News From Around the Web
> Three Tennessee-based providers operating under some variation of Friendship Home Health paid $6.5 million to resolve claims that the companies improperly billed TennCare, Medicare and Tricare over a six-year period, according to the Department of Justie (DOJ). Prosecutors accused Friendship and owner Theophilus Egbujor of billing for private duty nursing services performed by someone who was excluded from Medicare and Medicaid, and submitting claims without the appropriate documentation. Statement
> Two durable medical equipment (DME) suppliers in Utah and Indiana agreed to a $7.5 million settlement to resolve false claims allegations involving power wheelchairs, the DOJ said. Rehab Medical Inc., located in Indianapolis, served as a partial successor of Orbit Medical Inc., located in Salt Lake City. Prosecutors alleged that Orbit sales representatives altered prescriptions and documentation and forged physician signatures in order to provide patients with power wheelchairs. Statement
> The former owner of a Miami outpatient physical and respiratory therapy clinic was sentenced to more than six years in prison for his role in a $2.5 million fraud scheme, according to the DOJ. Ankur Roy, owner of Selectcare Health Inc., and two co-conspirators submitted false claims to Blue Cross Blue Shield and Medicare for respiratory therapy that was never provided. Roy used approximately $600,000 in reimbursements to pay off credit card and student loan debt. Statement
Fierce Finance News
> The Centers for Medicare and Medicaid Services released its annual hospital payment data, which shows that five doctors received more than $10 million in Medicare reimbursement in 2013. Additionally, hospital charges for the top Medicare Severity Diagnosis Related Groups, including joint replacements, have seen a moderate increase. Article
Fierce Payer News
> Medical loss ratio has increased from 80 percent in 2010 to 85 percent in 2013, according to an analysis by the Kaiser Family Foundation, indicating that insurers have not been hit financially by provisions of the Affordable Care Act. The law requires insurers to achieve an MLR of at least 80 percent for small group plans, and 85 percent for larger group plans, or pay a rebate to customers. Article
And finally… A legitimate trash-cicle in Boston. Article