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Bad medicine: Eight doctors with ties to Staten Island with criminal convictions - Owner of neuropsychology clinic charged with insurance fraud - Allegiance Health Settles False Claims Act Allegations with DOJ - And More

Headlines

Bad medicine: Eight doctors with ties to Staten Island with criminal convictions

Owner of neuropsychology clinic charged with insurance fraud

Allegiance Health Settles False Claims Act Allegations with DOJ

Government issues warning about pill pushed on the elderly

Operators of a mental health provider indicted on health care fraud and tax evasion charges

Fort Myers doctor agrees to $2.8 million fine for Medicare fraud, kickback scheme

Mercy Health to pay $14.25 million fine to Feds

Heavy price: Prison, $1.4M restitution for health-care executive in fraud scheme

Ex-health care boss gets 19 years in prison in a $15 million fraud case

Nurse practitioners arrested and indicted for unlawful distribution of prescription opioids and health care fraud

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News of Interest

FierceHealthcare: “OIG approves telehealth purchasing arrangement that would support HIV care”
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JD Supra: Deciphering the OIG's findings in its recent report on non-compliant telehealth claims”
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McKnight’s Long-Term Care News: “Medicare expands pre-approval program for power wheelchairs”
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Highlights from The Compliance & Ethics Blog

Five HIPAA compliance challenges that small practices need to overcome

Maintaining round-the-clock HIPAA compliance is a constant challenge for healthcare providers and other HIPAA covered entities. For small and medium-sized organizations, the challenge of HIPAA compliance can be particularly difficult due to a lack of skilled personnel, resources, and budget.
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Ryan Meade on compliance and ethics in healthcare [Podcast]

You hear a lot about compliance programs in healthcare, but not so much about ethics programs.  Sure, there are many discussions of medical ethics, but not as many conversations, at least at conferences, about the business ethics issues.
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Headlines

Bad medicine: Eight doctors with ties to Staten Island with criminal convictions

On June 6, 2018, silive.com reported, “Test-referral scams. Running pill mills to dispense powerful painkillers. Medicare fraud.

“In recent years, eight doctors who either practiced or lived on Staten Island have been criminally convicted, mainly on federal charges.”
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Owner of neuropsychology clinic charged with insurance fraud

On June 5, 2018, Becker’s Hospital Review reported, “Michael Howard Kabat, owner of a San Diego-based Neuropsychology Consult Services, was charged June 4 with health insurance fraud related to an alleged multimillion dollar fraudulent billing scheme, according to a Fox 5 San Diego report.

“The owner is accused of falsely billing three health insurers — Blue Shield of California, the Medicare Trust Fund and Scripps Health Plan — more than $2.2 million from late 2012 to early 2016.” 
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Allegiance Health settles False Claims Act allegations with DOJ

On June 5, 2018, Arkansas Business reported, “The U.S. Department of Justice said Tuesday that Allegiance Health Management Inc. of Shreveport, Louisiana, and four of its hospitals agreed to pay $1.7 million to resolve False Claims Act allegations.”
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Government issues warning about pill pushed on the elderly

On June 4, 2018, CNN reported, “The US government is warning insurance companies to be on the lookout for suspicious prescriptions of a drug being used in nursing homes across the country.”

According to the news report, “Since Nuedexta came on the market in 2011, Avanir has generated millions of dollars in annual sales from prescriptions of the drug in nursing homes. And the federal government has been footing a large portion of the bill in the form of Medicare Part D prescription drug funding, for people 65 and over and the disabled.”
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Operators of a mental health provider indicted on health care fraud and tax evasion charges

On June 4, 2018, the U.S. Department of Justice announced, “A federal grand jury sitting in Greensboro, North Carolina returned an indictment, which was unsealed today, charging the operators of a mental health provider with multiple crimes related to the submission of false claims to Medicaid and tax evasion.

