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USDOJ – NJ: Former director of diagnostic testing center admits bribing doctors in cash-for-patients scheme
In the following post, note that the dollars involved are relatively modest:
The former executive director of Orange Community MRI LLC, today admitted paying bribes to doctors since April 2008 and agreed to forfeit $89,000 in proceeds from the crime, U.S. Attorney Paul J. Fishman announced.Chirag Patel, 37, of Warren, N.J., pleaded guilty to an Information charging him with one count of soliciting and receiving illegal cash kickbacks for patient referrals in violation of the federal health care anti-kickback statute.
According to documents filed in this case and statements made in court:
On Dec. 8, 2011, Patel was arrested and charged with offering and paying cash kickbacks to a New Jersey health care practitioner in exchange for referrals to Orange Community MRI. On Dec. 13, 2011, 13 New Jersey doctors and one nurse practitioner were arrested and charged in separate Complaints with accepting similar cash kickback payments from Orange MRI. Each of the defendants was recorded taking envelopes of cash in exchange for patient referrals.
Patel is the ninth person charged in the December 2011 takedown to plead guilty. Patel is the second member of Orange Community MRI to plead guilty; Ashokkumar Babaria, the former owner and medical director of Orange Community MRI, pleaded guilty on Sept. 27, 2012.
As part of his plea agreement, Patel agreed to forfeit $89,180 that constitutes criminal proceeds of the crime. As part of his guilty plea, Ashokkumar Babaria agreed to forfeit his revenues traceable to corrupt referrals, which the government has estimated could reach as much as $2 million. The seven health care providers that referred patients to Orange MRI who have plead guilty thus far have collectively agreed to forfeit over $150,000 in illegal kickbacks from Orange MRI.
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.
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USDOJ: Clinic Owners Plead Guilty in Detroit-Area Infusion Therapy Scheme
Two owners and operators of clinics that claimed to specialize in treating HIV and other conditions pleaded guilty today for their roles in an infusion therapy scheme carried out at two Detroit-area clinics that submitted millions of dollars in fraudulent claims to Medicare.
The guilty pleas were announced by Assistant Attorney General Lanny A. Breuer of the Department of Justice’s Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; Special Agent in Charge Robert Foley III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (HHS-OIG) Chicago Regional Office.
Raymond Arias, 40, and his wife, Emelitza Arias, 25, of Troy, Mich., each pleaded guilty, before U.S. District Judge Paul D. Borman of the Eastern District of Michigan, to one count of conspiracy to commit health care fraud. At sentencing, the defendants each face a maximum potential penalty of 10 years in prison and a $250,000 fine. Sentencing is currently scheduled for Feb. 12, 2013.
According to plea documents, Raymond Arias conceived of and oversaw fraud schemes at two clinics for which he was a beneficial owner: Elite Wellness LLC, and Carefirst Occupational & Rehabilitation Center Inc. He admitted to paying physicians to refer Medicare beneficiaries to Elite Wellness, and to purchasing Medicare beneficiary identifications for the purpose of submitting fraudulent claims to Medicare for expensive infusion therapy services that were not rendered as claimed by Carefirst.
According to court documents, Raymond Arias attempted to hide the Elite Wellness scheme from law enforcement by directing a nominee owner to assume control of the claims submitted and the bank account into which Medicare payments were deposited. After the nominee owner became involved, Raymond Arias and his alleged co-conspirators submitted approximately $10 million in claims over a 3-month period beginning in August 2010.
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: Owner and Operator of Florida Halfway House Company Sentenced to 51 Months in Prison for Role in Medicare Fraud Scheme
The owner and operator of New Way Recovery Inc., a Florida corporation that operated several halfway houses, was sentenced today to serve 51 months in prison for his role in a $205 million Medicare fraud scheme involving fraudulent claims for purported partial hospitalization program (PHP) services, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; 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 HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.
Hassan Collins, 41, was sentenced by U.S. District Judge Kevin Michael Moore in the Southern District of Florida. In addition to his prison term, Collins was sentenced to serve three years of supervised release and ordered to pay $2,413,675 in restitution, jointly and severally with co-conspirators.
On June 14, 2012, Collins pleaded guilty to one count of conspiracy to receive and pay health care fraud kickbacks.
According to court documents, from approximately April 2004 through approximately September 2010, Collins, along with co-conspirators, received kickback payments in exchange for referring Medicare beneficiaries, who did not qualify for PHP treatment, for purported PHP services to American Therapeutic Corporation (ATC), a Florida corporation that operated several purported PHPs throughout Florida. Collins and his co-conspirators caused false and fraudulent claims to be submitted to Medicare for PHP services purportedly provided to Medicare beneficiaries at ATC’s locations, when, in fact, the services were never provided.
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.
Modern Physician: Practice Makes Perfect: Preparing for shared-risk reimbursement models
In June, the MGMA-ACMPE released the results of a questionnaire that ranked members’ most-pressing practice management challenges. In this edition of “Practice Makes Perfect,” we’ll tackle No. 2 on that list: Preparing for reimbursement models that place a greater share of financial risk on the practice.
One of the many hot topics at our upcoming annual conference in San Antonio will be the changing healthcare environment and how practices can—and should—prepare for new payment methodologies. The federal government and commercial insurance companies are in the midst of changing the way they pay hospitals and doctors. Some of these changes are the result of the Patient Protection and Affordable Care Act as well as market forces. These changes will affect practices in all settings, and it’s important to prepare for reimbursement models that place a greater share of financial risk on the practice.
