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Texas Attorney General Indicts Orthodontist for Health Care Law Fraud in State and Federal Probe
Dr. Michael David Goodwin, 63, an orthodontist who practices in Amarillo, Texas, and Crown Point, Indiana, has been charged in a federal indictment with 11 counts of health care fraud, alleging that he defrauded the Texas Medicaid program of approximately $1.5 million, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
According to the indictment that was returned by a federal grand jury today, approximately 90 to 95 percent of Goodwin’s orthodontics’ patients were Medicaid beneficiaries. The Texas Medicaid program provides orthodontic services for Medicaid beneficiaries who fit the following criteria: 1) children who are 12 years old and older with severe handicapping malocclusions; 2) children who are up to 20 years old with cleft palate; or 3) other special medically necessary circumstances, including crossbite therapy and head injury involving severe traumatic deviation.
See on www.oag.state.tx.us
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US Attorney’s Office – W. Dist. MO: Psychologist Pleads Guilty To $1 Million Health Care Fraud
David M. Ketchmark, Acting United States Attorney for the Western District of Missouri, announced today that a psychologist practicing in the Lebanon, Mo., area pleaded guilty in federal court today to engaging in a $1 million scheme to defraud Medicare and Medicaid.
Rhett E. McCarty, 67, of Lake Ozark, Mo., pleaded guilty before U.S. District Judge Howard F. Sachs to health care fraud and to forgery.
McCarty is a licensed psychologist and private practitioner who provided psychotherapy services to recipients of both Medicare and Medicaid in their homes in the Lebanon area.
Between Sept. 17, 2008, and April 5, 2012, McCarty submitted Medicare and Medicaid claims for daily or near daily psychotherapy services to 19 beneficiaries for which he was paid $1,276,334. Although McCarty did provide some services for most of these beneficiaries, he admitted that he did not see those beneficiaries more than once a week. McCarty also admitted that, based on an estimate of the services he did provide, the amount he was paid by Medicare and Medicaid for services he did not provide to these 19 beneficiaries was $1 million.
McCarty also admitted that he forged (or caused another person to forge) the signatures of five of the beneficiaries on patient sign-in sheets in order to obtain $418,507 in Medicare and Medicaid payments.
By pleading guilty today, McCarty must forfeit to the government $1 million, which represents the proceeds of the fraud scheme.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
US Attorney’s Office – Idaho: Caldwell Optometrist Pleads Guilty To Defrauding Health Care Benefit Progtams
BOISE – Christopher Card, 59, of Caldwell, Idaho, pled guilty in United States District Court today to a superseding information charging him with one count of executing a scheme to defraud health care benefit programs, U.S. Attorney Wendy J. Olson announced. Card is a licensed optometrist in Idaho and the former owner, manager and care provider at Total Vision, P.A., in Caldwell.
According to the plea agreement, on various dates between 1993 and August 31, 2010, Card executed a scheme to defraud Idaho Medicaid, Medicare, Blue Cross of Idaho, Regence Blue Shield of Idaho, and the Rail Road Retirement Board (RRB), by making false statements, and by submitting false, fraudulent, and fictitious claims for reimbursement to these health care benefit programs. The total loss to the health care benefit programs and the restitution agreed to by the parties is $1 million.
According to the plea agreement, Card fraudulently billed health care benefit programs, especially Medicaid and Medicare, for false diagnoses, including glaucoma, acquired color deficiency (color blindness), tension headaches, macular degeneration, treatment of eye injuries and removal of foreign objects from the eye. Card billed for testing that did not actually occur and for testing results that were falsified or altered. He admitted that in late October 2008, he altered his fraudulent diagnoses and billing practices when he learned that federal and state health care fraud investigators interviewed a former employee.
According to the plea agreement, 18 patients identified in the original indictment were diagnosed by Card with glaucoma or glaucoma-related conditions. All were subsequently examined by other doctors; only one was determined to actually have the glaucoma or glaucoma related diseases that Card had diagnosed. Card falsely diagnosed the 18th patient, and others, with acquired color deficiency. According to the plea agreement, the patients named in the original indictment were not the only patients for whom Card falsely billed health insurance companies.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Gov. Brown Calls Special Session On Health Care Reform – CBS San Francisco
Gov. Jerry Brown is telling California lawmakers that he will call a special legislative session on health care at the end of the year.
See on sanfrancisco.cbslocal.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Virginia moving on implementing health reform
Virginia has made progress in updating its computer system for verifying eligibility for Medicaid and has passed insurance regulations in preparation for implementing federal health care reform, according to a report by a nonprofit organization tracking states’ efforts.
