Ohio lawmaker wants changes in Medicaid payments to nursing homes - July 28, 2010
A local state lawmaker is trying to change a new Medicaid payment system that has caused companies to close, others to lay off employees and, more alarmingly, is hurting nursing home patients who need services such as ventilators, dialysis or custom wheelchairs.

UnitedHealth to stop dropping policies of sick - July 20, 2010
UnitedHealth Group Inc said on Wednesday it would immediately stop terminating healthcare coverage for policyholders after they become ill, to comply with a new healthcare law months ahead of schedule.

Houston Medical Equipment Company Owner, Operator and Patient Recruiter Plead Gu - July 20, 2010
Houston–area residents Doris Vinitski and John Lachman pleaded guilty today in connection with their roles in a durable medical equipment Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.

3 charged in Medicare fraud scheme - July 20, 2010
Federal agents charged three men Friday with billing Medicare for at least $2.9 million of phony physical therapy, in what officials say is a new version of health care fraud in South Florida.

Brooklyn Park home care provider admits to scamming Medicaid - July 20, 2010
A Brooklyn Park home health–care provider for low–income clients pleaded guilty to paying kickbacks to lure referrals to his company as part of a scheme to obtain hundreds of thousands of dollars in fraudulent Medicaid reimbursements.

Pennsylvania Medicaid Waste Estimated at $1/4 Billion a Year - July 20, 2010
A new state government report shows fraud in Pennsylvania’s Medicaid program may have cost taxpayers more than $1 billion over the past four years—more than three times what the state had previously reported.

Hospitals Probed Over Bid-Rigging - July 20, 2010
Federal prosecutors are investigating allegations that bid rigging and fraud at Mount Sinai Medical Center and New York–Presbyterian Hospital resulted in the hospitals awarding contracts worth tens of millions of dollars to outside contractors.

Two Plead Guilty in Texas to Health Care Fraud, Illegal Health Care Kickbacks - July 20, 2010
Houston–area residents Doris Vinitski and John Lachman pleaded guilty today in connection with their roles in a durable medical equipment Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.

Florida House set to vote on Medicaid overhaul - July 19, 2010
A massive overhaul that would put most of Florida's 2.7 million Medicaid participants in private managed care plans cleared the state House on Monday.

Data aids Medicaid detectives - July 19, 2010
State investigators are collecting millions more dollars each year as they catch more Medicaid fraud and mistakes, but it’s not always in the way you might think.

VA audit turns up concerns - July 18, 2010
Truman Memorial Veterans’ Hospital is taking steps to improve several deficiencies cited in a recent report by the Office of the Inspector General.

Investigation Finds Gap Between Hospital Expenditures, Billing - July 18, 2010
Between September 2008 and October 2009, California hospitals charged health insurers an average of 53% more than the amount they reported that it cost them to provide services to insured patients, according to a Sacramento Bee investigation.

Lawmakers launch bipartisan effort against Medicare Fraud - July 18, 2010
Two South Florida lawmakers on opposite sides of the political fence have introduced a bill designed to fight the $1 billion Medicare fraud problem.

US House bill to double Medicare fraud penalties - July 18, 2010
Medicare fraud suspects would face longer prison sentences under a U.S. House bill proposed Tuesday that also advocates biotechnology such as fingerprint scanning to ensure patients are getting the goods the government is billed for.

South Florida lawmakers unite to fight Medicare fraud - July 18, 2010
Facing a room packed with Miami senior citizens, two South Florida congressional members from opposing parties took the remarkable step of jointly backing new legislation aimed at ridding the region –– and nation –– of a multibillion–dollar scourge: Medicare fraud.

OIG: No More Identical Claims NPIs - July 18, 2010
Along with the list of items the HHS Office of Inspector General has said it will examine this year in the DME sector, its latest report turns attention back to what the OIG calls a “claims processing vulnerability.”

Obama Issues Hospital Directive - July 18, 2010
Presidential memorandum requires action on LGBT hospital visitation, other steps by Department of Health and Human Services.

