Dallas anesthesiologist convicted for billing for services while he was on his private jet; 'King of nursing homes' convicted in Sacred Heart scam

> A Dallas anesthesiologist was convicted for a scheme that targeted several private insurance companies including Blue Cross Blue Shield of Texas, UnitedHealthcare, Aetna, Cigna and Humana. Richard Ferdinand Toussaint Jr., who founded Ascendant Anesthesia and practiced at several Dallas hospitals, submitted claims for anesthesia services when he was undergoing surgery himself, flying on his private jet or at a hospital several miles away. Prosecutors said Toussaint fraudulently billed health plans approximately $10 million over the course of 18 months. Announcement

> A federal jury convicted Venkateswara R. "V.R." Kuchipudi, M.D., for his involvement in a widespread fraud scheme at Sacred Heart Hospital in Chicago. Kuchipudi is the 10th defendant convicted in the case in which hospital executives paid kickbacks to doctors to induce patient referrals. Prosecutors indicated Kuchipudi (aka "the king of nursing homes") was "one of Sacred Heart's most prolific sources of patient referrals," sending elderly patients to the hospital in exchange for free labor in the form of physician assistants and nurse practitioners. Announcement

> A Florida doctor pleaded guilty to falsely diagnosing patients in order to inflate Medicare Advantage risk scores. Isaac Kojo Anakwah Thompson diagnosed 387 Medicare Advantage beneficiaries with a rare chronic spine disease to boost Medicare payments made through Humana's plans. Thompson received an 80 percen of the $2.1 million provided to Humana. Announcement

Health Payer News

> The Department of Health and Human Services announced provisions of the Affordable Care Act have led 20 million adults in the U.S. to obtain health insurance since 2010. Calling it a historic reduction in the uninsured, HHS added that 6.1 million enrollees ages 19-25 have gained coverage thanks in part to the law's provision allowing them to stay on a parent's insurance, and the uninsured rate among black non-Hispanics and white non-Hispanics each dropped more than 50 percent. Article

> Proposed changes to Medicare Advantage payment rules could mean cuts as deep as 3.9 percent in 2017, according to a report prepared for America's Health Insurance Plans, which has lobbied against payment reductions. The proposed changes would create new risk adjustment models for duel-eligible beneficiaries, which would reduce funding by 2.1 percent and impact programs aimed at managing chronic conditions. Article

And finally… Who doesn't need a little police backup when they're getting dressed in the morning? Article

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