“Catinia Farrington and Haydn Thomas, both formerly of Durham, North Carolina, are charged with conspiracy to commit health care fraud, health care fraud, aggravated identity theft, and tax evasion. Thomas is also charged with one count of money laundering.”
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Fort Myers doctor agrees to $2.8 million fine for Medicare fraud, kickback scheme

On June 4, 2018, News-Press reported, “A Fort Myers doctor who received kickbacks from medical equipment and pharmaceutical companies as part of a number of Medicare fraud schemes will pay a $2.8 million fine as part of his punishment, the Department of Justice said Monday.” 
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Mercy Health to pay $14.25 million fine to Feds

On June 3, 2018, WKYC 3 reported, “Cincinnati-based Mercy Health is forking over more than $14 million dollars to the Feds.”

According to the news report, “The total settlement is $14,250,000 to settle allegations that Mercy Health had improper financial relationships with referring physicians.”
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Heavy price: Prison, $1.4M restitution for health-care executive in fraud scheme

On June 2, 2018, silive.com (NY) reported, “A health-care executive from Staten Island is on the hook for nearly $1.4 million for his role in a ring that authorities said ripped off $33 million from the Medicaid and Medicare systems through kickbacks and fraudulent medical clinics in Brooklyn.

“Asher Oleg Kataev, 49, was sentenced on Thursday in Manhattan federal court to three years in prison and three years of supervised release and must pay back $1.38 million in forfeitures and reimbursement, said authorities.”
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Ex-health care boss gets 19 years in prison in a $15 million fraud case

On June 1, 2018, Houston Chronicle reported, “The former CEO of a multi-state physical therapy chain based in Houston was sentenced Friday to 19 years in federal prison and ordered to pay $15 million in restitution, according to the U.S. Attorney's Office.” 
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Nurse practitioners arrested and indicted for unlawful distribution of prescription opioids and health care fraud

On June 1, 2018, U.S. Attorney for Nevada Dayle Elieson announced, “Three Southern Nevada residents, including two nurse practitioners, have been arrested and charged in a 29-count indictment for unlawful distribution of prescription opioids and Medicare/Medicaid fraud.” 
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Regulatory News

CMS Update

Declines in hospital-acquired conditions save 8,000 lives and $2.9 billion in costs
On June 5, 2018, the Centers for Medicare and Medicaid Services announced, “Data released today by the Agency for Healthcare Research and Quality (AHRQ) show continued progress in improving patient safety, a signal that initiatives led by CMS are helping to make care safer. National efforts to reduce hospital-acquired conditions, such as adverse drug events and injuries from falls helped prevent an estimated 8,000 deaths and save $2.9 billion between 2014 and 2016, according to the report.” 
READ PRESS RELEASE

CMS unveils scorecard to deliver new level of transparency within Medicaid and CHIP Program
On June 4, 2018, the Centers for Medicare & Medicaid Services (CMS) announced it “released the first ever Medicaid and Children’s Health Insurance Program (CHIP) Scorecard, a central component of the Administration’s commitment to modernize the Medicaid and CHIP program through greater transparency and accountability for the program’s outcomes. For the first time, CMS published state Medicaid and CHIP quality metrics along with federally reported measures in a Scorecard format.” 
READ PRESS RELEASE

In the Federal Register

FR Index 2018: READ MORE

CMS Transmittals

2018: READ MORE

From the OIG

OIG releases Spring 2018 Semiannual Report to Congress
This spring edition of the Semiannual Report to Congress covers OIG activities from October 2017 through March 2018. Historically, about 80 percent of OIG's resources are directed to work related to Medicare and Medicaid. This is mirrored in the organization and content of the report. 

Updated Corporate Integrity Agreement List

Updated Provider Self-Disclosure Settlements

OIG Podcast: Increases in Reimbursement for Brand-Name Drugs in Part D

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Health Care Compliance Library
HCCA offers members and registered guests access to an extensive library of articles. Information provided covers topics in corporate compliance and ethics in healthcare organizations. Contributing authors include attorneys, chief compliance officers, providers of auditing, monitoring, coding, billing and technology services, and other members of our compliance community.