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Louisiana Couple sentenced in Medicare fraud case
A Plaquemine couple is headed to federal prison after admitting that they used their medical equipment company to defraud Medicare of slightly more than $1 million.
The couple admitted they billed Medicare for equipment that was either medically unnecessary or never delivered to Medicare beneficiaries. In some cases, Medicare was billed for expensive equipment for which inferior products were substituted.
Between January 2006 and March 2008, according to their charge, the Stewarts and “others known and unknown to the United States attorney” falsely billed Medicare for $1.9 million in power wheelchairs, orthotics and other durable medical equipment.
See on www.fox8live.com
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ID theft scammers pretend to be Medicare reps, offer free medical supplies to get information – The Prescott Daily Courier – Prescott, Arizona
Prescott, AZ: Better Business Bureaus across the country have received calls from seniors being targeted for Medicare fraud, said Mary Hawkes, director of the BBB Yavapai County office.
“Seniors in northern Arizona report receiving calls from individuals claiming to be with Medicare offering free items such as a back brace and diabetic supplies in exchange for consumers’ financial and personal information,” Hawkes said, “Due to the high likelihood that callers are not associated with Medicare, the Better Business Bureau is alerting the senior community to be wary of calls offering Medicare benefits.”
Local seniors said after the caller identifies himself or herself as a representative from Medicare, he or she offers free items to entice consumers to provide their Medicare number, as well as insurance and personal information.
See on www.dcourier.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 Holocaust Blogpost: Florida, HCA, Rick Scott and Medicare Fraud
Some strong opinions and YouTube videos from the Medical Holocaust Blogpost:
“Rick Scott is just one of many corporate gangsters operating in the lucrative and largely unregulated medical industry. Now street level thugs in Florida have taken a lesson form guys like Rick Scott and are bilking Medicare for billions. Rick Scott wins the gold medal when it comes to bilking Medicare and private insurance out of billions and his gold medal performance has inspired other criminals of a slightly different pedigree to follow in his footsteps.”
See on medicalholocaust.blogspot.fr
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.
A Harsh Reminder of How Active the OIG, DOJ, and State AGs are in Health Fraud Prevention
A harsh reminder to healthcare providers that the OIG, DOJ, and state AGs are actively prosecuting healthcare fraud.
See on oig.hhs.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: Hospital Chain HCA Inc. Pays $16.5 Million to Settle False Claims Act Allegations Regarding Chattanooga, Tenn., Hospital
HCA Inc., one of the nation’s largest for-profit hospital chains, has agreed to pay the United States and the state of Tennessee $16.5 million to settle claims that it violated the False Claims Act and the Stark Statute, the Department of Justice announced today.
As alleged in the settlement agreement, during 2007, HCA, through its subsidiaries Parkridge Medical Center, located in Chattanooga, Tenn., and HCA Physician Services (HCAPS), headquartered in Nashville, Tenn., entered into a series of financial transactions with a physician group, Diagnostic Associates of Chattanooga, through which it provided financial benefits intended to induce the physician members of Diagnostic to refer patients to HCA facilities. These financial transactions included rental payments for office space leased from Diagnostic at a rate well in excess of fair market value in order to assist Diagnostic members to meet their mortgage obligations and a release of Diagnostic members from a separate lease obligation.
The Stark Statute restricts financial relationships that hospitals may enter into with physicians who potentially may refer patients to them. Federal law prohibits the payment of medical claims that result from such prohibited relationships.
“The Department of Justice continues to pursue cases involving improper financial relationships between health care providers and their referral sources, because such relationships can corrupt a physician’s judgment about the patient’s true healthcare needs,” said Stuart F. Delery, the Acting Assistant Attorney General for the Department of Justice’s Civil Division.
“Physicians should make decisions regarding referrals to health care facilities based on what is in the best interest of patients without being induced by payments from hospitals competing for their business,” said Bill Killian, U.S. Attorney for the Eastern District of Tennessee.
“Improper business deals between hospitals and physicians jeopardize both patient care and federal program dollars,” said Daniel R. Levinson, Inspector General of the Department of Health and Human Services. “Our investigators continue to work shoulder to shoulder with other law enforcement authorities to stop schemes that imperil scarce health care resources.”
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: US Attorney’s Office New Jersey – Fifth New Jersey Health Care Practitioner Pleads Guilty In Cash-For-Patients Scheme
NEWARK, N.J. – Dinesh Patel, a New Jersey doctor practicing in Newark, pleaded guilty today to participating in a cash-for-patients scheme with a diagnostic facility in Orange, N.J., and agreed to pay back thousands of dollars in bribe money he received in the past two years, U.S. Attorney Paul J. Fishman announced.
Patel, 58, of Livingston, N.J., pleaded guilty today before U.S. District Judge Claire C. Cecchi to an Information charging him with one count of violating the federal healthcare program anti-kickback statute. Patel will forfeit $7,600 he received in kickbacks during the years 2010 and 2011.
According to documents filed in this case and statements made in court:
On Dec.13, 2011, Patel was arrested and charged with accepting cash kickback payments from Orange Community MRI (“Orange MRI”), a diagnostic facility, in exchange for his referral of Medicare and Medicaid patients. Also on Dec. 13, 2011, 12 other New Jersey doctors and one nurse practitioner were arrested and charged in separate complaints with accepting similar cash kickback payments from Orange MRI. As revealed in the Complaints, each of the defendants were recorded taking envelopes of cash in exchange for patient referrals. On Dec. 8, 2011, an Orange MRI executive was arrested and charged in a separate Complaint in connection with his participation in the scheme.
