Hospital, physician group settle kickback allegations | Fla. hospice settles health fraud accusations for $3.2M | Nurse sentenced for role in health insurance fraud scheme
July 9, 2020
NHCAA SmartBrief
Top Story
Oklahoma Center for Orthopaedic and Multi-Specialty Surgery, its part-owner and management firm, USP OKC and USP OKC Manager, and Oklahoma City-based Southwest Orthopaedic Specialists and two of its physicians, agreed to pay a total of $72.3 million to settle allegations that they violated the False Claims Act. Authorities said the center had an improper relationship with the physicians of Southwest that resulted in the submission of fraudulent claims from 2006 to 2018 to Tricare, Medicaid and Medicare for services provided to patients who were illegally referred.
Full Story: The Oklahoman (Oklahoma City) (tiered subscription model) (7/8) 
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Law Enforcement & The Courts
Fort Myers, Fla.-based Hope Hospice will pay $3.2 million to resolve allegations of violating the False Claims Act. Authorities said Hope deliberately submitted false claims to Medicare for services involving patients who weren't terminally ill and also submitted false claims to Tricare, Medicaid and Medicare for medically unnecessary general inpatient hospice care.
Full Story: Department of Justice (7/8) 
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Fallon Page, a nurse from Hattiesburg, Miss., was sentenced to 18 months in prison plus three years of supervised release for mail fraud connected with her involvement in a health insurance fraud scheme. Authorities said Page accepted kickbacks in exchange for referring patients to Medical Solutions, an Ocean Springs, Miss.-based compounding pharmacy, from August 2014 to at least October 2014, which allowed the pharmacy to collect improper reimbursements from health insurance companies.
Full Story: Department of Justice (7/8) 
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Purificacion Cristobal, a nurse practitioner and operator of a medical clinic in New York City, was charged with one count of participating in a conspiracy to illicitly distribute narcotics. Authorities said Cristobal diverted large quantities of oxycodone by illegally writing prescriptions that allowed her to distribute tens of thousands of the pills to people who had no real medical need for them.
Full Story: Department of Justice (7/8) 
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Policy & Regulatory News
Tools & Technology
Cellphone location data can help fight the spread of the coronavirus by alerting health officials when crowds form in particular areas, Colorado State University researchers say. "All we have to do is perform the measurements using anonymous data that is already being collected for other reasons. We are not tracking individuals," explains Edwin Chong, a CSU professor.
Full Story: Network World (7/7) 
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The MiniMed Mio Advance infusion set has been released by Medtronic for the company's insulin pump users in the US.
Full Story: Seeking Alpha (free registration) (7/7) 
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Medical News
Catch a Fraudster: Finding the Needle in the Haystack with AI. Even at conservative estimates, health care fraud costs the US $68 billion annually. Prime Therapeutics is fighting back with a first-of-its-kind initiative that uses SAS AI to weed out fraud, waste and abuse. Join us for this webinar to learn how, since launching its analytics platform in mid-2018, Prime Therapeutics investigators have saved health plans $355 million in recovered payments and cost avoidance. Learn more and register.
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Each year, NHCAA hosts the industry's newest investigators and analysts to prepare them for the fight against health care fraud. Over the past few weeks, NHCAA has been closely monitoring and evaluating the situation around COVID-19 to ensure we are taking the necessary measures to protect the health and well-being of our members. In light of the travel restrictions and recommended safety precautions, NHCAA has rescheduled the Boot Camp from April to Dec. 8-10, 2020. Learn more.
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