Showing posts with label Medicaid Fraud. Show all posts
Showing posts with label Medicaid Fraud. Show all posts

Tuesday, October 23, 2018

How Our Government Helps Drug-Dealing Doctors Kill Us


madinamerica
Lawrence Kelmenson, MD October 21, 2018
 

Psychiatry and Pain Management’s soaring profits since 1990 were fed by a unique combination of favorable circumstances never before seen: First, they’re paid mostly by federal funds. These include Medicaid, Medicare, and tax subsidies for employer-paid healthcare. But unlike other federally subsidized industries, health industry goods and services are covered by insurance, so high costs don’t deter client use of them. Just imagine all the fine food and posh restaurants we would access if we had hunger insurance that paid for them.

Mental health and pain treaters have advantages over other industries that rely on insurance payments: Medicare and Medicaid, being federally funded, are able to spend endless public money with few restrictions on coverage, regardless of cost. For example, Medicare costs jumped after a 2008 law raised mental health reimbursement from 50% to 80%.1 Private health insurers tried to rein in rising mental health costs, but were blocked by 1996,2 2008, and 20103 parity laws that forbade mental healthcare limits, copays, deductibles, or certification requirements from being greater than for physical care. This is part of why private insurance is now so costly.

To tap into this endless money, the pain and ‘mental illness’ fields made use of another advantage: Unlike events covered by other types of insurance, an illness is an arbitrary concept. Doctors can thus broaden its definition in order to broaden their domain: It can be a subjective physical perception with no clear or treatable source. For example, chronic pain became an illness. Illnesses do not even need to be physical: Painful thoughts and feelings, and kids acting like kids, also became illnesses. This was endorsed by a 1992 law4 that granted funds for services for the ‘one quarter who will suffer from mental disorders’, and for biomedically-focused mental illness research to be done at the NIH.

So, unlike other insurers that can verify house fires, car wrecks, or death, health insurers can’t verify mental illness or pain. Unlike other MDs, psychiatrists and pain doctors can invent infinite chronic (and thus lucrative) illnesses. Each client can be labeled with many different ones; there’s no limit. And each illness can justify a doctor’s luring the patient into lifelong addiction to euphoria-giving pills.

These MDs can also pad profits by putting clients on disability: Clients will then return regularly/eternally to prove ongoing disability, to ensure that their SSD checks and food/housing/healthcare assistance continue. Since they won’t work, they’ll have the time (and health insurance) to do so. A 1984 law5 made adult disability approval hinge on subjective functional impairment instead of objective disease evidence; this made mental illness (or chronic pain) easier to get SSD for. In 1991,6 the Social Security administration made child disability also hinge on functionality instead of illness proof. Child SSI cases rose five-fold soon after, mostly for mental illness.7 So illness-creators opened doors to disability benefits as well as insurance cash; that’s convenient, since their addictive ‘meds’ make it hard to work.

Two 1990 laws8 9 specified depression, ADHD, etc.to be valid causes of disability (before then, schizophrenia was the only ‘mental illness’ considered disabling). This further eased access to SSD/SSI funds. These laws also rewarded these illnesses by making life-easing accommodations available to those who ‘have’ them. For example, Billy prefers to play video games rather than do homework. By getting him labeled ADHD, his busy parents and teachers won’t have to struggle to teach him good work habits, since he’ll now be given less schoolwork (he’ll also be drugged into submission, so he won’t need to be raised). And his label may qualify his family for SSI, Medicaid, and other benefits.

400 million addictive prescriptions are filled yearly.10 It’s caused so much addiction and overdosing, including among kids who steal their parents’ pills, that the lifespans of white Americans have dropped steadily (they use 2.5 times as many psych11 and opioid12 ‘meds’ as non-whites). Then a 2000 law13 authorized doctors to treat the addictions they caused with yet more opioids (suboxone, or prison heroin). It’s such blatant drug-dealing that this law had to be enacted to make it legal (it circumvented a 1914 law14 that criminalized the prescribing of opiates to maintain addicts’ addictions). Suboxone is often peddled at drug rehabs, where clients thus score rather than quit drugs. Since the 2008 parity law made insurers cover treatment for addiction the same as for physical illness, these rehabs make a killing.

