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Healthcare News

 

Former physician, business partner get prison sentence in $7M Las Vegas fraud case

4/18/2019


(FierceHealthcare)
A former physician and his business partner were hit with prison time for their role in a $7.1 million scheme to defraud Medicare by filing false enrollment documents.


Camilo Q. Primero, 76, of San Dimas, California, and Aurora S. Beltran, 63, of Glendora, California, pleaded guilty to conspiracy to commit healthcare fraud and money laundering and were sentenced to 33 months in prison, according to an announcement from the Department of Justice. 


In addition, each was sentenced to three years of supervised release following the prison term and each will have to pay nearly $2.5 million in restitution.


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Humana launches value-based model for oncology

4/17/2019


(FierceHealthcare)
Humana is working with physician groups across the U.S. to launch a value-based care oncology program designed to provide integrated treatments for its Medicare Advantage (MA) and commercial members.


Called Humana’s national Oncology Model of Care (OMOC), the program aims to improve patient experiences and health outcomes for patients with a cancer diagnosis, the insurer announced


Humana will give providers analytics and provide compensation for enhanced care navigation based on quality and cost within the following care components: inpatient admissions, emergency department visits, medical and pharmacy drugs, radiology as well as laboratory and pathology services.


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UnitedHealth beats Q1 projections, but Medicare-for-All talk starts stock sell-off

4/16/2019


(FierceHealthcare)
Buoyed by significant growth in Medicare Advantage, UnitedHealth Group beat Wall Street expectations during the first quarter of 2019 with a 19% jump in its profits.


The company reported its earnings were $4.8 billion in the first quarter of 2019 ended March 31. That's up $779 million over the first quarter of 2018, according to the company's latest earnings data released Tuesday. The company also reported a bump in the revenue for the first quarter reaching $60.3 billion, up 9% from $55.2 billion in the first quarter of 2018.


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CMS conducting 'comprehensive review' of nursing home oversight processes following OIG report

4/15/2019


(FierceHealthcare)
The Centers for Medicare & Medicaid Services is undertaking a comprehensive review of its regulations and processes when it comes to ensuring safety and quality in nursing homes, CMS Administrator Seema Verma announced on Monday.


The announcement came the same day the Department of Health and Human Services' Office of Inspector General released a report saying CMS needs to do more to address gaps in federal oversight of nursing home investigations in Oregon.


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Study: Primary care accounts for a fraction of overall Medicare spend

4/15/2019


(FierceHealthcare)
Despite an industry focus on the benefits of primary care, spending on such services makes up just a fraction of Medicare spending, according to a new study.


Researchers at RAND Corporation analyzed spending patterns and found spending on primary care accounts for between 2.12% and 4.88% of overall spending for Medicare Parts A, B and D.


It reached those figures using two different definitions of primary care, one that included services provided just by family practice, internal medicine and pediatricians, and a broader one that also included geriatricians, nurse practitioners, physician assistants and gynecologists.


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Trump administration appeals judge's decision to block Medicaid work requirements in Kentucky, Arkansas

4/11/2019


(FierceHealthcare)
The Trump administration will appeal a judge’s decision to block Medicaid work requirements in two states.


The Department of Justice on Wednesday filed appeal notices for rulings that rejected such requirements in Kentucky (PDF) and Arkansas (PDF), taking the cases to the District of Columbia Circuit Court. 


District Judge James Boasberg ruled last month that the Centers for Medicare & Medicaid Services failed to consider the central goal of the Medicaid program—to provide coverage to low-income individuals—in approving work requirements in the two states. 


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Metro Detroit pharmacy fraud scheme involved health care claims made for dead patients

4/9/2019


(FierceHealthcare)
LIVONIA, Mich. (WXYZ) — Four defendants have been charged in connection with a fraud scheme where $48 million worth of health care claims were made for patients after they died.


According to a criminal complaint, Mohamad Makki, 43, and Wansa Nabih Makki, 41, were charged with multiple health care fraud offenses. Mamoud Makki, 36 and Hossam Tanana, 53, husband of Wansa, were charged with laundering some of the proceeds in the health care fraud scheme.


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Florida healthcare executive convicted in $1.3B Medicare, Medicaid fraud scheme

4/9/2019


(FierceHealthcare)
The owner of several South Florida skilled nursing and assisted living facilities has been found guilty for his role in a $1.3 billion scheme to defraud Medicare and Medicaid—one of the largest in U.S. history.


Philip Esformes, 50, of Miami Beach, was convicted by a jury on 18 counts in the case, and sentencing has not been scheduled, according to an announcement from the Department of Justice. 


Esformes was found guilty of leading an extensive fraud scheme from between January 1998 and July 2016, according to the DOJ. Esformes bribed physicians to refer patients to his nursing facilities, where they were given medically unnecessary care or inappropriate services that were then billed to Medicare and Medicaid. 


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Top concerns for Medicare beneficiaries: Part B, appeals and affordable medications

4/5/2019


(FierceHealthcare)
The top concerns of Medicare enrollees include navigating Part B, appealing Medicare Advantage (MA) denials and affording meds, according to an annual report from the Medicare Rights Center.


“Year after year, our findings from the analysis of our national helpline data show that too many older adults and people with disabilities have problems navigating the complexities of the Medicare program and affording their coverage,” Joe Baker, president of the Medicare Rights Center, said in a statement. “It’s time that the real-life experiences of people with Medicare who are trying to access needed health care are taken into account and acted on to improve the Medicare program.”


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Michigan Practice to Shutter after Hackers Delete Patient Files

4/1/2019


(Health IT Security)
Michigan-based Brookside ENT and Hearing Center plans to close, after hackers deleted all patient files during a ransomware attack, according to local news outlet, WWMT West Michigan.


The practice’s computer system was completely encrypted, and hackers demanded $6,500 to decrypt the files. When the practice's owners and co-founders John Bizon, MD and William Scalf, MD refused the ransom demand, the cybercriminals wiped the entire system, including all patient records.


All appointment schedules, payment data, and patient information was erased. Bizon said no patient data was accessed, as the electronic health record system’s files were encrypted. Further, no data was copied or shared before the data was erased by the hackers.


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