News From Around the Web
> The former CEO of the Las Vegas endoscopy center that sparked the nation's largest hepatitis C outbreak has been sentenced to one year in prison for conspiring to commit healthcare fraud. Tonya Rushing, conspired with Dipak Desai, the former owner of the Endoscopy Center of Southern Nevada, to overcharge Medicare by overstating the time nurse anesthetists spend with patients and instructing staff to falsify patient records and billing documents. Rushing received approximately $1.3 million for her role in the scheme. Annoucement
> A Southern California woman was sentenced to 6.5 years in prison for her role in a scheme that billed federal healthcare programs more than $7 million for unnecessary power wheelchairs. Adeline Ekwebelem was convicted of 16 counts of fraud last September after the court determined her durable medical supply company paid kickbacks to marketers that recruited Medicare beneficiaries off the street, as well as physicians that wrote fraudulent prescriptions for wheelchairs. As a result, Medicare paid nearly $3.5 million to the company. Annoucement
> The medical director of the state-run psychiatric center in Miami was sentenced to five years in prison for fraudulently collecting $5.5 million from Medicare for mental health services. From 2008 to 2011, Barry Kaplowitz, a licensed physician at Hollywood Pavilion, helped falsify medical records for over 400 patients in order to bill Medicare for unnecessary intensive outpatient treatment, which led to 2,800 false claims. Kaplowitz is the sixth individual tied to Hollywood Pavilion to be convicted and sentenced. Previously, the hospital's CEO was sentenced to 25 years, and collectively, four hospital executives have been ordered to pay $39 million. Announcement
Health Finance News
> A new bill in Congress aims to change the RAC payment structures, shifting from a percentage-based commission to a flat fee. Additionally, RACs would face financial penalties for having a high percentage of overturned claims. The bill is backed by the American Hospital Association (AHA). Article
Health Payer News
> Data released by the Centers for Medicare and Medicaid (CMS) last week shows that Part D spending reached $103 billion in 2013. Name brand drugs accounted for $19 billion in spending, although more than 75 percent of prescriptions were generic medications, an approach that has help limit medication spending. For example, the generic heartburn drug omeprazole was prescribed four times as often as the name brand Nexium, and with just one-fourth the cost. Article
And finally … Forget Floyd Mayweather, this salty old guy beat up a bear. Video