Mental health treaters capitalized on all these favors to become our most costly healthcare sector15 and a major cause of healthcare becoming our government’s top expense and top tax subsidy. Costs of other government programs also spiked, due to mental health, pain, and addiction treaters baiting and trapping millions into reliance on Social Security and other benefits. Since 2016, Congress has had to divert funds from the SS retirement to the SS disability trust fund,16 since the latter couldn’t keep up with all its mental illness and chronic pain claimants (its main recipients17). Businesses cut full-time workers in order to avoid paying their costly healthcare as is required by law. This drove yet more people to seek federal benefits. Nearly a fourth of Americans are on Medicaid now.

Psych drug and opioid prescribers are bankrupting us and exploding our debt. We spend more on healthcare and its addictive pills than all other nations, yet are still pounded by propaganda about “millions suffering needlessly from untreated mental illness.” Things will only get worse; many more mental health laws are on the way. 18 19 20 21 22 23 24 25 26
Deja Vu

Something similar actually did occur before: The British East India Company, aided by England’s parliament which invested in it, bailed it out, and made laws giving it monopolies, dominated trade in the East in the 1700s. It helped spread British colonialism there. In the 1800s, it profited greatly by growing opium in India and selling it in China. This hurt China’s economy by siphoning its silver and turning industrious Chinese people into idle, unproductive addicts. Its emperor finally halted opium imports after his son (China’s prince) died of an overdose (as did our “Prince”). The BEIC reacted by conquering, with British assistance, all Chinese ports and nearby areas, in order to ensure continued opium selling. This began what China calls its “century of humiliation” in which a great empire was brought to its knees and subjugated by England, France, and Japan.27

Are we at the start of our own lost century, with psych pill and opioid dispensers taking on the BEIC’s role? Like our drug-dealing doctors, it succeeded largely due to close alliance and support from its government every step of the way. The only difference is: Our own healers and leaders are killing us!


Show 27 footnotes

Previous articleMr. Rogers, Trauma-Informed Care, and the Limits of Information
Next articleNew Report Points to Gaps in the Evidence for Pediatric Bipolar Disorder
Lawrence Kelmenson, MD


Lawrence Kelmenson has practiced psychiatry for 32 years, working with children, adults, and families. He graduated medical school from State University of New York, and completed psychiatric residency training at Cornell. He then became staff psychiatrist, and later medical director, of Craig House Hospital in Beacon, New York until 2000, and has since conducted a psychotherapy-based private practice in Cold Spring, New York. 


Thank You Dr Kelmenson and MIA.

Wednesday, April 4, 2018

California Commits Massive Medicaid Fraud

American Spectator
David Catron
April 2, 2018, 12:05 am

California is indeed the Golden State where Medicaid is concerned. The HHS Office of Inspector General (OIG) has found that, by exploiting Obamacare’s expansion of the program, California has enrolled hundreds of thousands of ineligible adults in Medicaid. Consequently, the state has bilked the federal government out of more than $1 billion in funding to which the state was not entitled. Indeed, these figures probably understate the amount of money that California officials have fraudulently extracted from the taxpayers. The OIG sampled a mere six-month period, from October 1, 2014 through March 31, 2015, to arrive at its damning assessment.

If the word “fraud” seems over the top, consider what happens to doctors who filch Medicaid funds to which they aren’t entitled. This case, reported by the Boston Globe, is typical: “A Brookline doctor has been sentenced to 11 months in jail and ordered to pay $9.3 million for running a Medicaid fraud scheme.” Likewise, Michigan CBS affiliate WNEM reports that a Saginaw doctor “was charged with three felony counts of Medicaid fraud.… Each charge is punishable by up to four years in prison and a $50,000 fine.” Such cases are prosecuted every day and the charge pursued by the authorities is “fraud.” So, isn’t the skullduggery described below also fraud?


