Top Color:
Main Color:
Bottom Color:
Layout Style:
  • Wide
  • Boxed
HCCAnet Facebook Twitter LinkedIn Youtube Pinterest
You are here : Resources  >  View
Melgen will stay in prison while he appeals health care conviction - Eastern Kentucky ambulance officials plead guilty to health care fraud - Missed visits, uncontrolled pain and fraud: Hospice lacks oversight, report says - And More

Headlines

Melgen will stay in prison while he appeals health care conviction

Eastern Kentucky ambulance officials plead guilty to health care fraud

Missed visits, uncontrolled pain and fraud: Hospice lacks oversight, report says

Thief River Falls (MN) chiropractor charged with wire fraud, ID theft

Mount Pleasant (SC) speech therapist convicted

Former MetroHealth COO, interim CEO convicted in elaborate maze of kickback, fraud schemes

Opening a Medicare home-health agency in Texas? Think again

Somerset (NJ) cardiologist sentenced 20 months in prison for defrauding Veterans Affairs program

Closed business ordered to repay $2.9 million for Medicaid fraud

Pittsford psychiatrist charged with health care fraud

Va. woman convicted of $83M Medicare, insurance fraud

divider

Highlights from The Compliance & Ethics Blog

Risks of ‘black box’ machine learning in compliance and privacy programs

Recent machine learning advances have the potential to revolutionize patient care through better clinical risk prediction and precision medicine. Rightfully so, the compliance and privacy communities are adapting these machine learning methods to help protect patient data. While these technologies will likely help detect and prevent future breaches [1], careful consideration must be taken to understand the risks of these machine learning methods when applied to compliance and privacy programs. READ MORE

Boards are starting to get it

In the last few weeks, there have been a dizzying number of CEO departures not for financial malfeasance, disappointing performance or major legal issues.  Instead, they have left because of violations of the company’s code of conduct.  Papa John’s, Texas Instruments, Intel and Clarks all saw their CEOs exit the building. READ MORE

divider

Headlines

Melgen will stay in prison while he appeals health care conviction

On August 2, 2018, Palm Beach Post reported, “Dr. Salomon Melgen will remain behind bars while he appeals his conviction on 67 charges of health care fraud and his 17-year prison sentence, a federal judge ruled this week.” READ MORE

Eastern Kentucky ambulance officials plead guilty to health care fraud

On August 2, 2018, WCLU Radio.com reported, “Three people at an eastern Kentucky ambulance service have pleaded guilty to health care fraud for submitting false bills for Medicaid and Medicare reimbursements.

“News outlets cited court records in reporting that Arrow-Med Ambulance owner Hershel Jay Arrowood; his wife, Lesa Arrowood, who handled billing; and manager Terry Herald entered guilty pleas Tuesday in federal court in Lexington.” READ MORE

Missed visits, uncontrolled pain and fraud: Hospice lacks oversight, report says

On August 1, 2018, Tampa Bay Times reported, “Elderly patients spent over two weeks in uncontrolled pain or respiratory distress. Acute care was rare on weekends. And recruiters went door to door pitching fraudulent schemes, luring healthy patients to sign up for hospice in exchange for free housecleaning and medicine.

“These details appear in a report on hospice released this week by a government watchdog agency calling on federal regulators to ramp up oversight of a booming industry that served 1.4 million Americans in 2016.” READ MORE

Thief River Falls (MN) chiropractor charged with wire fraud, ID theft

On August 1, 2018, Star-Tribune reported, “A chiropractor from Thief River Falls, Minn., has been charged with orchestrating an elaborate scheme to defraud health insurers by submitting claims for scores of services he never provided, federal prosecutors said Wednesday.” READ MORE

Mount Pleasant (SC) speech therapist convicted

On August 1, 2018, U.S. of Attorney for the District of South Carolina Sherri A. Lydon announced, “Following a four-day trial before U.S. District Judge Richard Gergel, a federal jury convicted Gena Randolph, 44, of Mount Pleasant, of committing a $2 million health care fraud scheme.

“Randolph was convicted of one count of Health Care Fraud, one count of Aggravated Identity Theft, and four counts of Making False Statements Relating to Health Care Matters.  Randolph could be sentenced up to 10 years in federal prison on the Health Care Fraud count and up to five years on the False Statement counts, which will be in addition to a mandatory sentence of two years for the count of Aggravated Identity Fraud.” READ MORE

Former MetroHealth COO, interim CEO convicted in elaborate maze of kickback, fraud schemes

On July 31, 2018, Healthcare Finance reported, “The former chief operating officer for Ohio's MetroHealth Hospital System and three dentists who worked in the system were convicted for their roles in a fraud conspiracy involving hundreds of thousands of dollars in bribes and kickbacks related to the hospital's dental program, the Department of Justice announced.

