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USDOJ S.D. Florida: Owner of Miami Home Health Company Sentenced to 37 Months in Prison for $60 Million Health Care Fraud Scheme
The owner of a Miami health care agency was sentenced today to 37 months in prison for his participation in a $60 million home health Medicare fraud scheme, announced U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.
Rodolfo Nieto Jr., 40, of Miami, was sentenced today by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to his prison term, Nieto was sentenced to serve three years of supervised release and ordered to pay $1.1 million in restitution.
On Aug. 14, 2012, Nieto pleaded guilty in the Southern District of Florida to one count of conspiracy to defraud the United States and to receive health care kickbacks.
Nieto was the owner and operator of Ronat Home Health Care Inc. According to court documents, during the time of the conspiracy, Ronat was a Florida home health “staffing agency” that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. Ronat subsequently became a home health agency.
According to court documents, from approximately January 2006 to approximately November 2009, Nieto accepted kickbacks in return for recruiting Medicare beneficiaries to be placed at Nany Home Health Inc., a Miami home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. The owners and operators of Nany paid Nieto kickbacks in return for allowing Nany to bill the Medicare program on behalf of the patients Nieto had recruited through Ronat. Specifically, as part of the scheme, Nany billed Medicare for home health services purportedly provided by Ronat.
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.
USDOJ E.D. California: Third Physician Sentenced To Lengthy Prison Sentence In Medicare Fraud Case
Dr. Ramanathan Prakash, 65, of Northridge, CA, was sentenced today by United States District Judge Morrison C. England, Jr. to a statutory maximum 10 year prison sentence. The defendant had been found guilty of Conspiring to Commit healthcare fraud, and three counts of healthcare fraud by a jury on July 8, 2011. Judge England also imposed a $75,000 fine and ordered Prakash to pay $607,456.80 in restitution.
According to testimony presented at trial, from February 2006 through August 2008, Vardges Egiazarian, 63, of Panorama City, owned and controlled three health care clinics in Sacramento, Richmond, and Carmichael. Egiazarian and others recruited doctors to submit applications to Medicare for billing numbers. Prakash participated in the establishment of a clinic in Sacramento, although he lived in the Los Angeles area. He established the Medicare provider number for the clinic, signed the lease and established a bank account for the clinic. He only visited the clinic twice.According to evidence at trial, Prakash never treated a single patient at the clinic. Clinic patients, almost all of whom were elderly and non-English speaking, were recruited and transported to the clinics by individuals who were paid according to the number of patients they brought to the facilities. Rather than being charged a co-payment, the patients were paid for their time and the use of their Medicare eligibility, generally $100 per visit. False charts were created stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using preprinted templates. Some clinic employees admitted to performing various tests on themselves, and placing the results in patient files.
Patient files were then transported to Los Angeles where Prakash signed them indicating he provided or approved the treatments. In all, the three clinics submitted more than $5 million worth of fraudulent claims to Medicare, $1.7 million of which was actually paid. In return for their roles, Prakash and the other physicians received 20 percent of the billings paid under their provider numbers.
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.
USDOJ: Boehringer Ingelheim Pharmaceuticals to Pay $95 Million to Resolve False Claims Act Allegations
Connecticut-based Boehringer Ingelheim Pharmaceuticals Inc. has agreed to pay $95 million to resolve allegations relating to the improper promotion of the stroke-prevention drug Aggrenox, the chronic obstructive pulmonary disease (COPD) drugs Atrovent and Combivent, and the hypertension drug Micardis, the Justice Department announced today.
The Food and Drug Administration (FDA) has approved Aggrenox to prevent secondary strokes, Combivent to treat continued symptoms of bronchospasm in patients with COPD who already are on a bronchodilator and Micardis to treat hypertension. The settlement resolves allegations that Boehringer improperly marketed each of these drugs and caused false claims to be submitted to government health care programs.
According to the government’s allegations, Boehreinger promoted each of the three drugs for uses that were not medically accepted indications and were not covered by federal health care programs. Specifically, the settlement resolves allegations that Boehreinger promoted Aggrenox for certain cardiovascular events such as myocardial infarction and peripheral vascular disease; that Combivent was marketed for use prior to another bronchodilator in treating COPD; and that Micardis was marketed for treatment of early diabetic kidney disease. The uses were not for medically accepted indications and were not covered by federal health care programs.
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.
OIG Work Plan Will Examine Hospital-Based Physician Practice Billing
The OIG 2013 Work Plan will focus on many topics to make sure health care providers are dotting i’s and crossing t’s.
One topic is will be to determine the effects of nonhospital-owned physician practices billing Medicare as hospital-based physician practices.
[This is very timely given the renewed wave of hospital acquisitions and employment of physicians.]
See on www.bna.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.
WSJ CIO Journal: One Stanford Doctor Wants to Focus on Real Patients, Not iPatients
Electronic medical records don’t always reflect what really happens during an examination. Physicians are so busy checking off boxes and keying in vital signs that sometimes they spend more time with the virtual patient than the real one.
“Many of us recognized that there was a gap between what the medical record claimed was done on the patient, in a sense, and the actual execution of the task,” Dr. Abraham Verghese, a professor at Stanford University’s School of Medicine and best-selling novelist, said in a Thursday Wall Street Journal article. “It reflects an increasing dependence on technology and paying lip-service to the actual examination of the patient,” he said.