On the basis of our sample results, we estimated that the State agency made Medicaid payments of $628,838,417 (Federal share) on behalf of 366,078 ineligible beneficiaries and $402,358,529 (Federal share) on behalf of 79,055 potentially ineligible beneficiaries.


Don’t be confused by the vague bureaucratic vernacular used in the above passage. When the OIG says, “the State agency made Medicaid payments (Federal Share),” it means all of the money used to cover these ineligible enrollees was provided by the federal government. For the period of time covered by the OIG audit, the federal Share of the costs for newly eligible, adult enrollees is 100 percent (which isn’t true in the case of low-income beneficiaries for whom the program was originally created). In other words, every dime California ostensibly “paid” for the people described above came straight out of your federal tax bill. As the OIG explains:



Thank You Mr Catron and American Spectator

Wednesday, December 6, 2017

$5.5 Million In Unallowable Medicaid Payments Made To Dead People In Texas

freebeacon
Ali Meyer
December 6, 2017 5:00 am

$1.77 million in payments has not been identified or recovered

The Texas Health and Human Services Commission paid managed-care organizations $5,521,704 in Medicaid capitation payments after beneficiaries died, according to an audit from the Department of Health and Human Services Office of Inspector General.

According to the report, a capitation payment is one that the state makes to a contractor for each beneficiary's medical services enrolled under the state plan. This payment is made regardless of whether or not the beneficiary receives services in that period.

"The State agency performs monthly reviews of capitation payments and beneficiary eligibility to identify and recover unallowable payments made after a beneficiary's death," the report explains. "We compared the dates of death noted in the Texas Medicaid eligibility system or the State Bureau of Vital Statistics records to [Social Security Administration]'s dates of death to confirm whether SSA's dates of death were correct."

While auditors found that the Texas Health and Human Services Commission made efforts to identify and recover unallowable payments, they still made roughly $5.5 million capitation payments after beneficiaries had died. The state was able to recover about $3.75 million of those payments, but roughly $1.77 million in payments had not been identified or recovered.

"We determined that 107 of the 174 deceased beneficiaries, or 61 percent, had payments made over one year after their dates of death," auditors said.

The report said the Texas Commission did not have safeguards in place to make sure that unallowable payments were not made. For example, 116 of 174 deceased beneficiaries, or 66 percent, did not have a date of death recorded in the system.

Auditors recommended that the state agency try to recover the $1.77 million in unallowable payments, strengthen its safeguards for identifying beneficiaries who have died, and end their eligibility so future payments won't be made. The state agency agreed with the recommendations and said it would ensure capitation payments were stopped. It would also conduct a thorough review of recording death information.

Thank You Ms Meyer and Free Beacon.

