Pasadena doctor who falsely claimed patients were terminally ill is sentenced to four years for fraud

http://www.latimes.com/local/lanow/la-me-ln-pasadena-doctor-prison-20160824-snap-story.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=33409508&_hsenc=p2ANqtz–KDKuU4PH1yztKbkXarPsY58B6-80M433Uz-u6qd86BDE6zJ4zbv5sPgwskL5rfPSDgOeUJw0jeuHlEK79jrfz4jh2Jg&_hsmi=33409508

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A Pasadena doctor convicted of falsely certifying that more than 79 patients were terminally ill as part of a scheme to bilk Medicare and Medi-Cal was sentenced by a federal judge to four years in prison.

U.S. District Judge S. James Otero also ordered Boyao Huang, 43, to pay $1,344,204 in restitution last week. In May, Huang was found guilty of four counts of healthcare fraud at the conclusion of a two-week trial that centered on a ploy to defraud the government of $8.8 million by making it pay for hospice-related services. Huang could have received up to 10 years in prison for each of the counts.

Eleven ways MACRA will impact your business

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/eleven-ways-macra-will-impact-your-business?GUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=24082016

The Medicare Access and CHIP Reauthorization Act, known as MACRA, is one of the most significant payment changes since Medicare’s inception in 1965.

“Physicians and other clinicians payments will be at risk, beginning with a plus or minus swing of 4% in 2019, that increases to plus or minus 9% by 2023,” says Chester A. Speed, JD, LLM, vice president, public policy, AMGA.

To be successful under MACRA, providers will have to consider the clinical, financial and cultural changes they need to make to do well under risk, according to Speed.

“And while providers can rightfully say they’ve seen this before in the 1990s, risk, or value-based payments are now written into law and they are here to stay,” he says.

What impact will MACRA have on your organization? We asked experts to tell us.

Presidential election: 4 things managed care should watch

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/presidential-election-4-things-managed-care-should-watch?GUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=24082016

As the 2016 presidential election approaches, analysts and experts are advising healthcare executives to watch and monitor certain issues, such as pharmaceutical spending and healthcare reform, which will surely impact the health insurance industry. Here’s a look at what they recommend keeping a close eye on in particular.

New York Hospitals Facing Fiscal Code Blue

http://www.bloomberg.com/politics/articles/2016-08-22/new-york-city-hospitals-seen-unwilling-to-take-stronger-medicine?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=33278487&_hsenc=p2ANqtz–Ua5Q-PC5Hs3i1ni8bTaDNOfHhzF8R8meSEL9ZdWL6LejSQMUC3wLCDN9J_cuBB9IHRmZmF7BdmyqhMlNtFPa8KBOrzA&_hsmi=33278487

New York City’s public hospitals are in critical condition with rising costs and plummeting revenue. There’s no dispute about that diagnosis. The problem is with Mayor Bill de Blasio’s proposed cure, according to health policy makers, hospital administrators and budget watchdogs.

As NYC Health + Hospitals President Ram Raju describes it, the largest U.S. municipal-healthcare provider is an ailing system of 11 hospitals that’s losing revenue because of increased competition from non-profit hospitals for Medicaid patients and drastic cuts in federal and state aid for indigents.

His prescription: shift its 40,000-plus employees into a system of neighborhood clinics and transform campuses into affordable housing and long-term care, build enrollment of its MetroPlus insurance plan and persuade federal and state governments to spend more. That aid is projected to fall by almost $1 billion -– from $2.2 billion in FY16 to $1.4 billion in 2020.

Drug and Device Makers Pay Thousands of Docs with Disciplinary Records

http://www.healthleadersmedia.com/physician-leaders/drug-and-device-makers-pay-thousands-docs-disciplinary-records?spMailingID=9400653&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=981898992&spReportId=OTgxODk4OTkyS0

Physicians whose state boards have sanctioned them for harming patients, unnecessarily prescribing addictive drugs, bilking federal insurance programs, and even sexual misconduct nonetheless continue to receive payments for consulting, giving talks about products, and more.

Cut Healthcare Spending or Face the Public Option

http://www.healthleadersmedia.com/finance/cut-healthcare-spending-or-face-public-option?spMailingID=9394331&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=981810720&spReportId=OTgxODEwNzIwS0#

“If we don’t get a handle on spending at some point, we will have a government-financed system,” predicts the head of the Pacific Business Group on Health.”

Florida scam reveals breadth of compound pharmaceutical billing

http://www.fiercehealthcare.com/antifraud/florida-scam-reveals-breadth-compound-pharmaceutical-billing?mkt_tok=eyJpIjoiTTJNNE9ESmpNR1psWmpWaSIsInQiOiJXOXlcL0xySWFOazE4RUJ3cUNVaWtoMnZ3WVZDMUdQUGlLUmNaemNHZklCMEhJQW1xS01MNE1pRGNXUlpURXBUVGtDOE5nQWxqUmRMZ3BOSGZwT1pDajV4dHRma0hQZ1F4amlFNnBEZGhqdW89In0%3D&mrkid=959610&utm_medium=nl&utm_source=internal

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Eight Florida residents were charged last week with billing the federal government more than $633 million for compounded pharmaceuticals over a three-year period, according to the U.S. Attorney’s Office for the Middle District of Florida–events that underscore the intensity of emerging fraud concerns about compounded drugs.

A group of eight co-conspirators, led by Nicholas A. Borgesano—the president of five pharmacies and several medical billing companies in Tampa Bay and Miami—billed Medicare, Tricare and private insurance companies more than $633 million for compounded pharmaceutical prescriptions between October 2012 and December 2015, according to the indictment.

The group was paid more than $157 million for illegitimate prescriptions that were often allegedly the result of elaborate kickbacks. In some instances, the group allegedly misrepresented some claims by billing for certain high-priced ingredients that were not included in the final compounded prescription.

As part of the arrest, authorities confiscated 17 properties, 15 luxury vehicles and several boats.

Earlier this year, federal and state authorities raided pharmacies in four states, including Florida, as part of a widespread bust involving compounding pharmacies. Federal officials have been targeting compounding pharmacies following a spike in high-priced Tricare claims. Investigators and legal experts have said the cases and investigations brought forward thus far are “just the beginning.”

How Clinton and Trump view Medicare and retiree health plans

http://www.cbsnews.com/news/how-clinton-and-trump-view-medicare-and-retiree-health-plans/?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=33162087&_hsenc=p2ANqtz-9oAIbaDQtxb4QcswlBvNhptpEnOvAuPzdM3wZ5GPdm93T9u09D7SfE0LClB9DcepAVRVolZJmQkwZXYhWNWpR3jUrmqg&_hsmi=33162087

 

VIDEO: Healthcare Economist & Futurist Dr. Bill McGivney

http://healthcareexecutivesnetwork.org/mcgivney/

Healthcare Executives Network

 

Fake owner pleads guilty in $4.2M home health fraud scheme

http://www.healthcaredive.com/news/fake-owner-pleads-guilty-in-42m-home-health-fraud-scheme/424577/

  • Ramon Collado Gonzalez of Miami, Florida pleaded guilty Monday to acting as the straw owner of Golden Home Health Care as part of a $4.2 million home healthcare fraud scheme, the U.S. Attorney’s Office for the Southern District of Florida announced Tuesday.
  • Gonzalez admitted he was recruited to cover for the real owners, Mildrey Gonzalez and Milka Alfaro, who were charged separately for their alleged roles.
  • Gonzalez signed documents for the submission of false Medicare claims in exchange for monthly payments and periodic bonuses, the press release states.