Two Houston-area Residents Convicted in Medicare Fraud Scheme Involving Fraudule - July 18, 2010
A federal jury in Houston today convicted Helen Etinfoh, 50, and Paula Whitfield, 43, for their roles in a Medicare fraud conspiracy involving, among other things, fraudulent claims of hurricane damage to power wheelchairs, announced the Departments of Justice and Health and Human Services (HHS).

Los Angeles Business Owner Pleads Guilty to Submitting Nearly Half a Million Dol - July 18, 2010
The owner and operator of a Los Angeles durable medical equipment (DME) company pleaded guilty today to submitting nearly one half of a million dollars in false claims to Medicare, announced the Departments of Justice and Health and Human Services.

Detecting and preventing Medicare fraud - July 18, 2010
Medicare fraud is purposely billing Medicare for services that were never provided or received. Why should we care? The answer is very simple: Medicare fraud is costing the government billions of dollars per year.

Rome couple accused of $30 million Medicare and Medicaid fraud - July 17, 2010
While residents in their nursing homes suffered, a Rome couple is accused of using more than $30 million worth of federal funds to buy real estate and fancy cars, according to the U.S. Attorney's Office.

Delayed Compliance with New Regulations Has Increased Data Breaches and Medical - July 17, 2010
National survey shows 85 percent of hospitals are not compliant with the HITECH Act; 41.5 percent have 10 or more breaches annually; and possible ID fraud going uninvestigated.

"Meaningful use" takes time (HIMSS 2010 conference) - July 17, 2010
For more than a year, there's been a "hurry up and wait" attitude toward adoption of health information technology, as many doctors delayed buying electronic medical record systems until they got details on how their practices could earn incentive pay for use.

Investigators Tout Fraud Convictions In California, Florida And New York - July 17, 2010
Authorities are crediting their Medicare and Medicaid fraud initiatives for convictions and guilty pleas in California, Florida and New York.

Beltline Medical Supplies owner sentenced for Medicare fraud - July 17, 2010
The owner of a Dallas medical supplies company has been sentenced to 24 months in jail by a federal court for making false claims to Medicare, according to the U.S. Attorney’s office for the Northern District of Texas.

Get Your Compliance Program in Shape to Avoid, Defend Against Auditors - July 17, 2010
Whistleblower lawsuits and multimillion dollar Medicare fraud settlements involving otherwise reputable hospitals and health systems are becoming standard media fodder on the Department of Justice Web site.

Medical supplier sentenced to prison for motorized wheelchair scam - July 17, 2010
U.S. Attorney John M. Bales announced that the owner of a medical supply business has been sentenced to federal prison for federal health care fraud violations in the Eastern District of Texas.

Braintree man convicted of $1.5M Medicare fraud - July 17, 2010
A federal jury convicted a Braintree man on April 9 of defrauding Medicare of $1.5 million during a one–year period.

Health law will be costly for Floridians - July 17, 2010
The nation's new health care law represents a monumental series of missed opportunities. Instead of lowering the cost of health care for Americans, this law will increase costs.

Los Angeles Business Owner Pleads Guilty to Submitting Nearly Half-a-Million Dol - July 15, 2010
The owner and operator of a Los Angeles durable medical equipment (DME) company pleaded guilty today to submitting nearly one–half of a million dollars in false claims to Medicare, announced the Departments of Justice and Health and Human Services.

Medicare's fraud hot line begins to root out billing scams - July 15, 2010
Medicare has stepped up its anti–fraud efforts with a Florida consumer hot line that helps the federal program root out scams and refer tips to law enforcement.

Families allege poor care at facility - July 14, 2010
The families said they were moved to speak after Wednesday's arrests of 14 staff members at the nursing home. The workers were charged with endangering the welfare of residents and falsifying records as a result of a hidden–camera investigation by state Attorney General Andrew Cuomo.

Group to petition over bill's cuts in Medicare payments - July 14, 2010
The recently signed health care bill will reduce reimbursement to physicians by 21 percent. Physicians are saying they cannot handle any more reduction in their return. Among other problems, King said reimbursements from many managed care contracts are tied to Medicare reimbursements, meaning they also will go down.