Patel is the fifth person arrested in the December 13 takedown to plead guilty. In all, the five defendants who have pleaded guilty thus far accepted nearly $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.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
USDOJ: Five Individuals Charged in Detroit for Alleged Roles in $24.7 Million Medicare Fraud Scheme
WASHINGTON – Five individuals were charged in court documents unsealed today in the Eastern District of Michigan for their participation in a Medicare fraud scheme involving purported home health and psychotherapy services, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
According to court documents, the scheme allegedly involved a total of more than $24.7 million in fraudulent claims submitted to Medicare for purported home health care and psychotherapy services that were medically unnecessary and/or never provided.
Court documents allege that the defendants are operators, employees and marketers associated with home health care and psychotherapy clinics operating in and around Detroit. Defendants charged in court documents unsealed today include: Mohammed Sadiq, 65, Troy, Mich.; Jamella Al-Jumail, 23, of Brownstown, Mich.; Firas Alky, 40, of Shelby Township, Mich.; Clarence Cooper, 53, of Detroit; and Beverly Cooper, 58, of Detroit.
Four defendants charged in the superseding indictment were previously charged and arrested in May 2012 for their roles in the scheme. Defendants previously charged include: Sachin Sharma, 36, of Shelby Township; Dana Sharma, 29, of Shelby Township; Abdul Malik Al-Jumail, aka Tony, 52, of Brownstown; Felicar Williams, 49, of Dearborn, Mich.
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.
D.C. Week: Lawmakers Talk Health Before Heading Out — Focus is on Medicare Advantage Plan Cuts under the ACA
WASHINGTON — Members of Congress tackled several health-related issues this week before leaving the nation’s capital and hitting the campaign trail for a final election push.
Democrats and Republicans traded jabs this week on health reform’s impact on Medicare Advantage plans, with one side praising the law’s effects and the other predicting it will hurt the program.
The Obama administration reported that the Affordable Care Act (ACA) has strengthened Medicare Advantage. Since the ACA was passed in 2010, Medicare Advantage premiums have fallen by 10% and enrollment has risen by 28%, according to a statement from the Department of Health & Human Services (HHS).
HHS also projected enrollment to increase 11% in the next year with premiums remaining steady.
But Republicans in the House of Representatives held a hearing Friday on Medicare Advantage plans and took the opportunity to bash cuts in the plan under the ACA saying it will negatively impact enrollment and benefits for seniors.
See on www.medpagetoday.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.
CMS Press Release: Medicare Advantage Program is projected to remain strong with an increase of 11% for 2013
Enrollment in the Medicare Advantage (MA) program is projected to increase by 11 percent in the next year and premiums will remain steady, Health and Human Services Secretary Kathleen Sebelius announced today. Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has risen by 28 percent.
“Thanks to the Affordable Care Act, the Medicare Advantage and Prescription Drug programs have been strengthened and continue to improve for beneficiaries,” said Secretary Sebelius. “Since the law was enacted in 2010, average premiums have gone down, enrollment has gone up, and new benefits and lower drug costs continue to help millions of seniors and people with disabilities.”
For the third year in a row, the Centers for Medicare & Medicaid Services (CMS) used authority provided by the Affordable Care Act to protect beneficiaries from significant increases in costs or cuts in benefits. Access to supplemental benefits remains steady and beneficiaries’ average out-of-pocket spending remains constant.
The average MA premium in 2013 is projected to increase by only $1.47 from last year, coming to $32.59. However, if beneficiaries choose lower cost plans at the same rate in 2013, as they did in 2012, the average premium is expected to increase by only 57 cents. Access to the Medicare Advantage program will remain strong, with 99.6 percent of beneficiaries having access to a plan. Additionally, the number of plan choices will increase by 7 percent in 2013.
Last month, CMS announced that the average estimated basic Medicare prescription drug plan premium was projected to be $30 in 2013, holding steady from last year. Today’s projections show that access to a Medicare prescription drug plan will remain strong in 2013. Everyone with Medicare will have access to a wide range of plan choices.
The Annual Open Enrollment Period for health and drug plans begins on October 15 and ends December 7.
See on www.cms.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.
Report faults Medicaid patient cost in New York’s residential centers for the developmentally disabled
ALBANY — New York’s residential centers for the developmentally disabled cost Medicaid about $1.9 million a year for each patient, and federal overpayments that total $15 billion since 1990 should end immediately, according to a congressional oversight committee.
In a report this week, the House Committee on Oversight and Government Reform said the overpayments represent “massive waste,” are likely illegal and should stop immediately. The report also faulted lax oversight.
“Overwhelming evidence suggests that the federal government has failed to question New York state’s excessive developmental center payment rates adequately,” the report said. “Given the extraordinarily dire federal budget situation, the Center for Medicare and Medicaid Services’ failure to prevent the massive Medicaid overpayments flowing to New York state’s developmental centers needs to be corrected immediately.”
See on www.timesunion.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.
Joseph Rugg's Health Law Blog 