Physicians may soon be at financial risk as payers test and adopt new payment methods. The CMS and private insurers are proposing models to replace separate payments to hospitals, doctors and other providers with a single bundled payment, and we are seeing multiple definitions of bundling. A common type of bundled payment involves a single payment for all services furnished before, during and after a hospitalization, including outpatient diagnostic tests, inpatient facility costs, drugs, supplies and the professional services of every physician involved in the patient’s care.
In addition, the CMS and many insurers are testing variations on the capitation payment concept that was widely used in the health maintenance organization craze of the 1990s. Commonly referred to as “global payment,” this reimbursement method pays a set amount per patient (usually adjusted by demographics) and the provider accepts responsibility for a predetermined set of services regardless of the costs.
Both bundled and global payment reflects a sea change from the traditional fee-for-service payment system. Payers hope that bundled and global payments will create incentives for primary-care physicians, specialists and hospitals to better coordinate services and share accountability for the cost and quality of services. They hope the new payment systems will improve the care their beneficiaries receive while lowering the total cost of care by eliminating redundant services.
These new payment methods require doctors to think in new ways and will challenge the information systems of even the most sophisticated fee-for-service practice. Bundled and global payments change a practice’s profit calculation from emphasizing service volume to operating efficiency.
In this new payment environment, practices that gather the right information and provide high-quality, lower-cost care will be the most profitable.
See on home.modernphysician.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.
Medical Homes Survey: Primary care with a personal touch – Modern Healthcare
Medical Homes Survey reveals diverse settings, but single goal: Increase quality of care.
When primary-care physicians needed to go somewhere new to revitalize their field, they found that there was no place quite like the patient-centered medical home: A practice model that emphasizes care coordination, increased access and enhanced doctor-patient communication—all with an emphasis on continuous quality improvement.
Modern Healthcare’s second annual Medical Homes Survey, conducted June 25-Sept. 28, drew responses from 29 organizations. The survey sample illustrates the wide variety of settings among the 4,870 sites that have been recognized as medical homes. One survey response came from an organization with a staff of 350 doctors, and another came from a solo practice. The largest group in the survey has an enrolled patient population of 939,000 while the smallest has 823. One thing they have in common is a desire to increase the quality of care by advancing an old-fashioned concept that is often enhanced by the newest technology.
See on home.modernhealthcare.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.
Modern Physician: Lovelace Health acquires physician practice
Albuquerque-based Lovelace Health System has acquired Southwest Medical Associates, a physician practice that will retain its name, leadership and all 150 employees in the deal. No financial terms were disclosed, said a spokeswoman for Lovelace.
Effective immediately, the transaction starts a new physician model for Lovelace that will rely on a mix of employed, strategically aligned and community physicians.
See on home.modernphysician.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.
Physician Associates to be bought by Orlando Health – Orlando Business Journal
According to the Orlando Business Journal: Physician Associates LLC has agreed to negotiate exclusively to be acquired by Orlando Health.
The details of the arrangement, including dollar value, have not been disclosed, but analysts spoken to for a story in August speculated the deal could be valued anywhere from $20 million to $60 million.
“Physician Associates LLC and Orlando Health today announced the physician practice has selected Orlando Health as the organization with which it will begin exclusive acquisition negotiations,” said Kena Lewis, Orlando Health spokeswoman.
Florida Hospital also was vying to buy the practice.
See on www.bizjournals.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.
Guest opinion: Medicare Part D: A success story for Florida’s seniors
Lawmakers in Washington are working hard to reduce entitlement spending and lower the deficit. These are worthy goals. However, during this process, it’s vitally important that policymakers not compromise successful federal programs.
Medicare Part D is such a program. Part D needs to be preserved and protected, as it has dramatically improved seniors’ access to prescription drugs and has cost taxpayers far less than expected.
Part D employs a unique market-based structure that offers enrollees genuine choice in their coverage and harnesses competition to keep prices down. The government doesn’t directly provide coverage through Part D — private insurers do. Seniors are free to choose among a broad range of plans based on their needs. The government monitors the market and provides financial support to enrollees.
See on www.news-press.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.
The New Values Voters: People Of Faith For Health Care Reform
Faith communities have also spoken out for reforming our health care system, urging that it reflect the values of human dignity, shared responsibility, compassion, stewardship of resources, and concern for those who are vulnerable. Advocates for reform include the U.S. Conference of Catholic Bishops, the United Methodist Church, the Evangelical Lutheran Church in America, the Episcopal Church, the Union for Reform Judaism, the Central Conference of American Rabbis, and others.
Such support is also reflected in the values of people in the pews. A 2009 survey by the Pew Forum on Religion and Public Life showed 6 in 10 Americans—including 48 percent of white evangelicals, 55 percent of Catholics, 56 percent of white mainline Protestants, and 72 percent of the religiously unaffiliated—favoring a government guarantee of health insurance for all citizens, even if it would mean raising taxes.
See on thinkprogress.org
Former Indiana surgeon nabbed in Italy gets 7 years in prison
A former Indiana surgeon arrested on a snowy Italian mountainside after five years on the run was handed a stiff prison term Friday for billing insurers and patients for procedures he didn’t perform, with the federal judge saying he used patients like an ATM machine.
See on www.foxnews.com
Joseph Rugg's Health Law Blog 