“Edward R. Hills, Sari Alqsous, Yazan B. Al-Madani and Tariq Sayegh were all convicted on criminal charges and will be sentenced November 27.” READ MORE

Opening a Medicare home-health agency in Texas? Think again

On July 31, 2018, Bloomberg/BNA reported, “A few bad apples can spoil the bunch, the saying goes, and Medicare home-health agencies and nonemergency ambulance providers in several states are living proof. Elevated fraud and abuse concerns in six states recently led Medicare to extend an enrollment prohibition for new home-health agencies and nonemergency ambulance providers.” READ MORE

Somerset (NJ) cardiologist sentenced 20 months in prison for defrauding Veterans Affairs program

On July 31, 2018, TAPInto reported, “Somerset cardiologist Apostolos Voudoris was sentenced to 20 months in prison Tuesday morning for billing the Veterans Affairs program for hundreds of procedures he did not perform.

“This sentencing follows his 2017 trial, where Voudoris pleaded guilty before U.S. District Judge William H. Walls in Newark Federal Court to over 350 counts of false medical documentation between 2011 and 2015, totaling $238,230 in fraudulent payments.

“Voudoris, 44, a physician specializing in cardiology and electrophysiology, has provided contracted services to veterans at the Veterans Affairs Medical Center in East Orange New Jersey since 2006.” READ MORE | DOJ PR

Closed business ordered to repay $2.9 million for Medicaid fraud

On July 31, 2018, The Robesonian reported, “A now closed Robeson County business has been ordered to pay a nearly $3 million penalty after being convicted of Medicaid fraud.

“Chief United States District Judge James C. Dever III issued the judgment against Compassionate Home Care Services Inc., Carol Anders, and Ryan Santiago for their participation in a fraud on the North Carolina Medicaid program in violation of the federal and North Carolina False Claims Acts, Robert J. Higdon Jr., the United States attorney for the Eastern District of North Carolina, announced Tuesday.” READ MORE | DOJ PR

Pittsford psychiatrist charged with health care fraud

On July 31, 2018, Rochester Democrat & Chronicle reported, “A Pittsford psychiatrist has been charged with health care fraud and making false statements about health care matters.

“Dr. Muhammad A. Cheema, 45, was charged Monday by the U.S. Attorney for the Western District of New York.” READ MORE

Va. woman convicted of $83M Medicare, insurance fraud

On July 30, 2018, WTOP reported, “A Loudoun County, Virginia, woman who ran a sleep study clinic has been convicted on charges of running a health care fraud that siphoned $83 million from Medicare and private insurers.

“Young Yi, 44, of Sterling, who formed the 1st Class Sleep Diagnostic Center and 1st Class Medical, was convicted Monday of one count of conspiracy to commit health care and wire fraud, seven counts of health care fraud, one count of conspiracy to defraud the United States and one count of filing a false tax return, the U.S. attorney’s office for the Eastern District of Virginia said in a statement. She’ll be sentenced Nov. 2.” READ MORE

back to top

divider

Regulatory News

CMS Update

Provider Compliance

Ophthalmology Services: Questionable Billing and Improper Payments — Reminder
The Office of the Inspector General (OIG) reports that Medicare is vulnerable to fraud, waste, and abuse for wet Age-related Macular Degeneration (wet AMD) and cataracts:

  • Administration of Lucentis injections for wet AMD more than once every 28 days (based on local coverage determinations)
  • Billing for a second cataract surgery on the same eye
  • Submitting disproportionately more claims for complex than standard cataract surgery

Review the following resources for proper claims coding, billing, and payment:

In the Federal Register

2018 Federal Register items per day: READ MORE

FR Index 2018 READ MORE

CMS Transmittals

2018: READ MORE

From the OIG

Updated: Work Plan
Eye on Oversight: Hospice

Audit Reports
Wisconsin Physicians Service Insurance Corporation Claimed Unallowable Medicare Part A Administrative Costs for Fiscal Year 2013 (A-05-16-00052)
https://oig.hhs.gov/oas/reports/region5/51600052.asp

Wisconsin Physicians Service Insurance Corporation Claimed Unallowable Medicare Part B Administrative Costs for Fiscal Year 2013 (A-05-16-00053)
https://oig.hhs.gov/oas/reports/region5/51600053.asp

OEI Report
Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity: An OIG Portfolio
https://oig.hhs.gov/oei/reports/oei-02-16-00570.asp

OIG Annual Publication 
Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Unimplemented Recommendations
https://oig.hhs.gov/reports-and-publications/compendium/files/compendium2018.pdf

divider

Acronym Library

Find CMS Acronyms print

View Results

Can't View the Full Content of this Resource?

To View the full content on this page you might have to login to your HCCA account. If you do not already have a login and password you can create one for free.

If you have a login click here

To create a free login click here

 
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.