But Virginia is behind in some key areas — it hasn’t created health insurance exchanges or marketplaces where people could buy affordable health insurance plans, and it may not be producing enough doctors to care for hundreds of thousands of newly insured people expected to be covered when reform is fully implemented.
The report, paid for by the Robert Wood Johnson Foundation, a health care philanthropy, was done by researchers at the Urban Institute, a nonprofit policy research organization, “Virginia has made significant progress in health reform implementation, despite significant political opposition in and out of the state government,” conclude the report’s authors, Linda J. Blumberg, John Holahan and Vicki Chen, of the Urban Institute.
See on www2.timesdispatch.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
State health initiative in Indiana for poor may be on last legs
The future of a state health insurance program for the working poor is in jeopardy after the federal government granted only a one-year extension for the effort.
The denial puts extra pressure on state lawmakers and the next Indiana governor who must decide next year whether to expand Medicaid, which provides health care for the poor and disabled.
Michael Gargano, Family and Social Services Administration secretary, said Friday he received notification from the Centers for Medicare & Medicaid Services offering to approve a one-year extension for the Healthy Indiana Plan to Dec. 31, 2013.
The Centers for Medicare & Medicaid Services did not approve a multiyear extension for the program and declined to respond to the state’s questions about using it to serve Hoosiers who may be eligible under a Medicaid expansion if the state decides to do so in 2014.
See on www.journalgazette.net
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Tax-exempt health insurance carrier planned for state
The Missouri Foundation for Health has donated $500,000 to help with the development of a new tax-exempt health insurance carrier for small employers and individuals in the state.St.
Louis-based not-for-profit consulting firm The Mission Center hopes to launch the Missouri Community Healthcare Co-Op by January 2014. The Mission Center also is submitting an application to the Centers for Medicare and Medicaid Services for low-interest loans for as much as $50 million to launch the co-op, according to a news release from The Mission Center.
Small businesses and individuals face the greatest hurdles in finding affordable coverage from for-profit companies. The co-op hopes to lower costs and improve coverage for entities that struggle to access coverage.
See on www.columbiatribune.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Memorial Hermann Accountable Care organization to participate in Medicare Shared Savings program
Memorial Hermann Accountable Care Organization, an affiliate of Memorial Hermann Healthcare System and its physician network, MHMD, have been selected to participate in the Medicare Shared Savings Program as an Accountable Care Organization, a new program sponsored by the Centers for Medicare and Medicaid Services.
Through the Shared Savings Program, MHACO will work with CMS to provide Medicare fee-for-service beneficiaries with high-quality care, while lowering the rate of growth in Medicare costs through preventative medicine and careful management of patients diagnosed with chronic diseases. CMS will use robust quality measures to reward ACOs that achieve these outcomes.
In addition to Memorial Hermann’s 12 hospitals, numerous specialty institutes and advanced outpatient facilities, MHACO is a 332-member provider network comprised of both independent physician practices and physicians employed by Memorial Hermann affiliates. These physicians are a part of the Advanced Primary Care Practices patient-centered medical home initiative developed by MHMD.
MHACO believes a key factor in CMS’ selection of MHACO to participate in the Shared Savings Program is use of the innovative Advanced PCPs, built on MHMD’s clinical integration program that unites independent physicians of every specialty throughout the Houston area in a common commitment to quality and accountability.
See on www.yourhoustonnews.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Health Reform Could Improve AIDS Treatment in Kentucky, Advocate Says
At a two-day HIV/AIDS conference this week in Lexington, an AIDS advocate pushed for better communication about health care reform among health care providers, advocates and the state.
According to Amy Killelea, senior manager for health care access at the National Alliance of State and Territorial AIDS Directors, now is the time for advocates to let state legislators and the Kentucky office of Health Care Reform know what they need as part of health care reform.
See on www.thebody.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
When Data Makes You Look Bad – HealthLeaders Media
With the launch of an updated Hospital Compare site, and growing interest among the media, healthcare leaders need to face the fact that sometimes the data makes them look bad.
CMS now publicly posts hospital-specific results for 84 measures, with more expected in the next two years. Along with each measure, the public can download spreadsheets showing data for each hospital all in one file; one can see who’s better or worse even within a region, state, county, or ZIP code.
These rating systems alert employers, community leaders, and health plans, for example, whether your patients got the right antibiotic at the right time, how long the hospital made patients wait in the ED, and the rate of central line bloodstream infections, or numbers of foreign objects left inside body cavities during surgery. Even the hospital’s cost for an episode of care is held up for public view.
See on www.healthleadersmedia.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
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