SoCal trio convicted of submitting $2.4 million in false claims for ambulance services; DOJ prosecutors lash back at attempt to dismiss corruption claims against Sen. Menendez

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> Two managers, along with the former owner and operator of a Southern California ambulance company, were convicted of a Medicare fraud scheme in which the trio submitted $2.4 million in false claims. Yaroslav Proshak owned ProMed Medical Transportation in Los Angeles, while Emilia Zverev and Sharetta Michelle Wallace served as billing and staffing managers. All three conspired to bill for ambulance transportation for patients that did not need it, while instructing EMTs to falsify documents in order to justify the claims submitted to Medicare. Announcement

> In response to a series of motions submitted by Sen. Robert Menendez's (D-N.J.) defense team to dismiss the corruption charges against him, prosecutors with the Department of Justice have aggressively countered, calling Menendez's arguments "naked rhetoric that conflicts with the facts and the law," according to Politico. The prosecution contends that hard evidence "such as contemporaneous emails" show that Mendez received political donations and gifts from Florida ophthalmologist Salomon Melgen in exchange for intervening in a Medicare investigation. Defense attorneys argue the investigation was founded on false accusations that Menendez was involved in underage prostitution activities during trips to the Dominican Republic. Article

> A Louisiana physician pleaded guilty to writing false home health referrals for patients that he knew were not confined to their homes. Winston Murray, M.D., admitted the referrals were used by Interlink Health Care Services Inc. and Lakeland Health Care Services Inc. to bill Medicare for medically unnecessary home care. The two providers were part of a larger scheme in which home health companies submitted more than $56 million in false claims to Medicare. Release

Health Payer News

> A new report from the Commonwealth Fund indicates that Medicare Advantage competition is low, an issue that may be exacerbated by the recent consolidation within the health insurance industry. According to the report, 97 percent of U.S. counties offer little to no competition in the Medicare Advantage insurance market, and the remainder were only "moderately" competitive. Article

> Blue Cross of Northeastern Pennsylvania is facing a class-action lawsuit accusing the insurance company of "blatantly unlawful conduct" by donating $90 million to charity rather than dispersing the money to its members. The insurer joins other Blue Cross plans that have face criticism for maintaining a surplus as a non-profit company. Article

And finally… Who hasn't had the occassional homicidal thought after contracting lice? Article

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