April 21, 2021
NHCAA SmartBrief
Top Story
Mass. provider settles false claims allegations
Massachusetts Eye and Ear agreed to a nearly $2.7 million settlement to resolve accusations of violating the False Claims Act. Authorities said Massachusetts Eye and Ear routinely submitted false claims to MassHealth and Medicaid for office visits at which doctors provided laryngoscopies and nasal endoscopies.
Full Story: Department of Justice (4/20) 
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Law Enforcement & The Courts
Jonas Knopf, a licensed insurance producer from New Jersey, entered a guilty plea to one count of making false statements related to a health care benefits program. Authorities said Knopf, who was the CEO of Madison Financial Services, used false personal information to give Blue Cross Blue Shield the impression that his clients were actually paid employees, causing the health care insurers to pay out $1.5 million in fraudulent claims.
Full Story: Department of Justice (4/19) 
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Cheikh Cisse of Baltimore was sentenced to three years and one day in prison and was ordered to pay $83,247 in restitution and forfeit $30,000 after pleading guilty to theft of government property and aggravated identity theft. According to his plea, Cisse, who worked for the Social Security Administration as a claims specialist, used fake identities and the identities of other individuals to file fraudulent claims for Social Security benefits in an attempt to collect more than $236,000.
Full Story: Department of Justice (4/19) 
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Jody Lyons of Schenectady, N.Y., was sentenced to two years of probation after pleading guilty to stealing Social Security benefits. According to her plea, Lyons withdrew $95,961 in Social Security benefits that were deposited into her mother's bank account from January 2015 until August 2018, when the SSA discovered her mother had died in 2015.
Full Story: Department of Justice (4/20) 
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Policy & Regulatory News
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Tools & Technology
Vaccine passports raise privacy, legal questions
(Ethan Miller/Getty Images)
IBM's Excelsior Pass and apps like it that display COVID-19 vaccination status or test results are touted as tools for restoring normalcy to public life, but they also raise significant privacy and legal issues. The US government will not create or mandate digital passports, but agencies are discussing guidelines that developers could use to alleviate concerns, says White House adviser Andy Slavitt, and whether apps are subject to HIPAA privacy and security rules depends on who develops them, says attorney Savera Sandhu.
Full Story: Bloomberg Law (subscription required) (4/19) 
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A survey by Mount Sinai Visiting Doctors found more than 80% of the 873 homebound patients who had telehealth visits required the assistance of a family member or paid caregiver to complete the visit. The study, published in the Journal of the American Geriatrics Society, found almost one-third of older patients had trouble interacting with physicians during telehealth visits due to cognitive or sensory problems.
Full Story: McKnight's Senior Living online (4/19) 
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Medical News
This virtual training program, designed for investigators and analysts new to health care fraud, will feature a mix of live and on demand presentations over seven days. The interactive group provides a community for networking and discussion about critical concepts. Participants will be able to synthesize information at their own pace and put new skills to work immediately. Register here.
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