Saturday, July 30, 2016

18 U.S. Code § 1031 - Major Fraud Against The United States

Prohibited By Law

cornell law
18 U.S. Code § 1031 - Major fraud against the United States

(a)Whoever knowingly executes, or attempts to execute, any scheme or artifice with the intent—
(1)
to defraud the United States; or
(2)
to obtain money or property by means of false or fraudulent pretenses, representations, or promises,
in any grant, contract, subcontract, subsidy, loan, guarantee, insurance, or other form of Federal assistance, including through the Troubled Asset Relief Program, an economic stimulus, recovery or rescue plan provided by the Government, or the Government’s purchase of any troubled asset as defined in the Emergency Economic Stabilization Act of 2008, or in any procurement of property or services as a prime contractor with the United States or as a subcontractor or supplier on a contract in which there is a prime contract with the United States, if the value of such grant, contract, subcontract, subsidy, loan, guarantee, insurance, or other form of Federal assistance, or any constituent part thereof, is $1,000,000 or more shall, subject to the applicability of subsection (c) of this section, be fined not more than $1,000,000, or imprisoned not more than 10 years, or both.
(b)The fine imposed for an offense under this section may exceed the maximum otherwise provided by law, if such fine does not exceed $5,000,000 and—
(1)
the gross loss to the Government or the gross gain to a defendant is $500,000 or greater; or
(2)
the offense involves a conscious or reckless risk of serious personal injury.
(c)
The maximum fine imposed upon a defendant for a prosecution including a prosecution with multiple counts under this section shall not exceed $10,000,000.
(d)
Nothing in this section shall preclude a court from imposing any other sentences available under this title, including without limitation a fine up to twice the amount of the gross loss or gross gain involved in the offense pursuant to 18 U.S.C. section 3571(d).
(e)In determining the amount of the fine, the court shall consider the factors set forth in 18 U.S.C. sections 3553 and 3572the factors set forth in the guidelines and policy statements of the United States Sentencing Commission, including—
(1)
the need to reflect the seriousness of the offense, including the harm or loss to the victim and the gain to the defendant;
(2)
whether the defendant previously has been fined for a similar offense; and
(3)
any other pertinent equitable considerations.
(f)
A prosecution of an offense under this section may be commenced any time not later than 7 years after the offense is committed, plus any additional time otherwise allowed by law.
(g)
(1)
In special circumstances and in his or her sole discretion, the Attorney General is authorized to make payments from funds appropriated to the Department of Justice to persons who furnish information relating to a possible prosecution under this section. The amount of such payment shall not exceed $250,000. Upon application by the Attorney General, the court may order that the Department shall be reimbursed for a payment from a criminal fine imposed under this section.
(2)An individual is not eligible for such a payment if—
(A)
that individual is an officer or employee of a Government agency who furnishes information or renders service in the performance of official duties;
(B)
that individual failed to furnish the information to the individual’s employer prior to furnishing it to law enforcement authorities, unless the court determines the individual has justifiable reasons for that failure;
(C)
the furnished information is based upon public disclosure of allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, or GAO report, hearing, audit or investigation, or from the news media unless the person is the original source of the information. For the purposes of this subsection, “original source” means an individual who has direct and independent knowledge of the information on which the allegations are based and has voluntarily provided the information to the Government; or
(D)
that individual participated in the violation of this section with respect to which such payment would be made.
(3)
The failure of the Attorney General to authorize a payment shall not be subject to judicial review.
(h)Any individual who—
(1)
is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by an employer because of lawful acts done by the employee on behalf of the employee or others in furtherance of a prosecution under this section (including investigation for, initiation of, testimony for, or assistance in such prosecution), and
(2)
was not a participant in the unlawful activity that is the subject of said prosecution, may, in a civil action, obtain all relief necessary to make such individual whole. Such relief shall include reinstatement with the same seniority status such individual would have had but for the discrimination, 2 times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorney’s fees.

(Added Pub. L. 100–700, § 2(a), Nov. 19, 1988, 102 Stat. 4631; amended Pub. L. 101–123, § 2(a), Oct. 23, 1989, 103 Stat. 759;Pub. L. 103–322, title XXXIII, § 330002(a), (f), Sept. 13, 1994, 108 Stat. 2140; Pub. L. 111–21, § 2(d), May 20, 2009, 123 Stat. 1618.)


Thank You Cornell Law

Friday, July 29, 2016

18 U.S. Code § 371 - Conspiracy To Commit Offense Or To Defraud United States

Continuing with our series on The Actual Laws being violated by Psychiatry:

No one can legally charge money to sell Homicide.

18 U.S. Code § 371 - Conspiracy to commit offense or to defraud United States

If two or more persons conspire either to commit any offense against the United States, or to defraud the United States, or any agency thereof in any manner or for any purpose, and one or more of such persons do any act to effect the object of the conspiracy, each shall be fined under this title or imprisoned not more than five years, or both.

