NY audit reveals $513 million in improper Medicaid payments; owners of Detroit adult day care center, home health agencies sentenced for $29 million scheme;

News From Around the Web

> Reoccurring deficiencies within New York's computer system has resulted in $513 million in improper Medicaid payments and missed revenue between 2011 and February 2015, plus another $361 million in questionable transactions, according to the Associated Press. New York Comptroller Thomas DiNapoli announced that auditors had identified gaps within the claims processing system that led to improper payments, but the state's Medicaid director said auditors' criticisms regarding the computer system have already been addressed. Article

> Two home health owners and the operator of an adult day care center in Detroit have been sentenced for their respective roles in a $29 million Medicare fraud scheme, according to the Department of Justice (DOJ). Felicar Williams, owner of Haven Adult Day Care Center LLC, was sentenced to five years for billing for services that were not actually provided, in some cases for patients that were already deceased. Williams then sold patient information to Abdul Malik Al-Jumail and Jamella Al-Jumail, who used the information to fraudulently bill for home health services that were never provided. Statement

> A couple that owned a Houston medical clinic have been sentenced for their role in a $9 million Medicaid scheme that took place from January 2006 through October 2009, according to the DOJ. William Owuama was sentenced to five years in federal prison, while his wife, Marla, got 12 months' probation and house arrest. William served as the owner of the clinic, paying beneficiaries for medical visits and billing Medicaid for vestibular testing using the provider number of a doctor that had been incarcerated. Marla served as a registered nurse and helped run the clinic. Statement

Health IT News

> A Government Accountability Office (GAO) report says that using electronically readable Medicare cards would have limited impact in reducing fraud. The success of electronic cards will depend on provider participation and the cost and benefits compared to current paper card systems. The GAO also noted that the Centers for Medicare & Medicaid Services will still pay claims regardless of whether or not an electronic card is used, and storage of electronic health data could lead to additional problems. Article

Health Finance News

> Medicare plans to take a closer look at payments to hospice providers in an effort to avoid duplicate payments, but some are concerned it will limit the ability for patients to transition to end-of-life care. Federal investigators have previously raised concerns regarding for-profit hospice providers that drive up service costs, and the potential for hospice billing fraud. Article

And finally … This email from Drexel University makes the classic "reply all" mistake look tame. Article

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