Medical biller sentenced to four years for $4 million scheme; Feds intervene in whistleblower suit against Mississippi critical access hospital;

News From Around the Web

> A medical biller at a home health provider in Chicago was sentenced to nearly four years in prison for her role in a $4 million fraud scheme. Mary Talaga, the primary biller for Medicall Physicians Group Ltd., routinely billed for "care plan oversight" even though doctors did not provide that service. Talaga also billed for services for patients who were deceased or services provided by medical professionals who were no longer employed by the company. Announcement

> The feds have intervened in a false claims lawsuit against a Mississippi critical access hospital and the hospital's management company that allegedly charged "excessive and ineligible expenses" dating back to 2002. The whistleblower compliant claims Ted and Julie Cain, who own the hospital and the management company, claimed expenses for personal luxury automobiles on the hospital's cost reports and abused the special Medicare rules for payments to critical access hospitals. Announcement

> A ruling by a federal judge could push the trial for Sen. Robert Menendez (D-N.J.) back as much as a year, according to the New York Times. The judge is expected to rule on a motion to dismiss the corruption charges against Menendez, who, according to prosecutors, sought out favors for Salomon Melgen, M.D., related to improper Medicare claims. The defense argued that Menendez's actions related to general policy concerns and not Melgen's situation specifically. Either way, both parties indicated they would appeal the ruling, pushing the trial to the fall of 2016. Article

Health Payer News

> Presidential candidate Hillary Clinton announced a proposal to cap monthly and annual out-of-pocket costs on prescription medication by requiring pharmaceutical companies to pay higher rebates to Medicare. Her proposal would save the program approximately $100 million, although she did not address the issue of drug companies disclosing pricing information, an issue that the other Democratic candidate, Bernie Sanders, addressed in his recent prescription drug plan. Article

Health Finance News

> California has launched a price comparison site with the help of Consumer Reports and the University of California San Fancisco. Although California Healthcare Compare lists prices for more than 100 procedures, it only lists out-of-pocket estimates for insured patients, which can range drastically from a few hundred dollars to thousands. Article

And finally… Justice never sleeps, even when it involves copyright infringement against selfie-taking monkeys. Article

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