If, however, the offense, the commission of which is the object of the conspiracy, is a misdemeanor only, the punishment for such conspiracy shall not exceed the maximum punishment provided for such misdemeanor.
(June 25, 1948, ch. 645, 62 Stat. 701; Pub. L. 103–322, title XXXIII, § 330016(1)(L), Sept. 13, 1994, 108 Stat. 2147.)


Thank You Cornell Law

of Related interest:

18C95

Monday, June 27, 2016

Feds Arrest More Than 300 In National Fraud Bust

Well, Zip, a dee do dah day. When it's not in Auntie DiFi, Uncle Sid, Cousin Kamala, and that weird guy down the street, Gavin's, back yard they Can actually find HC Fraud.

(Actually they found it, repeatedly, according to our stat counter way back when we Reported it. Then they appointed Janet, DHS Napolitano as President of the UC system. Go figure.)

fiercehealthcare
by Evan Sweeney |
Jun 22, 2016 1:30pm



Federal authorities announced a record-breaking coordinated fraud takedown Wednesday that charged 301 people involved in various healthcare fraud schemes totaling $900 million in false claims.

The historic fraud bust, led by the Medicare Fraud Strike Force, was another notch in the belt for federal authorities, surpassing last year’s coordinated arrest of 243 people linked to $712 million in false billing.

Like last year’s takedown, authorities underscored the importance of the collaborative effort, which spanned 36 federal districts and involved several federal agencies, including the Department of Justice, the FBI, the Department of Health and Human Services Office of Inspector General, as well as local and state authorities, including 23 Medicaid Fraud Control Units.

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense,” Attorney General Loretta Lynch said during a press conference announcing the takedown. “It is a serious crime. The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people--many of them in need of significant medical care.”

Lynch highlighted several specific schemes, including one in which a network of clinics in Brooklyn is accused of bribing patients in order to bill Medicare and Medicaid more than $38 million for unnecessary medical treatment. She also identified several new fraud trends within Medicare Part D, including evidence of stolen doctor IDs used to create fake prescriptions, and a growing number of schemes involving compound medications, which were linked to a massive spike in fraudulent billing within Tricare last year.

HHS Secretary Sylvia Mathews Burwell credited the work of nearly 1,000 federal agents who “employed advanced analytics and cutting edge investigative work” to expose various schemes. She added that the high cost of drugs, and the fact that Part D is a relatively new program,makes it a target for fraud.

For more:
- read the DOJ announcement
- here’s Lynch’s remarks
Read More:
HHS Office of Inspector General
DOJ
CMS

Thank You Mr Sweeny and FH.

Tuesday, May 17, 2016

FierceHealthPayer Anti Fraud: This Week's Headlines

fiercehealthpayerantifraud

HHS misses key opportunities for improper payment recovery

While it generally complied with federal improper payment reporting requirements, the Department of Health and Human Services fell short in several key areas, according to an independent audit conducted by Ernst & Young LLP.

OIG to physicians: Be careful whom you do business with

In a new "Eye on Enforcement" video, the Office of Inspector General warns physicians to be wary of taking payments from other providers, highlighting a kickback concern the government has targeted over the last several years.

Feds probe relationship between drugmakers, pharmacy benefit managers

Federal prosecutors are investigating contracts between three pharmaceutical companies and unnamed pharmacy-benefit managers, an indication the federal government is increasing its scrutiny of potential False Claims Act violations within the agreements, according to the Wall Street Journal.

Medicare contractors relying more on data analytics to investigate fraud

Although the number of fraud and abuse investigations initiated by Medicare benefit integrity contractors declined between 2012 and 2013, contractors leaned heavily on predictive analytics to identify fraudulent billing, according to a report released by the Office of Inspector General.

