain conditions and fraud prevention, but a survey of more than 4,000 patients found that more than 70% were uneasy with the idea of facial recognition technology in a hypothetical precision medicine study, researchers reported in the journal PLOS ONE. Respondents also expressed concerns about the privacy of medical records and genetic data, and the researchers suggest taking steps to build public trust before using facial imaging data in health care and medical research.
Full Story: Health IT Security (10/25) 
LinkedIn Twitter Facebook Email
Health Insurance Industry News
Average monthly premiums for silver Affordable Care Act plans sold through the federal exchange are expected to drop by 3% in 2022, marking the fourth consecutive year of decline, while the number of participating health insurers will increase by 32 to 213 for the coming plan year, according to the CMS. Enhanced premium subsidies included in the American Rescue Plan mean the average lowest-priced plan for ACA enrollees will cost $41 per month, while 4 in 5 people will be able to find a plan for $10 a month or less.
Full Story: CNN (10/25) 
LinkedIn Twitter Facebook Email
Medical News
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.
LinkedIn Twitter Facebook Email
Want to see what career opportunities are out there? NHCAA Career Connection offers a one-stop spot to post your resume, seek career coaching and more. If you're looking for a new challenge in your current field or are interested in exploring something different, Career Connection has the tools and resources you need to take the next step.
LinkedIn Twitter Facebook Email
About NHCAA | Join NHCAA | Education & Training Opportunities
About the AHFI Program | Career Connection
Sharing NHCAA SmartBrief with your network keeps the quality of content high and these newsletters free.
Help Spread the Word
Or copy and share your personalized link:
We struggle to climb, or we struggle to fall. The thing is to discover which way we're going.
Daphne du Maurier,
LinkedIn Twitter Facebook Email
SmartBrief publishes more than 200 free industry newsletters - Browse our portfolio
Sign Up  |    Update Profile  |    Advertise with SmartBrief
Unsubscribe  |    Privacy policy
SmartBrief, Inc.®, 555 11th ST NW, Suite 600, Washington, DC 20004