Ex-Calif. hospital owner sentenced in $900M-plus fraud, kickback case | Ex-Texas ambulance firm operator sentenced in health care fraud case | Alaska dentist found guilty of unlawful dental acts, Medicaid fraud
January 21, 2020
NHCAA SmartBrief
Top Story
Ex-Calif. hospital owner sentenced in $900M-plus fraud, kickback case
Faustino Bernadett, a doctor and former owner of Long Beach, Calif.-based Pacific Hospital, received a prison sentence of one year and three months and was ordered to pay $60,000 in fines after admitting his involvement in a $900 million-plus health care fraud and kickback scheme involving spinal surgery claims. Authorities said Bernadett, in conspiracy with the hospital's former owner Michael Drobot, paid over $30 million in kickbacks for approximately 1,400 spinal-fusion surgeries from 2008 to 2010, which resulted in over $900 million worth of fraudulent claims, mostly to the state's workers' compensation system.
Long Beach Post (Calif.)/City News Service (1/17) 
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Law Enforcement & The Courts
Ex-Texas ambulance firm operator sentenced in health care fraud case
Joseph Kimble, former operator of non-emergency ambulance transport firm Tiger EMS in Texas, was sentenced to two years and six months in prison and was ordered to pay $751,986.30 in restitution after pleading guilty to health care fraud. Authorities said Kimble submitted fraudulent claims to Medicare and Medicaid for medically unnecessary ambulance transport services.
KETK-TV (Jacksonville, Texas) (1/17) 
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Alaska dentist found guilty of unlawful dental acts, Medicaid fraud
Seth Lockhart, a dentist from Anchorage, Alaska, who was filmed riding a hoverboard while performing a dental procedure on a sedated patient in 2016, was convicted of 46 counts including reckless endangerment, unlawful dental acts and Medicaid fraud. Charging documents showed Lockhart also performed unnecessary sedation on his patients and improperly billed the government for the procedures.
NBC News (1/18),  KTUU-TV (Anchorage, Alaska) (1/17) 
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La. pharmacist convicted for stealing drug meant for VA patients
Melissa Richardson of Shreveport, La., who worked as a pharmacist for the Overton Brooks VA Medical Center, was found guilty of 15 counts of acquiring a controlled substance by fraud. Evidence showed Richardson stole various amounts of hydrocodone meant for veteran patients on June 9, 2017.
Department of Justice (1/17) 
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Policy & Regulatory News
Tools & Technology
EHR, claims data alone, combined useful for predicting hospitalization
Analytic tools that use EHR data, claims data or both had similar power in predicting hospitalizations over a six-month period, researchers reported in the American Journal of Managed Care. "Although our results suggest some utility to combining EHR and claims data to inform predictive model creation, we find that even in scenarios in which only EHR or claims data are available, strong performance can be achieved provided that a diverse collection of variable types is represented," researchers wrote.
EHR Intelligence (1/16) 
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Research highlights benefits of blockchain technology in radiology
Blockchain technology can be useful in radiological practices because its capabilities to distribute and store medical images are similar to picture archiving and communication systems, radiologists Morgan McBee and Chad Wilcox wrote in an article in the Journal of Digital Imaging. McBee and Wilcox cited four areas where blockchain technology can be used: monitoring of medical devices, improving artificial intelligence tools, sharing of medical images and enhancing research capabilities.
Health Imaging online (1/16) 
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Medical News
Save the Date! Boot Camp for Health Care Fraud Investigators
April 21-23, 2020, in Tampa, Fla.
NHCAA's Boot Camp is a three-day training program that anchors the path to becoming an AHFI® and shows participants the skills necessary to become a leader within any health care anti-fraud organization. Designed for career switchers, inter-departmental transfers or new college graduates with less than three years of experience in health care fraud, this program will help your newest team members acquire an understanding of the core competencies necessary to combat health care anti-fraud. Learn more.
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Are you new to health care fraud detection? Learn the ropes at Boot Camp
Gain an understanding of the core competencies necessary to combat health care fraud at our intensive, three-day Boot Camp program. Start by defining the scope of the health care fraud challenge and examining each step of the investigative process from detection and choosing an investigative strategy, to effective report writing and presenting your case to others in the unit. Register today!
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Tradition is the albatross around the neck of progress.
Bill Veeck,
professional baseball club executive, owner, promoter
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