Senate report reignites concerns about physician-owned distributorships

Surgeons who have a financial interest in medical device companies are far more likely to perform certain surgeries, according to an updated report that calls for increased scrutiny of the financial arrangements on physician-owned distributorships by the Senate Finance Committee.
MORE NEWS

Thursday, March 10, 2016

Psychology's Ongoing Credibility Crisis

Scientific American
New studies have intensified the debate over psychology’s “reproducibility" problems.


Psychology’s current reproducibility crisis would not have surprised William James, who once fretted that psychology might never transcend its “confused and imperfect state.” Photo of William James via Wikimedia Commons.

It’s a tough time to be a young psychologist. This thought keeps occurring to me as we search for a new psychology professor at my school, Stevens Institute of Technology. When I meet candidates, I have to ask about their field’s replication—and credibility—crisis.

I feel as though I’m pressing them on some sordid personal matter, like whether alcoholism runs in their families, but the topic is unavoidable. Last summer, a group called the “Open Science Collaboration” reported inScience that it had replicated fewer than half of 100 studies published in major psychology journals.

The New York Times declared in a front-page story that the report “confirmed the worst fears of scientists who have long worried that [psychology] needed a strong correction. The vetted studies were considered part of the core knowledge by which scientists understand the dynamics of personality, relationships, learning and memory. Therapists and educators rely on such findings to help guide decisions, and the fact that so many of the studies were called into question could sow doubt in the scientific underpinnings of their work.”

The crisis keeps generating headlines. On Friday, a group of four prominent psychologists led by Daniel Gilbert of Harvard claimed in Science that last year’s Open Collaboration study was statistically flawed and did not prove its claim that “the reproducibility of psychological science is low.” “Indeed,” Gilbert and his co-authors state, “the data are consistent with the opposite conclusion, namely, that the reproducibility of psychological science is quite high.”

In a rebuttal, 44 authors involved in the Open Science Collaboration countered that the “very optimistic assessment” of Gilbert’s group “is limited by statistical misconceptions and by causal inferences from selectively interpreted, correlational data.”

The exchange, Benedict Carey notes in the Times, “is likely to feed an already lively debate about how best to conduct and evaluate so-called replication projects of studies.” That’s too cheery an assessment. The exchange reveals that psychologists cannot even agree on basic methods for arriving at “truth,” whatever that is.

It gets worse. Over at Slate, Daniel Engber reports that the influential theory of “ego depletion”—which holds that willpower is a finite resource that diminishes with use--might have been “debunked.”

Roy Baumeister and three other psychologists presented experimental evidence for the theory in a 1998 paper that has been cited more than 3,000 times. The theory has supposedly been corroborated by hundreds of other studies, and it underpins the 2011 bestseller Willpower: Rediscovering the Greatest Human Strength, by Baumeister and journalist John Tierney.

But a study of ego depletion involving “more than 2,000 subjects tested at two-dozen different labs on several continents,” Engber reports, found “exactly nothing. A zero-effect for ego depletion: No sign that the human will works as it’s been described, or that these hundreds of studies amount to very much at all.” The new study is scheduled for publication next month in Perspectives on Psychological Science.

Spelling out the disturbing implications, Engber notes that the ego-depletion effect “has been recreated in hundreds of different ways, and the underlying concept has been verified via meta-analysis. It’s not some crazy new idea, wobbling on a pile of flimsy data; it’s a sturdy edifice of knowledge, built over many years from solid bricks. And yet, it now appears that ego depletion could be completely bogus, that its foundation might be made of rotted-out materials. That means an entire field of study—and significant portions of certain scientists’ careers—could be resting on a false premise. If something this well-established could fall apart, then what’s next?”

Good question, over which all young psychologists are no doubt agonizing. To cheer themselves, they might consider the following four points:

First, there’s nothing new about psychology’s credibility crisis. More than a century ago, William James worried that the field he helped create might never transcend its “confused and imperfect state.”

Second, all scientific fields struggle with replication issues. Behavioral genetics and psychiatry are arguably much less credible than psychology, and string and multiverse theorists don’t even have empirical results to replicate!

