News From Around the Web
> Two former sales managers at Humana were each sentenced to one year and one day in prison and ordered to pay $900,000 for participating in a racketeering and bribery scheme. Former regional sales director Glen Allen Fine and former sales manager James E. Wenger previously pleaded guilty to taking $4 million in kickbacks from two managing general agencies in exchange for sending insurance agents that wanted to sell Humana Medicare Advantage and prescription drug plans. Announcement
> An Arizona doctor was sentenced to four years in prison for forging patient records, billing for services that were never provided, and participating in drug diversion schemes in exchange for cocaine, prostitutes and expensive alcohol. Edward Jack Sayegh, who owned Arizona Family Practice in Phoenix, pleaded guilty in August to a slew of charges including falsifying patient medical records and billing for phantom medical services. Announcement
> Philadelphia ambulance operator Zahar Tkach (also known as Alex Tkach) was indicted on fraud charges for inappropriately charging Medicare $1.25 million for unnecessary services. Tkach owned NovaCare Ambulance Services Inc. and Cardiac Care Ambulance Inc., which transported dialysis patients three times a week so that he could forge patient documents and fraudulently bill Medicare for emergency ambulance services. Tkach allegedly submitted those fraudulent documents to Medicare auditors. Announcement
Health Payer News
> An Office of Inspector General report released Tuesday reveals that contractors hired to build the Healthcare.gov website were not provided appropriate training. Although federal regulations implemented in 2012 required employees overseeing contracts worth more than $10 million to undergo 96 hours of training, the Centers for Medicare & Medicaid Services ignored the requirement, allowing one employee to work for 15 months without any training. Article
> An appeals court reversed a lower court's decision in a lawsuit against Aetna, ruling that a healthcare provider can sue an insurer for payment of health benefits provided a patient has assigned the provider the right to payment. The ruling could set a precedent regarding when providers have the legal standing to sue insurance companies. Article
And finally… It's fall, which means even the kayaks are pumpkin themed. Article