Monthly Newsletter

June 2023 Monthly Newsletter

Nurse Charged in Falsifying Patient Records

Medicaid Fraud Control Unit in Action

Registered nurse Patricia Lynn Nash of Michigan has been charged with 2 counts of falsifying medical records by intentionally placing false neurological assessment for a patient who later died.  These charges are both four-year felonies.  This case is being handled by the Medicaid Fraud Control Unit (MFCU) for Michigan.  Read more about this case.  Learn how to conduct internal forensic healthcare investigation audits, and/or auditing for healthcare compliance.

AHRQ Grantee Testing AI

Agency for Healthcare Research & Quality (AHRQ)

AI Use in Breast Cancer Screening Accuracy and Efficiency
AHRQ funding will test whether artificial intelligence (AI) algorithms can improve the overall accuracy of the breast cancer screening process, make workflow more efficient and help improve the patient experience. Based on the algorithm’s review, the exam may be flagged as suspicious for immediate review by a radiologist to determine whether further diagnostic examination is needed, all while the patient is still at the clinic.

While breast cancer screening has helped reduce U.S. patient deaths by nearly 40 percent since 1990, the screening process can be inefficient and linked to harms such as false positives and overdiagnosis. We are still experiencing 1 in 10 women undergoing breast cancer screening will get news that a screening mammogram shows abnormal findings requiring further examination. Read more about this groundbreaking research.

OIG Alert – Fraud Aimed at Native American Communities

Phony Sober Living Home Scam

The Office of Inspector General has issued a public fraud alert regarding activities targeting members of the Native American communities. The scam involves behavioral health outpatient treatment centers or “OTCs”.  Perpetrators masquerade as healthcare providers, offering fake medical services or treatments, while simultaneously stealing personal information and medical identities. They then fraudulently bill for services that were never provided.

These homes are actually fronts for illegal activities, posing a significant risk to individuals seeking help. In addition, Native Americans are falling victim to schemes involving trafficking and healthcare fraud. Click Here to learn more and how to report any information regarding these activities.

$5.7 Million Paid to Resolve Alleged Stark Law Violations

Whistleblower Reveals Physician Self-Referral Law Allegations Involving Compensation of 44 Massachusetts Eye and Ear Physicians 

Physician Self-Referral Law (sometimes referred to as the Stark Law), prohibits physicians from referring patients to receive “designated health services” payable by Medicare from entities, like hospitals, with which the physician has a financial relationship, unless the arrangement falls into the exceptions provided for by law. It also prohibits the entity from billing Medicare for those services. The law is intended to ensure that physicians’ medical judgments are not compromised by improper financial inducements. 

Massachusetts Eye and Ear has agreed to pay over $5.7 million to resolve allegations of violating the physician self-referral law.  The government’s investigation was prompted by False Claims Act allegations brought in a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act.  Read more about this case. Learn more about Stark Law and other potential compliance issues – take the online Corporate Compliance course w/online certification.

Conviction of Healthcare Marketer for Illegal Kickback Scheme

Medicaid Fraud Control Unit, OIG and FBI in Action

Patrick Osemwengie of Texas has been convicted for his role as part of a larger home health conspiracy that resulted in $17.7 million in fraudulent Medicare and Medicaid billings.

Osemwengie illegally sold patient referrals to Grace Healthcare and Ebra Home Health Services, whose owners pleaded guilty to charges stemming from this investigation. Osemwengie charged $500 for new patients and $250 for recertifications. The home health providers then billed Medicare and Medicaid for home health services that were never provided. Several recipients have confirmed that Osemwengie paid them kickbacks to sign up for home health services. Other recipients were prevented from receiving genuinely needed home health services because of the scheme.  Read more about this case.

Unlawful Disclosure of PHI Settles for $350,000 with OCR

MedEvolve, Inc. (“MedEvolve”) is a business associate, as defined under 45 C.F.R. § 160.103.  In a recent report released by the Office for Civil Rights (OCR), the government’s HIPAA enforcement agency, the investigation found that MedEvolve’s FTP server containing electronic protected health information (ePHI) was openly accessible to the internet. The information included patient names, billing addresses, telephone numbers, primary health insurer and doctor's office account numbers, and in some cases Social Security numbers.  OCR states that network servers are the largest category, by location, for breaches involving 500 or more individuals.

Findings include lack of an analysis to determine risks and vulnerabilities to ePHI across the organization, and the failure to enter into a business associate agreement with a subcontractor.  MedEvolve has paid a $350,000 monetary settlement to OCR and agreed to implement a corrective action plan which identifies steps MedEvolve will take to resolve the situation.  Click Here for more information.

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