Third, psychologists are still doing important, empirically sound work. Two who recently spoke at my school are Sheldon Solomon, co-creator of terror-management theory, which predicts how fear of death affects us; and Philip Tetlock, leader of a study on “superforecasters,” ordinary people who do a better job than many so-called experts at predicting social phenomena.

Fourth, psychology is arguably healthier than many other fields precisely because psychologists are energetically exposing its weaknesses and seeking ways to overcome them.
I look forward to discussing these issues with the young psychologists visiting my school.

Further Reading:
Meta-Post: Horgan Posts on Brain and Mind Science.
Meta-Post: Horgan Posts on Antidepressants, Brain Implants, Psychedelics, Meditation and Other Therapies for Mental Illness.
A Dig Through Old Files Reminds Me Why I’m So Critical of Science.


Thank You Mr Horgan and Scientific American.

" the report “confirmed the worst fears of scientists who have long worried that [psychology] needed a strong correction."

Semi private rooms at Club Fed would be the Perfect place to start correcting it.

Psychiatrists And Psychologists Not Reliable Expert Witnesses


Us Title 18 Part 1 Chapter 19 Sec. 371 Conspiracy To Defraud The United States: 5 years

Us Title 18 Part 1 Chapter 47 Sec. 1031 Major Fraud Against The United States: 10 years

Us Title 18 Part 1 Chapter 47 Sec. 1035 False Statements: 5 years

Us Title 18 Part 1 Chapter 63 Sec. 1341 Mail Fraud: Frauds and Swindles: 20 years

Us Title 18 Part 1 Chapter 63 Sec. 1347 Health Care Fraud: 10 years

Us Title 18 Part 1 Chapter 63 Sec. 1349 Attempt and Conspiracy

Us Title 18 Part 1 Chapter 95 Sec. 1957 Engaging In Monetary Transactions In Property Derived From Specified Unlawful Activity: over $10,000, 10 years

Just the Tip of the Iceberg.

Friday, February 19, 2016

Clinicians Ensnared In Multi-Million Dollar Fraud Schemes

fiercehealthpayer antifraud
February 16, 2016 | By 

Clinicians across the country are facing fraud charges for multimillion dollar schemes that run the gamut of medical specialties, from obstetrics and gynecology to pain medicine. 
  • A Miami physician pleaded guilty last week to a scheme in which Medicare paid out $20 million in fraudulent payments, according to the U.S. Attorney's Office for the Southern District of Florida. Henry Lora, M.D., served as the medical director for a Miami clinic known as Merfi Corporation. Lora and others wrote prescriptions for unnecessary home health services and falsified patient records in exchange for kickbacks. The owner of the clinic was sentenced to nine years in prison in 2014 for her role in the scheme.
  • In New Jersey, an obstetrician gynecologist was charged with submitting millions in claims for rectal tests he never performed, according to NJ.com. Prosecutors say Dr. Labib E. Riachi showed a distinct pattern of overbilling, submitting more claims for the test to diagnose fecal incontinence than the next 10 highest billers in the state combined. The complaint also states Riachi billed for more than 500 procedures while he was traveling in Europe, and submitted claims for physical therapy that were never performed by a licensed therapist.  
  • A New Mexico pain management physician linked to the death of four patients has pleaded guilty to charges that he wrote unnecessary prescriptions for oxycodone and methadone and billed Medicare and Medicaid for reimbursement, according to the Albuquerque Journal. Officials say Dr. Pawankumar Jain prescribed pain medication to four patients who later died of an overdose, including one in which Jain wrote two prescriptions for more than 500 tablets of methadone.
  • A nurse in Pennsylvania was convicted for her role in a scheme that submitted nearly $10 million in fraudulent hospice claims to Medicare. A federal jury convicted Patricia McGill, who served as director of professional services for Home Care Hospice in Philadelphia, of authorizing hospice services for patients who were not medically eligible, according to the U.S. Attorney's Office for the Eastern District of Pennsylvania.
To learn more:
- here's the announcement from the U.S. Attorney's Office for the Southern District of Florida
- read the NJ.com article
- read the Albuquerque Journal article
- here's the announcement from the U.S. Attorney's Office for the Eastern District of Pennsylvania

Related Articles:

Thank You Mr Sweeny and FHPAF.


