News From Around the Web
> A dermatologist that practiced in Lombard, Illinois, a suburb of Chicago, was sentenced to seven years in prison for his role in an eight-year scheme that led to $3.7 million in improper Medicare payments. Robert Kolbusz, M.D., treated patients for precancerous lesions when no lesions existed. In fact, many of those procedures were actually cosmetic laser treatments performed by staff members in his office. One teenage patient testified that she underwent a procedure that Kolbusz said would lighten her freckles, but records show he billed Blue Cross Blue Shield for more than $4,500 worth of pre-cancerous lesion treatments. Announcement
> Four New York residents included in June's nationwide fraud takedown pleaded guilty to a $4 million healthcare fraud scheme involving unnecessary physical and occupational therapy, and chiropractic services. Jeffrey Suh, owner of Plaza Medic Group Inc. and New Plaza Group Inc., along with his employees Kang Young Chung, Sophia Lin and Emily Shim, pleaded guilty for submitting false claims to Medicare for patients that did not qualify for therapy. Announcement
> A McAllen, Texas marketer pleaded guilty to healthcare fraud charges in which she paid money in exchange for Medicare beneficiary referrals. Martha Lidia Flores used the beneficiary information to create fraudulent referral forms by forging the signatures of physicians and submitting home health claims to Medicare from 2010 to 2012. Announcement
Health Payer News
> Pharmaceutical trade groups have requested a change to pharmaceutical patent law procedures that could end up costing federal health programs $1.3 billion over the next ten years. The change would exempt drug patents from being challenged through the Inter Partes Review, which could delay new, cheaper generic medicines. Article
> Although health insurance companies claim that Medicare Advantage facilitates inexpensive and high quality healthcare, those that operate the plans have not made cost-related data available. As a result, independent researchers have been unable to verify those claims, leading some to question the effectiveness of Medicare Advantage plans. Article
And finally… I'd offer an impression of my dog, but he's always sleeping. Article