"Doc fix" bill includes fraud provisions; appellate court upholds a 20 year fraud sentence

News From Around the Web

> The "doc fix" bill passed by the House of Representatives last week will include the provisions of the Protecting the Integrity Act that aims to reduce Medicare fraud, waste and abuse. Provisions include removing Social Security numbers from Medicare cards, preventing payments to incarcerated or deceased individuals, modifying durable medical equipment face-to-face encounters and expanding the model for prior authorization for non-emergency ambulance transportation nationally. Bill, Title V  

> The 11th Circuit Court of Appeals upheld a decision to sentence the owner of a home health provider to 235 months in prison for her role in a $7 million Medicare scheme. Dora Moreira, owner of Anna Nursing Services Corp., argued that a district court erred in striking 75 witnesses, excluded her compliance with Medicare regulations and did not give her the chance to defend herself against fraud claims. However, the court ruled that government prosecutors presented sufficient evidence that Moreira committed fraud and money laundering, and that her list of witnesses was "baseless and unrealistic" given her four day trial period. Court decision (.pdf)

> A New York pharmacist who operated in the Bronx and Queens was sentenced to three years in jail for his role in a $7 million scheme that defrauded Medicaid, Medicare and the state's AIDS Drug Assistance Program (ADAP). Purna Chandra Aramalla purchased expensive HIV drugs off of patients that sold the drugs rather than using them to treat their illness. Aramalla then repackaged and sold those drugs to other patients and then billed federal and state programs as if the drugs were new. Statement

Health Payer News

> Humana says that it's not alone in a Department of Justice (DOJ) investigation into risk adjustment scores assigned to Medicare Advantage beneficiaries. A regulatory disclosure filed by the company says the DOJ's extensive review involves a number of other plans, providers, and payers. The investigation follows reports from the Center for Public Integrity on massive improper payments linked to Medicare Advantage plans. Article

Health IT News

> Aetna Chief Information Security Officer Jim Routh says that cybersecurity for health payers is viewed more as a business risk than a strict technology problem. He says that Aetna executives meet daily to discuss the company's self-assigned risk score, and ranks every threat alongside pertinent security controls. Article.

And finally…  Pro tip: Don't call the cops over your bar tab. Article