News From Around the Web
> Robinson Health System Inc. has agreed to pay $10 million to resolve claims the provider engaged in improper financial relationships with physicians that violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute. The government alleged Ohio health system had management agreements that provides payments to two physician groups despite the fact that physicians failed to provide "sufficient bona fide management services," according to the Department of Justice (DOJ). Statement
> A Cleveland doctor was sentenced to more than two years in jail for his involvement in a four-year fraud scheme in which he received $7.5 million from Medicare for Botox injections that he never administered. Raymond Sean Brown, M.D., purchased just 254 vials of non-FDA approved Botox, but billed Medicare for nearly 18,000 vials, the DOJ said. Statement
> A Lincoln, Nebraska pharmacist was charged with healthcare fraud and ordered to remain in jail for allegedly falsely submitting $2.5 million worth of Medicare claims for a solution used in inhalers for cystic fibrosis patients, according to the Lincoln Journal Star. Scott Tran used the names of other area physicians who later denied ever prescribing the drug at all. Prosecutors also argued that Tran led a "double life" hiding $11 million in casino wagers from his wife. Article
Health Payer News
> Payers operating Medicare Advantage plans will see revenues increased 1.25 percent next year, while overall revenue is expected to increase 3.25 percent. The announcement came as a surprise considering that in February, CMS proposed a 0.95 decrease in MA reimbursement rates in 2016. Article
Health Finance News
> A recent study by the Robert Woods Johnson Foundation shows that eight states realized $1.8 billion in financial benefits by expanding Medicaid. States like Michigan and Washington saved more than $300 million each by expanding Medicaid to replace general funds used for the uninsured, and receiving matching funds from the federal government. Article
And finally… Be careful where you dangle your trophy fish. Article