Payer Roundup—Nevada candidates rally around Medicaid expansion; Therapy owner sentenced for fraud

Gavel court room lawsuit judge
DOJ announces Medicare fraud settlements and sentencing and Nevada gubernatorial candidates rally around Medicaid expansion. (Pixabay)

Physical therapy owner sentenced for fraud

The former owner of a physical therapy facility has been sentenced to three years probation following her conviction for healthcare fraud.

Judith Morale pleaded guilty in December to submitting claims for payments to Medicare that falsely described routine foot care services as "wound care" through which she obtained more than $41,000 in payments, the Department of Justice said. Morale has also been ordered to pay the payments back in full. 

“Ms. Morale defrauded Medicare out of thousands of dollars for her own personal enrichment,” Harold H. Shaw, special agent in charge, FBI Boston Division, said in a statement. “The FBI, working collaboratively with our law enforcement partners, will do everything we can to root out others like her, who are diverting scarce taxpayer funds from government programs, for their own greed-fueled schemes.” (Department of Justice)

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Nevada gubernatorial candidates pledge to protect Medicaid

Three of the major candidates for Nevada governor have pledged to preserve the Silver State's expanded Medicaid program.

Democratic county commissioners Steve Sisolak and Chris Giunchigliani as well as Republican Dan Schwartz, the state treasurer, made the promise on stage Tuesday before Nevadans for the Common Good, a group representing churches, nonprofits and schools, as reported by the Nevada Independent.

Adam Laxalt another Republican nominee and current state attorney general was invited but did not appear at the event. Laxalt has previously said he would not reverse the expansion, despite not agreeing with it. 

The pledges all but assure that expansion will remain in the state regardless of who wins the November election. (The Nevada Independent)

Hospital settles on over-billing allegations

Charles Cole Memorial Hospital, a nonprofit critical access hospital in Pennsylvania, has agreed to pay $373,547 to settle self-reported improper Medicare billings.

According to the Department of Justice, the hospital failed to bill under a particular modifier that reduced Medicare reimbursement amounts for services by physician assistants and nurse practitioners in its pain management, orthopedics, gastroenterology, and medical oncology physician office practices.

The agency announced the settlement Tuesday. (Department of Justice)