Wednesday, October 14, 2015

Fierce Health Payer ANTI FRAUD Headline News For Oct 14 2015

Most of this wouldn't be happening if Govt wasn't laying out your money for these fraudsters in the first place.

Second Miami physician charged in $20 million scheme

A Miami physician was indicted for his role in a $20 million fraud scheme in which he is accused of writing prescriptions for unnecessary services after taking kickbacks from home health agencies in the area, according to the Department of Justice.

Data analytics detect fraud schemes in Florida

Enforcement officials in Jacksonville, Florida, are relying on data analytics to uncover fraud, waste and abuse, a method that has already paved the way for several multi-million dollar settlements this year, according to the St. Augustine Record.

PharMerica pays nearly $10M to settle case tied to anti-seizure medication

The national nursing home pharmacy PharMerica Corp. agreed to pay $9.25 million to resolve claims that it took kickbacks from Abbott Laboratories to promote the anti-seizure medication Depokate, according to the Department of Justice.

National wound care provider accused of using 'superbills'

A national wound care provider, Healogics, is facing allegations from former employees that the company billed for unnecessary procedures, implicating clincs and hospital partners in 29 different states, according to the Jacksonville Business Journal.

Social Security numbers on Medicare cards: A well-worn welcome mat for fraud

The issue of including Social Security numbers of Medicare beneficiary cards has been discussed for more than four decades, including repeated warnings from the Government Accountability Office. Despite those warnings, the Centers for Medicare & Medicaid Services has failed to take even incremental steps to remove the identifying numbers, contributing to pervasive identity theft that exploits seniors and leads to millions in healthcare fraud schemes. 

Senate Committee hearing highlights identity theft risks among Medicare beneficiaries

Expert testimony at aSenate Committee on Aging hearing outlined how identity theft can lead to multi-million dollar fraud schemes--and the preventative measures that can protect personal health information.

Scammers take advantage of Medicare beneficiaries in Chicago

Scammers commonly referred to as "marketers" are taking advantage of Medicaid beneficiaries throughout Chicago, offering cash kickbacks or free services,  while billing for services that were never provided, according to WBEZ Chicago.

Four New Orleans women plead guilty to $30M home health scheme

A prominent New Orleans businesswoman and owner of Abide Home Care Services Inc. pleaded guilty, along with three others, to orchestrating a $30 million Medicare fraud scheme, according to the U.S. Attorney's Office in the Eastern District of Louisiana.

Study identifies $11M in Medicaid waste, fraud and abuse in Delaware

A much-anticipated review of the Delaware's Medicaid program revealed $11 million in potential fraud, waste, and abuse over the last three years, according to the Associated Press.

Senate hearing addresses Medicare and Medicaid overpayments

The federal government spent an estimated $124.7 billion in 2014 inimproper payments across 22 government agencies, most of which came from Medicare and Medicaid programs, according to expert testimony from a senior GAO official.

Salomon Melgen, plus payment data, put ophthalmologists in the hot seat

Two multi-million dollar cases against two ophthalmologists, including the headline-grabbing Salomon Melgen, have thrown the specialty into the regulatory hot seat. Add Melgen's high-profile case to payment data that lists Medicare payments to ophthalmologists that reach eight figures and an OIG report that identified $171 million in questionable claims, and you've got a recipe for additional federal scrutiny, plus potentially more fraud cases involving ophthalmologists.

Distinct enforcement themes emerge at AHLA fraud conference

Last week's Fraud and Compliance Forum, hosted by the American Health Lawyers Association, outlined current and future fraud enforcement trends straight from the mouths of OIG officials.

OIG identifies $76 million in questionable chiropractic claims

The government isn't doing enough to prevent improper chiropractic payments, particularly claims involving "maintenance therapy," according to a new OIG report, particularly claims involving "maintenance therapy." 

Anatomy of a fraud bust: Collaboration creates efficiency

With more large-scale, multi-million dollar fraud schemes surfacing across the country, enforcement officials are utilizing Medicare Fraud Strike Force teams to dismantle entire fraud operations. Rob Howard, assistant special agent in charge with the FBI in Detroit, explains how fraud enforcement officials discover and unravel large-scale schemes. 

Cardiologists nailed for inappropriate procedures

A cardiologist in Ohio has been convicted for overbilling Medicare $7.2 million for unnecessary cardiac procedures including stents, catheterizations, nuclear stress tests, and recommending patients for cardiac bypass surgery that wasn't medically necessary, according to  the U.S. Attorney's Office for the Northern District of Ohio. Meanwhile, a Kentucky cardiologist is awaiting trial after pleading not guilty to 27 counts of fraud and making false statements tied to unnecessary cardiac stents.

OIG: Medicare paid $30 million for untraceable ambulance rides

Medicare spent more than $30 million during the first half of 2012 on ambulance transports for patients that appear to be ghosts on paper, according to a new report released by the Office of Inspector General Tuesday.

Pennsylvania official plans to assemble homegrown fraud strike force

Last year, David Hickton, U.S. Attorney for the District of Western Pennsylvania, requested agents from the Department of Health and Human Services Office of Inspector General to help root out healthcare fraud that was becoming more prevalent in the region. They never showed, so this year he's decided to take matters into his own hands by creating a homegrown fraud task force, according to the Pittsburgh Post-Gazette.

In fight against fraud, humans just as important as machines

Last week's Medical Identity Fraud Alliance survey offered an important reminder that the fight against medical identity theft and fraud needs an equal dose of humans and technology, and that budget dollars should reflect and equal balance between IT and fraud personnel. Although predictive analytics offers exciting possibilities in the world of fraud prevention, these systems should be navigated by critically thinking humans.

After claiming providers committed $823M in dental fraud, Texas settles for just $20M

Lingering problems from the previous Texas Health and Human Services Commission administration have forced the state to offer reduced settlement packages to nearly 100 dental providers accused off overbilling Medicaid, according to The Houston Chronicle.

New inspector general at Texas agency aims to alter fraud enforcement perceptions

Stuart Bowen inherited a difficult job when he was appointed inspector general of the Texas Health and Human Services Commission, but nine months later, he's making notable progress.

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