Dynasplint pays $10M for circumventing Medicare bundled payment rules; Ohio cardiologist gets 20 year sentence for unnecessary procedures;

News From Around the Web

> Dynasplint Systems Inc., and its founder and president, George Hepburn, will pay $10.3 million to settle False Claims Act violations that the company unnecessarily provided splints to skilled nursing home patients. Federal prosecutors alleged that Dynasplint circumvented Medicare's bundled payment rules, and billed for splints provided to skilled nursing facility patients as if they were at home. Medicare's bundled payments cover all skilled nursing facility expenses, including medical equipment. Announcement

> An Ohio cardiologist has been sentenced to 20 years in prison for performing unnecessary catheterizations, stent procedures and coronary artery bypass surgeries, as well as submitting fraudulent claims to Medicare to the tune of $29 million. Dr. Harold Persaud upcoded certain claims submitted to Medicare and private insurers, recorded false results of nuclear stress tests to justify cardiac catheterizations, and improperly referred patients to undergo coronary artery bypass surgery that allowed him to bill for extensive follow-up testing. Announcement

> Two owners and two nurses at a Dallas home health company were arrested and charged with submitting $13.4 million in fraudulent claims to Medicare. For nine years, the owners of Timely Home Health Services, Inc. allegedly paid recruiters for Medicare beneficiary information and submitted claims for services that were never provided using falsified patient documentation that made it appear as though the beneficiaries were homebound. Announcement

Health Payer News

> Iowa will shift management of its Medicaid program to three privately managed companies by March 1. Four companies were initially awarded the contract, but WellCare lost its contract because it failed to disclose $137.5 million in fines it paid to resolve past False Claims Act litigation; however, WellCare officials say they intend to fight the decision with "every avenue available within the legal system." Article

> The Centers for Medicare & Medicaid Services (CMS) is setting up rules to more effectively monitor risk scores that cause some beneficiaries to appear sicker than they actually are. CMS is operating the HHS-Operated Risk Adjustment Data Validation program to track risk score inflation and educate payers. Insurers are also required to hire initial validation audit companies to verify patient information and risk scores. Article

And finally… Commuting during the holidays doesn't have to be stressful. Article

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.