> A Chicago psychiatrist known for his prolific prescribing of the antipsychotic drug Clozopine to elderly patients in nursing homes and hospitals was sentenced to nine months in prison for accepting nearly $600,000 in kickbacks from pharmaceutical companies in exchange for prescribing the drug. Announcement
> An EMT with the Philadelphia ambulance company Brotherly Love was sentenced to 37 months in prison for falsifying reports that made it appear as though patients needed emergency transportation despite the fact that they could walk. Announcement
> A New Jersey family physician was sentenced to 37 months in prison after pleading guilty to billing Medicare, Medicaid and private insurers for patient visits that never happened. Albert Ades admitted to fabricating blood pressure readings and other vital signs to make it appear as though patients had visited his office. Announcement
Health Payer News
> Although more insurers like Humana, OptimumCare and WellCare are rolling out home care management programs for senior citizens, the Centers for Medicare & Medicaid Services has expressed concerns that the in-home assessments are being used to generate additional payments under Medicaid Advantage risk-adjustment methodologies. Article
> Blue Cross Blue Shield of North Carolina could be facing hefty fines of $1,000 or more per day per violation after software failures that led the payer to improperly charge coinsurance, miscalculate deductibles and issue inaccurate denial of service reports. Article
And finally… A horse in a three-piece suit because why not? Article.