> The president of a Miami transportation company was sentenced to 60 months in prison and ordered to pay nearly $27 million in restitution for his role in a scheme that submitted more than $70 million in fraudulent bills to Medicare. Damian Mayol, president of Transportation Services Providers Inc. coordinated kickbacks to recruiters who referred patients to three mental health clinics in Miami. The clinics then billed Medicare for unnecessary partial hospitalization program services. Announcement
> A year after raiding an Oklahoma City pain clinic, prosecutors with the state's Medicaid Fraud Control Unit charged Harvey Jenkins, M.D., with 29 felony counts including defrauding the Medicaid program. Calling Jenkins "a drug dealer with a prescription pad," prosecutors argued that he and five employees at Aria Orthopedics ran a pill mill and prescribed large quantities of opioid painkillers from 2010 to 2015, The Oklahoman reports. Article
> The last of five defendants linked to $33 million Medicare fraud scheme involving Detroit home health and hospice companies has pleaded guilty to healthcare fraud. Muhammad Tariq, the owner of several home health and hospice companies, joined four other guilty pleas to charges that the group paid kickbacks to physicians, marketers and patient recruiters in exchange for referrals. One physician provided patients with prescriptions for controlled substances if they agreed to accept services from certain home health providers. Announcement
Health Payer News
> A new report from the Congressional Budget Office indicates that increasing Medicaid enrollment is driving projected Affordable Care Act costs skyward. The CBO says ACA provisions will cost the government $1.4 trillion over the next decade, $136 billion more than last year's estimate. However, the CBO noted that the cost of insuring Americans between 2016 and 2019 is 25 percent lower than originally projected. Article
> Following pointed criticism that the Affordable Care Act's risk adjustment program benefits larger, established insurers at the expense of smaller outfits, the Centers for Medicare & Medicaid Services is considering alterations that would take effect in 2018. CMS says it is looking into whether the current system "appropriately addresses plan differences," and is considering modifications that would use the plan's premium in the risk adjustment equation. Article
And finally… Bear cubs visit the Chicago Cubs--and it's adorable. Article