Ex-Florida hospital director gets prison time for role in $1B fraud scheme

https://www.beckershospitalreview.com/legal-regulatory-issues/ex-florida-hospital-director-gets-prison-time-for-role-in-1b-fraud-scheme.html

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The former director of outreach programs at Larkin Community Hospital in South Miami, Fla., was sentenced to 15 months in prison April 3 for her role in a $1 billion healthcare fraud scheme.

Four things to know:

1. The judge handed down the sentence just over two months after Odette Barcha pleaded guilty to conspiring to defraud the federal government and paying and receiving healthcare kickbacks.

2. Ms. Barcha was one of three defendants charged in an indictment unsealed in July 2016. She allegedly had physicians at Larkin Community Hospital discharge patients to skilled nursing homes and other facilities owned by Philip Esformes, who allegedly paid kickbacks for those admissions.

3. Prosecutors allege Mr. Esformes, who operated a network of more than 30 skilled nursing homes and assisted living facilities in Florida, admitted Medicare and Medicaid beneficiaries to the facilities even if they did not qualify for skilled nursing home care or for placement in an assisted living facility. Once admitted, the patients received medically unnecessary care that was billed to Medicare and Medicaid.

4. The seven-week trial of Mr. Esformes wrapped up March 29, according to the Miami Herald. On April 5, a federal jury found Mr. Esformes guilty of various counts, including paying and receiving kickbacks, bribery, money laundering and obstruction of justice, according to Law360

 

 

 

Detective, nurse altercation could spur review of hospital policies

http://www.modernhealthcare.com/article/20170904/NEWS/170909968/detective-nurse-altercation-could-spur-review-of-hospital-policies

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In a case that’s gone viral, a Salt Lake City nurse endured a police detective’s rough treatment, handcuffing, and threat of arrest to uphold her hospital’s policy of not allowing police to draw blood from a patient without an arrest, a search warrant, or the patient’s consent.

The incident is likely to spur hospital administrators to evaluate their policies surrounding police access to patients, said Jennifer Mensik, a nursing instructor at Arizona State University and vice president of continuing education for OnCourse Learning.

“I hear nurses all the time say it’s a lot easier not to argue with law enforcement and just draw blood,” Mensik said. “They don’t realize they are putting themselves at risk.”

The incident, captured by police officers’ body cameras, involved Alex Wubbels, a burn unit nurse at University of Utah Medical Center, refusing to let Salt Lake City Police Detective Jeff Payne draw blood from an unconscious patient who was severely burned in a car crash. During the encounter, Wubbels consulted via speakerphone with her supervisor, Brad Wiggins, who stated the hospital’s policy bars blood draws in such situations.

The U.S. Supreme Court ruled last year that police must obtain a warrant to test the blood of motorists suspected of drunken driving. In the Salt Lake City case, the patient, a reserve police officer, reportedly was driving a truck when his vehicle was struck head-on by a man in a pickup truck who was trying to evade police. He was not a suspect in any crime.

Mensik said police requests to draw blood from patients without an arrest, a warrant, or consent are common around the country. Nurses and emergency department staff often go along because they are busy or don’t know their hospital’s policy.

During the July 26 encounter, Wubbels, who’s worked at the hospital since 2009, calmly told Payne he couldn’t proceed with the blood draw. After Wiggins, the burn unit manager, said over the speakerphone that Payne was making a mistake by threatening a nurse, Payne is seen trying to swat the phone out of Wubbels’ hand, grabbing her by the arms, pulling her arms behind her back and handcuffing her.

“Help,” she screamed. “Help me. Stop. You’re assaulting me. Stop. I’ve done nothing wrong. This is crazy.”

Payne then strapped her into the front seat of his car. Another officer arrived and told her she obstructed justice.

“I’m also obligated to my patients,” she replied. “It’s not up to me.”

Wubbels was released without being arrested after hospital COO Dan Lundergan contacted police officials.

Wubbels and her attorney held a news conference last Thursday to describe the incident and play the 19-minute video taken from the officers’ body cams.

Salt Lake City Mayor Jackie Biskupski and Police Chief Mike Brown apologized on Friday for the conduct of Payne, who, along with another officer on the scene, reportedly has been placed on administrative leave. The police department, the district attorney, and the sheriff are conducting a criminal investigation into any misconduct that may have been committed by police during the incident.

Biskupski noted that Wubbles was “simply doing her job.”

“I just feel betrayed, I feel angry, I feel a lot of things,” Wubbles said during her press briefing. “And I’m still confused.”

Following the July 26 incident, the University of Utah Medical Center worked with the Salt Lake City police department to craft an agreement on how to handle police requests for blood draws and medical information from patients, said hospital spokeswoman Kathy Wilets.

Now, law enforcement personnel register at the hospital’s front desk and make their requests through hospital administrators rather than asking front-line providers directly.

Wilets called Wubbles a “rock star” for the way she stuck to hospital policy in that tense encounter with police. “We’re grateful to her. She put the needs of patients first and set a great example for everyone.”

Physician who claimed to have 11k patients sentenced to 35 years in prison

http://www.beckershospitalreview.com/legal-regulatory-issues/physician-who-claimed-to-have-11k-patients-sentenced-to-35-years-in-prison.html

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A 60-year-old Texas physician was sentenced Aug. 9 to 35 years in prison for orchestrating a $375 million healthcare fraud scheme, according to the Department of Justice.

Federal prosecutors said Jacques Roy, MD, and his cohorts used promises of cash, groceries and food stamps to recruit patients, including some of Dallas’ homeless, as part of the fraud scheme.

From January 2006 to November 2011, Dr. Roy’s office, Medistat Group Associates in DeSoto, Texas, handled more home healthcare visits than any physician’s office in the country. Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 home healthcare agencies for home health services during that time, according to the DOJ.

“A doctor cannot care for 11,000 patients at once,” Assistant U.S. Attorney P.J. Meitl said during the trial, according to The Dallas Morning News

In April 2016, Dr. Roy, who has lost his medical license, was found guilty on eight counts of healthcare fraud, two counts of making a false statement relating to healthcare matters, one count of obstruction of justice and one count of conspiracy to commit healthcare fraud. Three owners of home healthcare agencies were also convicted on various felony offenses.

In addition to his 35-year prison term, Dr. Roy was ordered to pay $268.15 million in restitution.