To help pay for reforms, Medicare fraud ripe for plucking, top South Florida pro - July 13, 2010
Democratic party leaders have pledged to pay for the new $940 billion health care reform law, in large part, by eliminating $500 billion in waste and fraud in Medicare over the next decade. Miami will almost certainly be their first stop.

Here we go again: Candidates pledge to search for 'waste, fraud and abuse' - July 13, 2010
Meg Whitman will "root out fraud" and "cut wasteful spending." Carly Fiorina wants to eliminate "the billions of dollars of waste and bloat that sits in our federal budget."

Here we go again: Candidates pledge to search for 'waste, fraud and abuse' - July 13, 2010
Meg Whitman will "root out fraud" and "cut wasteful spending." Carly Fiorina wants to eliminate "the billions of dollars of waste and bloat that sits in our federal budget."

Burtonsville-based business owner guilty of fraud - July 13, 2010
A Burtonsville–based business owner pleaded guilty last week to fraudulently billing Medicaid, Medicare and private insurance companies for wheelchairs he never provided, according to Raquel Guillory, spokesperson with the state's Attorney General office.

Make Medicaid better - July 12, 2010
Florida Attorney General Bill McCollum contends it's unconstitutional for the federal government to require Americans to buy health insurance, one of the key elements of the new national health–care plan. The courts will have to make that call.

N.C. and IBM team up to ferret out Medicaid fraud - July 12, 2010
Gov. Bev Perdue announced an effort Wednesday to track down Medicaid fraud by creating a partnership with IBM to discover abuses by patients and their health care providers.

South Florida is 'open territory' for organized crime - July 11, 2010
Ever since Al Capone bought a mansion on Miami's Palm Island in 1928, South Florida has been a destination for organized–crime figures who want to relax and do a little business.

Medicare fraud found in solicitations for wheelchairs - July 11, 2010
The Department of Justice announced in its press release today the federal court issurance of an order on March 25 which sentenced Leonard Nwafor, 44, to serve nine years in prison for Medicare fraud.

Health Care Reform: A Human Issue -- Not A Political Issue - July 11, 2010
"The anticipation is unbearable...! I hope it lasts." Those were the words spoken by Gene Wilder as the chocolatier Willie Wonka, from the words written by the children's book author and former M–5 agent, Raold Dahl. There are some who feel that way about health care reform. Properly crafted messages made it quite divisive.

Medicare audits to be expanded - July 11, 2010
Obama directs all federal agencies to intensify claims review in a fraud–fighting effort. A separate proposal for physicians to pose as patients prompts AMA concerns.

Government's RAC audits may be a goldmine for Murfreesboro's ClaimTrust - July 11, 2010
The federal government is taking a sharper look at Medicare spending, and a Murfreesboro company is trying to make sure that health care providers are ready.

House approves measure to combat Medicaid fraud - July 11, 2010
Maryland's attorney general moved a step closer to collecting more civil damages in Medicaid fraud cases as the House of Delegates approved a measure Friday that cracks down on false medical claims.

Parkland drug thefts spark federal investigation - July 11, 2010
Federal authorities are investigating a years–long series of drug thefts at Parkland Health & Hospital System that put hundreds of thousands of painkillers and tranquilizers in the hands of street dealers, The Dallas Morning News has learned.

Cape Cod Hospital cited in death by restraint - July 11, 2010
State investigators have cited Cape Cod Hospital for a federal violation of patient rights in the case of a Mashpee man who died after being restrained by hospital staff last year.

ClaimTrust Announces Its New RAC Resource Center - July 11, 2010
ClaimTrust®, a leading provider of revenue cycle tools and services for hospitals, today announced its new Recovery Audit Contractor (RAC) Resource Center, which will provide hospitals with useful resources, information and tips that will help them prepare staff and infrastructure for RAC record requests, demand letters and appeals.

What’s in the Health Care Bill for Medicare: Part 2 - July 11, 2010
A tax increase and lower payments to Medicare Advantage plans are expected to cut the Medicare budget by $400 billion over ten years. I found a summary of provisions on the Kaiser Family Foundation website.

