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USDOJ: US Attorney’s Office New Jersey – Fifth New Jersey Health Care Practitioner Pleads Guilty In Cash-For-Patients Scheme

September 23, 2012 Leave a comment

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

September 23, 2012 Leave a comment

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.

Report faults Medicaid patient cost in New York’s residential centers for the developmentally disabled

September 23, 2012 Leave a comment

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.

HCA Probe Spotlights Cardiologists’ ’Irresistible Temptation’ – HealthLeaders Media

August 30, 2012 Leave a comment

Physicians specializing in cardiology coined the term “oculostenotic reflex” over a decade ago. But the phrase has been popping up this month in conversations about accusations that thousands of patients underwent inappropriate heart procedures at HCA hospitals in Florida and in three other states, the subject of a federal probe.

Writing in the journal Circulation in 1995, Eric Topol, MD, and Steven Nissen, MD, described this phenomenon as “an irresistible temptation among some invasive cardiologists to perform angioplasty on any significant residual stenosis after thrombolysis”—that is, after clot-busting medications have been used.

Nissen and Topol wrote that while professional organizations don’t support this practice, “the ritual of reflex angioplasty is exercised thousands of times each year.”

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.

Texas Tribune — Proposed Medicaid Fraud Rules Worry Providers

August 25, 2012 Leave a comment

The state’s Health and Human Services Commission is seeking formal approval for new Medicaid fraud rules that doctors allege deny them due process and expand investigators’ power to halt their funding.

For months, HHSC’s Office of the Inspector General has been increasingly relying on a federal rule — part of President Obama’s health care plan — that allows the agency to freeze financing to any health provider accused of overbilling Medicaid. That means they can halt the flow of funding before they complete a full-fledged investigation, and often, providers say, before doctors are given any chance to defend themselves.

HSC says the new state rules — a rewrite of the existing statute — give investigators the tools to stop the bleeding before bad actors run off with the state’s money. They say fraud investigations aren’t opened without good reason, and the idea that there’s no due process is preposterous.

The agency says the new rules, which must be approved by the executive commissioner, are necessary to bring the state in line with federal health reform and measures passed in the last legislative session. It is “mostly a clean-up of the existing rules,” agency spokeswoman Stephanie Goodman said.

But attorneys for health care providers, who are still trying to parse the rewritten rules, say the language the state is preparing to codify appears to put even more power into investigators’ hands than what they’ve already received from the federal government.

See on www.texastribune.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.

Texas Attorney General Indicts Orthodontist for Health Care Law Fraud in State and Federal Probe

August 18, 2012 Leave a comment

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

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 – W. Dist. MO: Psychologist Pleads Guilty To $1 Million Health Care Fraud

August 18, 2012 Leave a comment

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

August 18, 2012 Leave a comment

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.

Whistleblower lawsuit Florida Hospital: Whistleblowers lawsuit against Florida Hospital claims Medicare fraud

August 10, 2012 Leave a comment

A whistle-blower lawsuit based on insider information from a former Florida HospitalOrlando billing employee and a staff physician alleges that seven Adventist Health hospitals in Central Florida have overbilled the federal government for tens of millions of dollars in false or padded medical claims.

The suit claims Florida Hospital used improper coding for more than a decade to overbill Medicare, Medicaid and Tricare, all federal government payors. In addition, it alleges, the hospital commonly overbilled for a drug used, for example, in MRI scans and billed for computer analyses that were never performed.

See on articles.orlandosentinel.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.

Doctors booted from Medicaid for massive oxy doses in Florida

July 18, 2012 Leave a comment

The state’s most prolific prescriber of Medicaid-financed oxycodone to the poor in 2010 and 2011 has been barred from participating in the taxpayer supported health care program, one of 76 such high-volume prescribers identified in a Palm Beach Post investigation.

Four others, including West Palm physician Dr. John Christensen, are either under regulatory scrutiny or have been disciplined for their prescribing patterns.

None wrote more oxycodone prescriptions than Dr. Jorge Leal. The Tampa-area anesthesiologist and pain clinic specialist prescribed over 715,000 doses of oxycodone billed to Medicaid over two years – on average, just under 1,000 doses a day. On busy days, Leal’s oxycodone scripts were filled by the bushel: Multiple times, more than 2,000 pills a day were filled by pharmacies and billed to Medicaid; during one 24-hour period, that number topped 4,000 pills.

See on www.palmbeachpost.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.

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