Pharmacy settles gift card kickback allegations; Houston physician, group home owner indicted for $5.2M mental health scheme;

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> Physician Pharmacy Alliance, Inc. (PPA) settled for $5 million to resolve allegations that it provided kickbacks in the form of gift cards to Medicare and Medicaid patients, according to the Department of Justice (DOJ). PPA offered home delivery pharmacy services throughout North Carolina, often waiving co-payments in addition to providing gift cards in an alleged attempt to capture patients enrolled in government health programs. Statement

> A Houston doctor and a group home owner were indicted for their respective roles in a $5.2 million Medicare fraud scheme tied to unnecessary mental health treatment, the DOJ said. Walid H. Hamoudi, M.D., and Geraldine J. Caroline allegedly worked together to submit false claims for patients enrolled in the partial hospitalization program, which provided mental health services through Riverside General Hospital. Prosecutors allege that Hamoudi paid kickbacks to Caroline in exchange for mental health referrals. Statement

> A Dallas physician has been accused of falsifying house calls and billing Medicare for $5 million worth of home visits that were actually conducted by an unlicensed employee, according to the Associated Press. Prosecutors allege that Hector Molina, M.D., who owned and operated Molina Medical Housecall Services, conspired with Blanca Mata to bill for visits she made to patients while he was out of the country. Article

Health Payer News

> Diabetes patients require $10,000 more in treatment costs than those without diabetes, according to a new analysis. Much of this spending is attributed to insulin, which offers both convenience and increased treatment costs. However, additional complications that arise from the inability to appropriately treat diabetes can cost nearly double. Article

> A mere five percent of Medicaid enrollees account for approximately half the cost of the $460 billion program, according to the Government Accountability Office. The report attributes the high costs to patients with chronic conditions and mental illness, along with diabetes and asthma. Article

And finally … Busted by an incriminating trail of macaroni salad. Article

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