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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
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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.
HEALTH AFFAIRS: In 2011 Nearly One-Third Of Physicians Said They Would Not Accept New Medicaid Patients, But Rising Fees May Help
HEALTH AFFAIRS: When fully implemented, the Affordable Care Act will expand the number of people with health insurance. This raises questions about the capacity of the health care workforce to meet increased demand. I used data on office-based physicians from the 2011 National Ambulatory Medical Care Survey Electronic Medical Records Supplement to summarize the percentage of physicians currently accepting any new patients. Although 96 percent of physicians accepted new patients in 2011, rates varied by payment source: 31 percent of physicians were unwilling to accept any new Medicaid patients; 17 percent would not accept new Medicare patients; and 18 percent of physicians would not accept new privately insured patients. Physicians in smaller practices and those in metropolitan areas were less likely than others to accept new Medicaid patients. Higher state Medicaid-to-Medicare fee ratios were correlated with greater acceptance of new Medicaid patients. The findings serve as a useful baseline from which to measure the anticipated impact of Affordable Care Act provisions that could boost Medicaid payment rates to primary care physicians in some states while increasing the number of people with health care coverage.
See on content.healthaffairs.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.
Doctors Caught Between Patient Pain, Prescriptions – HealthLeaders Media
For some physician leaders, pain management may become a significant boon to their business, especially as the U.S. population ages. In a Health Leaders Media Industry survey this year, 37% predicted pain management will grow 1 to 5% over the next five years.
But doctors are on a precipice as they prescribe pain medication, especially long-acting and extended-release opioid analgesics such as oxycodone. Most are aware of the persistent potential for abuse, misuse, or mistaken use of the highly potent prescription drugs among patients. And the stress is mounting – for the docs.
States are tightening treatment requirements, while the federal government weighs the possibility of mandatory educational plans for doctors in their handling of opioids, putting federal officials at loggerheads with much of the medical establishment.
Some physicians are so upset over what they term the “bureaucratic” infringements, that they are considering no longer seeing patients who seek pain treatment. Instead, they would prefer to refer those patients to colleagues who are willing to prescribe potent analgesics.
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.
House Bill to Press for One-Year SGR Delay – HealthLeaders Media
Rep. Michael Burgess (R-TX) said on Wednesday that he will submit legislation this week to delay for one year the implementation of the sustainable growth rate formula (SGR). Without the delay, or other action, physicians face a 28% cut in Medicare reimbursements in January 2013.
Burgess made the announcement at a meeting of the House Energy and Commerce Committee called to discuss innovations to reform Medicare physician payments.
He said that the SGR delay would allow Congress to get past the uncertainties presented by the upcoming elections, the expiration of existing tax policy, the extension of unemployment insurance, as well as potential debt limit debates.
The SGR formula was put in place as part of the Balanced Budget Act of 1997 to help control Medicare spending. It soon became apparent that significant cuts in physician reimbursements would be required to help reduce spending but since 2003 Congress has routinely declined to make those cuts.
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.
Colorado Shootings Put Docs vs. Glocks Law in Spotlight – HealthLeaders Media
Should doctors warn patients about the risks of guns in the home?
In Florida, physicians who did just that could have lost their medical licenses—until recently.
Weeks before one of the worst gun violence incidents in U.S. history, a group of physicians won a court victory in a little-noticed case against a Florida law that threatened to strip doctors of their medical licenses if they warned patients about the risks of guns in the home.
Florida politicians, citing Second Amendment rights, were adamant that docs weren’t in the gun-counseling business, and passed a statute to thwart such discussions. The physicians, however, prevailed in federal court to halt the measure.
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 Vascular Associates Sued in Dallas for Alleged Medicare, Insurance Fraud
A former employee of Dallas’ Texas Vascular Associates is suing the company and nine physicians after being fired for allegedly refusing to fraudulently bill Medicare and private insurance companies for patient services.
See on www.marketwatch.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.
Getting the Methods Right — The Foundation of Patient-Centered Outcomes Research — NEJM
Perspective from The New England Journal of Medicine —
Health care in the United States has changed dramatically over the past several decades. Today, patients have more options than ever. Making the right choices, whether for prevention, diagnosis, or treatment, requires a critical appraisal of the potential benefits and harms of the options, within the context of the patient’s characteristics, conditions, and preferences.
Many of these choices are available thanks to advances in medical research. Yet most patients and many clinicians find research somewhat mysterious. They have difficulty sorting through the mountains of medical evidence to identify information that is reliable and actionable for their unique circumstances. Patient-centered outcomes research and comparative-effectiveness research promise to enhance decision makers’ ability to fully understand and weigh alternatives.
See on www.nejm.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.
ABC Action News I-Team: Independent study shows Florida doctors continue to mark up drugs for hurt workers
A new study released Thursday, July 19, 2012, gives more ammunition to Florida business owners trying to get state legislators to close a legal loophole that they say allows physicians to gouge them when treating injured workers.
The ABC Action News I-Team exposed the problem — and the political money that appears to be keeping the loophole wide open — in a report last February. A bill designed to close the loophole died again during this year’s legislative session in Tallahassee.
The new study by the Workers Compensation Research Institute found that 62 percent of all prescription drug spending in Florida for injured workers was paid to physicians who dispensed medications from their offices — not to pharmacies, which typically charge much less for the same pills.
The cost discrepancy hits employers who must pay physicians the higher prices. Critics of the loophole say the larger workers compensation premiums may limit the ability of Florida employers to hire more workers to boost the state’s sluggish economy.
See on abcactionnews.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.
Patients seek Internet information to start dialogue with physicians about their care – amednews.com
Richard Kravitz, M.D. co-wrote a study that appeared online May 16 in the Journal of Health Communication that he hopes will help other physicians become more at ease when dealing with Internet-searching patients.
One of the most important things doctors should know, he said, is that patients aren’t going online because they don’t trust their physician or are skeptical of their diagnosis. They are searching the Internet to become more engaged in their care.
Dr. Kravitz said patients, especially those with rare conditions, can be a good source of new information for physicians. But while patients may be proficient at finding material online, the doctor’s role is to help them sort through it and assess whether it’s credible, he said.
“Doctors should try to relax about this and just engage in conversations with patients about the information they bring in, some of which will be truthful and relevant, and others won’t be,” Dr. Kravitz said. “We can’t do anything else except to have a candid dialogue about it.”
See on www.ama-assn.org
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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