NY clinic owner pleads guilty to $55 million fraud scheme; Psychologists charged with providing unnecessary tests for nursing home residents;

News From Around the Web

> The owner of two New York medical clinics pleaded guilty to a $55 million fraud scheme in which she paid cash kickbacks to patients to undergo physical and occupational therapy, diagnostic tests and office visits. Valentina Kovalienko admitted to billing Medicare and Medicaid for unnecessary procedures and tests that were performed by unlicensed physicians, and diverted reimbursement from the clinic to herself through an elaborate network of fake third-party vendors. Kovalienko's the 11th guilty plea connected to the scheme. Announcement

> Two clinical psychologists have been charged with participating in a $25 million fraud scheme that billed Medicare for unnecessary psychological tests for nursing home residents. The psychologists, Beverly Stubblefield and John Teal, worked for Nursing Home Psychological Services and Psychological Care Services, which operated in Louisiana, Mississippi, Florida and Alabama. Stubblefield and Teal are accused of administering unnecessary psychological tests under the direction of the company owners, who were indicted previously. Announcement

> The CEO of Chicago-based Mobile Doctors pleaded guilty to improperly billing Medicare $1.8 million by altering patient records to get a higher reimbursement rate for in-home services in Illinois, Michigan and Indiana. Dike Ajiri personally altered billing forms in order to get the maximum level of reimbursement for services that did not meet the standard of care for home services outlined by the American Medical Association. Announcement

Health Payer News

> New reports from the Government Accountability Office (GAO) reveal errors in Affordable Care Act coverage decisions led to duplicate coverage and overpayments. The GAO created 18 fake accounts, 10 of which were eventually approved for subsidized plans in federal and state marketplaces. Eight additional fake accounts were able to obtain Medicaid coverage. A subsequent GAO report pointed to gaps in enrollment oversight and coordination between ACA exchanges. Article

> Premiums for Affordable Care Act benchmark health plans are expected to rise 7.5 percent on average in 2016, according to the Centers for Medicare and Medicaid Services. Meanwhile, the average premium increase across the 30 largest markets will reach 6.3 percent, although most consumers will still be able to find plans for less than $100 a month. Article

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