Hospice provider settles for $6.5 million; Texas man accused of $1 million in wire fraud as fake MRI salesman

News From Around the Web

> A Bronx-based hospice provider agreed to pay $4.9 million to the United States and $1.6 million to the state of New York to settle allegations that it submitted fraudulent claims for services not adequately provided. Among other allegations, Compassionate Care Hospice failed to treat patients according to an individualized plan of care that required a nurse to visit a patient one to three times each week. Management falsified nursing notes to make it appear care had been provided, and then submitted fraudulent claims to Medicare and Medicaid. Announcement

> A Texas man has been charged with conspiracy to commit wire fraud for a scheme in which he impersonated a medical equipment salesman, convincing Dallas Medical Center to pay him nearly $1.1 million to purchase an MRI machine. Albert Davis and his co-conspirators allegedly convinced representatives at the Dallas hospital that he worked for Cerner Corp., based in Kansas City, using fake emails, Internet domains, bank accounts and phone numbers all linked to Cerner. The scheme was reported to authorities by Cerner once the vendor became aware of it. Announcement

> The owner of a Miami home healthcare company pleaded guilty last week to a $13 million scheme that included kickbacks and bribes to Medicare beneficiaries. Alexander Lara, owner of Longcare Home Health, admitted to intentionally billing Medicare for expensive physical therapy and home health services that were never provided. Lara paid kickbacks to recruiters, beneficiaries, doctor's offices and clinics in exchange for patient referrals and prescriptions that he used to bill Medicare. Announcement

Health Payer News

> A Philadelphia startup has designed a claims payment process that incorporates patients in an effort to root out fraud and abuse. The startup, known as TrueClaim, uses analytics to look at billing claims and contact patients if something looks suspicious, similar to the way credit card companies calls cardholders regarding suspicious billing. Article

> The Affordable Care Act is driving a 14 percent growth in the healthcare payer business process outsourcing market. With more claims to process and an increase in high-risk consumers, payers are increasingly outsourcing claims processing to third party providers such as Accenture, Genpact and Xerox, and trend that is expected to continue in the years to come. Article

And finally… A Massachusetts man is selling snow by the pound. Article

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