Creators of electronic medical records never envisioned that the technology might actually decrease the quality of patient care. Instead, they saw a world where medical errors would drop because charts could be easily accessed and read. They also hoped that electronic records would result in fewer duplicated tests and lower costs. Yet, the difficulty of using many of these systems means that, in some cases, it’s encroaching upon the quality of patient care. It’s a lesson for CIOs — the very technology they implement to solve a problem can actually make that problem worse if they don’t think carefully about the people using it.
See on blogs.wsj.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.
GWU Face the Facts: Medicaid covers nearly half the 1.2 million Americans getting regular treatment for HIV – 47%
Nearly 1.2 million Americans get regular treatment for HIV, and Medicaid covers almost half of them – 47 percent. Only 1 percent of Medicaid clients have HIV; their care consumes 2 percent of the Medicaid budget ($5.3 billion). They represent 23 percent of all HIV-infected people in the U.S; not all those infected are receiving treatment.
African-Americans are at particular risk for HIV. Half of Medicaid HIV patients are African-American, and the CDC estimates new HIV infections run six times as high among African-Americans as for white men.
See on facethefactsusa.org
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.
Alzheimer’s News 10/23/2012: Settlement ensures people with Alzheimer’s access to rehabilitative services
As one of the plaintiffs in the federal class action lawsuit Jimmo v. Sebelius, which challenged the Medicare Improvement Standard, the Alzheimer’s Association applauds the recently announced proposed settlement.
The long-practiced Medicare Improvement Standard provided that Medicare beneficiaries must achieve demonstrable improvements in order to receive rehabilitative services, such as physical, speech and occupational therapy. Without these demonstrable improvements, Medicare would not pay for these services. Now, under the settlement agreement, Medicare will pay for these services if they maintain the patient’s current condition or prevent or slow further deterioration.
The Association believes that eliminating the Improvement Standard is very important for the health and well-being of the growing number of Americans with Alzheimer’s disease. As an organization that has advocated for these changes on behalf of the millions of Americans living with Alzheimer’s and the millions more who will face the disease in the future, the Association determined it was important to join this lawsuit to secure these changes.
See on www.alz.org
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.
New Yorker 6-28-12: Atul Gawande: Why the Uninsured Are Still Vulnerable — The debate rages on
Below is an excerpt from Atul Gawande’s op-ed piece that was published in The New Yorker after the Supreme Court upheld the Affordable Care Act last June. The debate rages on during the presidential campaign.
* * * * *
During the nineteenth century, for instance, most American leaders believed in a right to vote—but not in extending it to women and black people. Likewise, most American leaders, regardless of their politics, believe that people’s health-care needs should be met; they’ve sought to insure that soldiers, the elderly, the disabled, and children, not to mention themselves, have access to good care. But many draw their circle of concern narrowly; they continue to resist the idea that people without adequate insurance are anything like these deserving others.
And so the fate of the uninsured remains embattled—vulnerable, in particular, to the maneuvering for political control. The partisan desire to deny the President success remains powerful. Many levers of obstruction remain; many hands will be reaching for them.
For all that, the Court’s ruling keeps alive the prospect that our society will expand its circle of moral concern to include the millions who now lack insurance. Beneath the intricacies of the Affordable Care Act lies a simple truth. We are all born frail and mortal—and, in the course of our lives, we all need health care. Americans are on our way to recognizing this. If we actually do—now, that would be wicked.
See on www.newyorker.com
Poking Fun at My Patients to create an environment that feels at least a little normal
“I joke around with my patients to create an environment that feels at least a little normal in the craziness of their disease, so they can focus on living, not dying.”
Certain aspects of medical school, like learning the basics of normal and abnormal organ function, or rotating onto specialty services as mini-apprenticeships to recognize disease and treat it, haven’t changed much in 100 years of medical education.
What has changed is the emphasis on communicating with patients, which includes understanding how social and cultural factors and life circumstances can influence everything from disease occurrence to medication compliance. This is a good thing.
Leukemia doesn’t read a person’s tax returns, and my patients run the gamut. In the same morning recently, I saw a Russian oligarch who comes for visits in his private jet and a 20-year-old whose leukemia diagnosis kept him from serving jail time, and who catches the Regional Transit Authority bus for his appointments. I need to have insight into their lives outside my stark exam room to appreciate how their environments will affect the care plans we develop.
We also learn how patients react to illness, and how a diagnosis like cancer can dramatically alter a family’s landscape, or how a person defines herself.
See on well.blogs.nytimes.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.
SGR Repeal Plea Backed by 110 Physician Groups
Here we go again:
More than 110 physician specialty and state medical society organizations this week renewed what has become an annual plea for Congress to repeal the sustainable growth rate formula.
If implemented according to schedule, the SGR will cut doctors’ Medicare pay 27%, leaving doctors with only 73 cents of every dollar the program pays them today starting on January 1, 2013.
The cost of repealing the SGR to restore those payments would be $245 billion over the next 10 years, according to August projections from the Congressional Budget Office.
See on www.healthleadersmedia.com
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