News From Around the Web
> A doctor, a pharmacist and an accountant in Long Island were arrested in connection to a $3 million prescription drug fraud scheme in involving "B-scripts." According to the Long Island Herald, Mohammad Hadi, M.D., is accused of writing legitimate prescriptions for pain medications for patients, while also writing a second set of "B-scripts" that were unnecessary. His alleged pharmacist accomplice, Salam Siddiqui, is accused of filling the prescriptions and billing Medicare and private insurers for both the fake and real prescriptions. An accountant, Rizwan Ahmed, is accused of helping them produce fraudulent invoices to hide their scheme. Article
> Federal investigators are requesting a decade's worth of records from Massachusetts General Hospital as part of an ongoing false claims investigation into double-booked operations. Although a report from the Boston Globe has raised concerns about patient safety, investigators are primarily focused on whether or not the hospital failed to meet certain restrictions outlined by Medicare when billing for concurrent surgeries. Article
> WellCare CEO Ken Burdick discussed a well-publicized 2007 fraud investigation that led to convictions of three employees who kept Medicaid funding that should have gone to Florida. He recently told the Tampa Bay Times that the incident "forced WellCare to dramatically strengthen its compliance activities." The insurance provider's compliance officer now reports directly to Burdick, and a culture shift within the company encourages people to report problems. Article
Health Payer News
> The Centers for Medicare & Medicaid Services announced plans to spend $32 million in an effort to improve health coverage for children eligible for Medicaid and the Children's Health Insurance Program. The announcement comes on the heels of a study in the Journal of the American Medical Association that pointed to differences in care quality and cost for insurance coverage for children in low-to-moderate income families. Article
> Payers are teaming up with providers to create smaller health networks, an approach that seeks to balance quality with cost, according to Henry Smith, senior vice president of operations and chief marketing officer with BlueCross BlueShield of Tennessee. Providers are able to accept discounted rates by getting doctors, hospitals and clinics to join into one "value" network. Article
And finally… All hail the Spaghetti Monster, the Pastafarian deity. Article