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.
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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.
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."
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.
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.
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.
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.
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.
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