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London cardiologist sentenced for health care fraud - Ex-Valeant, Philidor executives get prison for fraud - Two home health agency owners and two employees convicted - And More

 

 

London cardiologist sentenced for health care fraud

On October 31, 2018, WTVQ (KY) reported, “A London physician will spend almost four years in prison for health care fraud.

“The United States Attorney’s Office of the Eastern District of Kentucky announced Wednesday Dr. Anis Chalhoub was sentenced after being found guilty back in April of defrauding Medicare, Medicaid, and other insurers.”

 

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Ex-Valeant, Philidor executives get prison for fraud

On October 30, 2018, CNBC reported, “A former executive at Valeant Pharmaceuticals International and the former head of a start-up mail-order pharmacy were sentenced to one year in prison on Tuesday after being convicted of defrauding the drugmaker through a secret kickback scheme.

“Gary Tanner, 41, the former Valeant executive, and Andrew Davenport, 50, the former chief executive of Philidor Rx Services LLC, were also ordered to forfeit $9.7 million, representing the alleged kickbacks.”

 

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Two home health agency owners and two employees convicted

On October 30, 2018, MD Linx reported, “A federal jury found two home health owners and two employees guilty today for their roles in a scheme to bill Medicare and Medicaid for over $3.7 million in charges when the owners had previously been excluded from participating in federal health-care benefit programs.”

 

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Montgomery (AL) nurse practitioner convicted

On October 30, 2018, WSFA (AL) reported, “A federal jury found nurse practitioner Lillian Akwuba guilty Monday of 27 counts of drug distribution, health care fraud in a Montgomery pill mill case.”


According to U.S. Attorney for the Middle District of Alabama Louis V. Franklin, Sr. “a federal jury convicted nurse practitioner Lilian Ifeoma Akwuba, 39, of Montgomery, Alabama, on 17 counts of unlawfully distributing controlled substances, 4 counts of health care fraud, 1 count of conspiring to distribute controlled substances, and 1 count of conspiring to commit health care fraud.”

 

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DOJ

 

 

Abbott, AbbVie pay $25M to resolve long-standing kickback case

On October 29, 2018, Becker’s Hospital Review reported, “Abbott Laboratories and Abbvie Inc. will pay a total of $25 million to resolve allegations that Abbott paid kickbacks to physicians and employed unlawful marketing tactics to bolster prescriptions of its cholesterol drug TriCor, the Department of Justice said in a news release. The settlement comes nine years after a whistleblower first alerted feds to the alleged misconduct.”

 

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Hancock County addiction center co-owner admits to illegally selling suboxone

On October 26, 2018, U.S. Attorney for the Northern District of West Virginia Bill Powell announced in a press release, “Eric Drake, of Weirton, West Virginia, has admitted to illegally distributing controlled substances.” According to the government press release, Drake pled guilty to one count of “Distribution of a Controlled Substance.”

 

Per the government press release, “Drake was co-owner of an addiction treatment center, Advance Healthcare, Inc., located at 3300 West Street in Weirton.”

 

 

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Managed Care Compliance Conference | January 27-30, 2019 | Lake Buena Vista, FL | Learn More >Managed Care Compliance Conference | January 27-30, 2019 | Lake Buena Vista, FL | Learn More >

 

CMS Update

 

Contract Year (CY) 2020 Medicare Advantage and Part D Flexibility Proposed Rule

On October 26, 2018, the Centers for Medicare and Medicaid Services (CMS) announced it “issued a proposed rule that updates Medicare Advantage (MA or Part C) and the Medicare prescription drug benefit program (Part D) by promoting flexibility and innovation so that MA and Part D sponsors are empowered with the tools to improve quality of care and provide more plan choices for MA and Part D enrollees.”

According to CMS, “In addition to creating opportunities for increasing plan flexibility and plan choices, CMS is making critical updates with respect to program integrity and taking steps to help the agency recover improper payments made to Medicare Advantage organizations. If finalized, the proposed changes would result in an estimated $4.5 billion savings to the Medicare Trust Funds over ten years, largely arising from recovery of overpayments to MA plans.”

 

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CMS finalizes calendar year 2019 and 2020 payment and policy changes for Home Health Agencies and Home Infusion Therapy Suppliers

On October 29, 2018, the Centers for Medicare & Medicaid Services (CMS) announced it “issued a final rule [CMS-1689-F] setting out finalized Calendar Year (CY) 2019 Medicare payment updates, finalized quality reporting changes for home health agencies (HHAs), and finalized case-mix methodology refinements and a change in the home health unit of payment from 60 days to 30 days for CY 2020. This final rule also discusses the implementation of temporary transitional payments for home infusion therapy services to begin on January 1, 2019 and summarizes public comments related to full implementation of the new home infusion therapy benefit in CY 2021.”

 

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In the Federal Register

Current Items

2018 FR Index

 

 

CMS Transmittals

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Acronym Library

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Product Features

 

Investigative Interviewing

 

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Compliance 101, Fourth Edition

 

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Are you and your board compliance ready? | Get the knowledge and tools you need at the Board & Audit Committee Compliance Conference | Learn more >Are you and your board compliance ready? | Get the knowledge and tools you need at the Board & Audit Committee Compliance Conference | Learn more >

 

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Please feel free to contact Margaret Dragon, editor of Compliance Weekly News.

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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.