News From Around the Web
> A Miami pharmacy owner pleaded guilty to submitting fraudulent claims to Medicare for prescription drugs that were not medically necessary nor prescribed by legitimate physicians. Evelio Fernandez Penaranda, owner of Naranja Pharmacy Inc., admitted to submitting claims totaling $1.8 million using the information of beneficiaries and doctors without their consent. Announcement
> West New York Mayor Felix Roque pleaded not guilty to charges that he took $250,000 in bribes from Diagnostic Imaging Affiliates in exchange for patient referrals, according to NJ.com. The New York Attorney General's Office alleges that Roque took cash and campaign contributions from the company from 2007 to 2012. A status hearing for the case is scheduled for Sept. 14. Announcement
> A Brooklyn physician was sentenced to five years' probation and ordered to pay $4.4 million in restitution along with two other co-conspirators of a fraud scheme that totaled $13 million, according to SILive.com. Emma Poroger, M.D., who served as medical director and CEO of North Austin Medical in Queens, New York, authorized unnecessary sleep studies, IV vitamin infusion therapy, nerve conduction tests and EEGs, all of which were billed to Medicare. Announcement
Health Payer News
> Following mergers between four of the five largest health insurers in the country, all eyes are shifting toward how state and federal regulators will handle industry consolidation. The American Hospital Association and the American Medical Association called for regulators to investigate how the mergers will impact providers and to closely scrutinize any potential anti-trust violations. Article
A recent report shows that the average Medicare Advantage (MA) enrollee has a choice of more than 18 plans in 2015, and 94 percent of all enrollees had a choice of at least five plans. Experts indicate that these robust options are likely to continue for MA members in spite of recent mergers among the industry's largest insurers since larger organizations may be more effective at managing risk. Article
And finally… The next time I get pulled over, I'm pulling this guy out of my glove box. Article