New Jersey home health owner pleads guilty to fraud, bribing an NJ official; Indiana University Health, midwife practice face $100 million whistleblower lawsuit;

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> The owner of a New Jersey home health agency pleaded guilty to charges of Medicaid fraud, bribery, money laundering and tax evasion in connection with a scheme that costs the government $7 million, according to the Department of Justice (DOJ). Irina Krutoyarsky, owner of HHCH Health Care Inc., admitted that she submitted false documentation to the state nursing board to fraudulently obtain certifications for home health aides. Krutoyarsky also had aides routinely falsify records, give cash kickbacks to patients and bill for services that were never provided. She later offered a $10,000 bribe to an employee of the New Jersey Department of Labor, who was working undercover, in an effort to obstruct the investigation against her. Statement

> A whistleblower lawsuit against Indiana University (IU) Health and HealthNet, the state's largest midwifery practice, claims that the two organizations billed Medicaid for services provided by physicians, even though beneficiaries were cared for by nurse midwives, according to USA Today. The suit, which was filed by the former director of women's services at HealthNet and the medical director of OB-GYN services at IU Health Methodist Hospital, claims the two providers fraudulently billed Medicaid as much as $100 million. The suite further alleges that the lack of physician involvement may have contributed to brain damage to children, and at least one mother's death. Article

> The owner of a Miami home health agency was sentenced to nearly 10 years in prison for a Medicare fraud scheme that stole $32 million, the DOJ said. Felix Gonzalez, owner of AAA Advanced Care Inc., admitted to billing Medicare expensive therapy and home health services between January 2006 and March 2009 even though they were not medically necessary. Gonzalez also paid bribes to recruiters for referrals, prescriptions, plans of care, and certifications for therapy and home health services. Statement

Health Finance News

> Hospitals will get a small pay increase under the proposed payment formula submitted by CMS last week. The proposal includes a modest increase of 1.1 percent after accounting for market basket updates, market productivity cuts, and a 0.8 percent cut tied to the American Taxpayer Relief Act of 2012. Earlier this year the American Hospital Association advocated a 3.2 percent increase. Article

Health Payer News

> A report from the National Center for Policy Analysis indicates that negotiating drug plans, benefits and costs is detrimental to patients. The report pointed specifically to regulations that constrain free market competition, including limiting mail-order pharmacies that discourage drug plans from offering discounts for a preferred pharmacy or mail-order options, as well as obstructing competitive bidding, which is viewed as beneficial to consumers but often provides greater profits to local pharmacy service providers. Article.

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