Wednesday, January 27, 2016

Dallas Woman Sentenced To Five Years For Submitting Fraudulent Psychotherapy Claims

fiercehealthpayer antifraud
Using Medicaid provider numbers, a company president submitted more than $1 million in claims

Thursday, December 3, 2015

Ten Sentenced For Virginia Mental Health Scheme

Only Ten?
fiercehealthpayerantifraud
Prison terms for unqualified counselors range from 41 to 108 months


Ten former employees of a Virginia counseling provider have been sentenced to varying prison terms over the past year for submitting false claims to the state's Medicaid program.
David Weaver, who was sentenced to six years in prison in June, operated as a licensed mental health professional at Progressive Counseling Services, LLC in Virginia Beach. Weaver, along with Progressive's owner, created fraudulent patient assessments and billed Medicaid for services provided by nine counselors, many of whom were unqualified to provide mental health services. One of the counselors, Alfreda Stallion, was the last co-conspirator to be sentenced Nov. 30. She received 90 months in prison, while other terms ranged from 41 to 108 months. Announcement

Thank You Mr Sweeny and FHPAF.

Tuesday, November 24, 2015

NOS: 'Not Otherwise Specified' Diagnoses Rose To 50% From 2007-2010


In English? "Duh, We Don't Know", but the consumer gets screwed with their disgusting stench for Life anyway.

PubMed


National Trends in Psychiatric Not Otherwise Specified (NOS) Diagnosis and Medication Use Among Adults in Outpatient Treatment.
·         1Dr. Rajakannan, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore. Dr. Zito is also with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Safer is with the Department of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore. Send correspondence to Dr. Safer (e-mail: dsafer@jhmi.edu ).
Abstract
OBJECTIVE:
This study examined national trends between 1999 and 2010 in not otherwise specified (NOS) DSM-IV psychiatric diagnoses and in related medication treatment patterns reported for adults during outpatient physician office visits.
METHODS:
Data on physician office visits by adults (ages 18-64) with a psychiatric diagnosis were from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1999-2010) (N=52,026). Trends for visits with full-criteria diagnoses compared with visits with NOS diagnoses were analyzed for major psychiatric diagnostic groups, physician specialty, and prescribed medications. Population weighted chi square and logistic regression analyses were utilized.
RESULTS:
Between 1999-2002 and 2007-2010, the proportion of all mental health visits by adults to office-based physicians that involved an NOS diagnosis increased significantly, from 42% to 50% (p<.001). Significant proportional increases in NOS diagnoses included bipolar disorders NOS (5% to 55%), anxiety disorders NOS (50% to 62%), and mood disorders NOS (.4% to 1.8%). In 2007-2010, NOS visits accounted for a greater proportion of visits to nonpsychiatrists than to psychiatrists (61% and 35%, respectively). Psychotropic medications prescribed during visits increased over time for both full-criteria and NOS diagnoses, but the increase was greater for NOS visits, specifically for antipsychotics, anticonvulsants-mood stabilizers, and lithium. By 2007-2010, psychotropic monotherapy and multidrug regimens were comparable for full-criteria and NOS diagnoses.

CONCLUSIONS:
The proportion of U.S. physician visits with an NOS psychiatric diagnosis increased to nearly 50% in 2007-2010. The increase raises concerns about the precision of psychiatric diagnoses in community care and about the impact on concomitant medication regimens.


 
"The increase raises concerns about the precision of psychiatric diagnoses"

But 50% is still not enough to Do anything about Stopping it.

At what point does the maggot gag?