NOLA owner and physician found guilty of executing $34M home health scheme; Pharma exec accused of providing lavish kickbacks to promote wound dressing

> The owner of a New Orleans home health company and a physician were convicted for a healthcare fraud scheme that billed Medicare more than $34 million. Elaine Davis, owner of Christian Home Health Care Inc., and Pramela Ganji, M.D., were convicted of billing Medicare for unnecessary home health services from 2007 through June 2015. Davis paid marketers to recruit patients in the New Orleans area and then sent their information to Ganji, who prescribed home health services, even when home care was not necessary. Announcement

> Prosecutors say an executive with Advanced BioHealing Inc. paid kickbacks to Department of Veterans Affairs physicians to promote Dermagraft, a product used to treat diabeties related-sores, according to SeattlePI.com. Former executive Todd Clawson is accused of taking physicians on a fishing trip in Mexico and supplying on VA doctor with Def Leppard tickets. Others were allegedly plied with trips to Jackson Hole, Wyoming and Las Vegas, or paid as much as $3,000 for speaking engagements that took place at restaurants. Article

> The owner of two Miami medical clinics was sentenced to nearly seven years in prison for a fraud scheme in which he sold home health prescriptions to more than 20 home health agencies. Carlos Medina, owner of Doral Community Clinic Inc. and Advanced Medical of Doral Inc. charged cash kickbacks for home health prescriptions for patients who did not need home care. Often the home health agencies charged Medicare for services that were never provided, leading to more than $3 million in improper payments. Announcement

Health Payer News

> Anthem has filed a lawsuit against the pharmacy benefits manager Express Scripts for failing to provide prescription drug savings it says it is owed. The insurer is seeking damages and the ability to terminate its contract with Express Scripts, arguing the company has refused to ensure Anthem is receiving competitive benchmark pricing. Express Scripts said it has "acted in good faith" according to terms of the agreement. Article

> Legislators and healthcare experts butted heads over the benefits of Medicare Advantage last week. While some pointed to research that shows Medicare Advantage plans provide better care, Rep. Jim McDermott (D-Wash.) argued the government has "a lot of work [to do] to crack down on widespread upcoding and cherry-picking of beneficiaries." Article

And finally… You haven't lived until you've had vending machine sausage. Article

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