Discussion of Medicare's 'Competitive' Bidding Program for Home Medical Equipmen - July 10, 2010
Medicare has been touting the merits of the "competitive" bidding program for durable, or home medical equipment and services (HME) to convince Congress that the program is good for seniors. Unfortunately, proponents have conveyed misleading information and cherry–picked facts that exaggerate the benefits and ignore the severe shortcomings of the program.

North Carolina Home Medical Equipment Providers Travel to Washington to Advocate - July 10, 2010
Home medical equipment service providers from seventeen North Carolina–based companies travelled to Washington, D.C. last week to urge members of Congress to support new legislation that will strengthen homecare availability for millions of older Americans and people with disabilities who require home–based medical equipment and services.

Houston man convicted in $1 million adult diaper scam - July 10, 2010
The former co–owner of a Houston a durable medical equipment company has been convicted of bilking Medicaid of nearly $1 million in a scheme involving adult diapers, federal authorities said.

Health Care Bill Cracks Down on Abuses by Charitable Hospitals - July 10, 2010
Non–profit hospitals receive a special tax exemption in return for providing community service and charitable care. However, critics say some charitable hospitals rake in millions of dollars a year while providing very low levels of assistance to the poor and uninsured. Because the uninsured don't have the government or large insurance companies to negotiate payment rates on their behalf, patients often have to pay the full "sticker price" for medical services.

Analysis: How safe are Washington hospitals? - July 10, 2010
Seattle's Virginia Mason Medical Center is the safest hospital in Washington. That conclusion –– based on a computer analysis of patient treatment records at all hospitals in the state –– didn't surprise anyone in the healthcare business.

Maryland Hospital Association, lawmakers reach Medicaid fraud agreement - July 10, 2010
The Maryland Hospital Association struck a deal with state lawmakers and health care officials late last week that could help clear the way for a bill giving the state greater authority to find and penalize those who commit Medicaid fraud in Maryland.

Rai$ing the dead in Medicaid 'rip-offs' - July 10, 2010
A massive state audit claims that health–care providers billed Medicaid for services provided to 287 dead patients.

Nursing home staff face patient abuse counts - July 08, 2010
Fourteen nurses and aides at the Northwoods Rehabilitation and Extended Care Facility outside of Troy were charged Wednesday with endangering the welfare of an elderly resident, plus felony falsification of business records and multiple misdemeanor violations of the public health law.

Review heightens concerns over Medicare billing at nursing homes - July 08, 2010
More than a decade ago, Congress set out to squeeze the fraud out of Medicare billing at nursing homes, requiring more precise justifications for costs. It created new "ultra–high" billing categories intended to be used for only 5 percent of the patients needing highly specialized care and rehabilitation.

Detroit-Area Physical Therapist Sentenced to 62 Months in Prison for Role in Med - July 08, 2010
Sterling Heights, Mich., resident Solomon Nathaniel was sentenced today to 62 months in prison for his role in a wide–ranging conspiracy to defraud the Medicare program, announced Assistant Attorney General Lanny Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI's Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services, Office of Inspector General's (HHS–OIG) Chicago Regional Office.

Medicare payments for physical therapy have poor prognosis - July 05, 2010
With healthcare legislation stalled in Washington, a cap on coverage may leave a half–million patients to shoulder the financial burden or give up on treatment.

Seattle physical therapist charged with abusing patients - July 05, 2010
A Swedish Medical Center physical therapist is facing sex crime charges following allegations that he improperly touched two patients. In charging documents, King County prosecutors contend that Michael James Shannon, 38, groped two patients, telling each that the contact was part of their therapy.

The largest Medicare fraud ever in the nursing home industry? - July 04, 2010
Yesterday's Washington Post cites SEIU's role in discovering a possible case of Medicare fraud by California–based nursing home company North American Health Care (NAHC), which operates 35 nursing homes in four states. According to SEIU's research, confirmed by the Washington Post, NAHC may be falsifying patient records and overcharging Medicare by tens of millions of dollars each year.

Athletic club remains open after charges - July 04, 2010
Between 2004 and 2006, it is alleged that Rehab One, a chiropractic and rehabilitation facility inside the club, and Rehab Two, a gym located in the basement of Levin’s home, fraudulently billed Independence Blue Cross approximately $1.9 million for procedures that were either not medically necessary.

Houston Defendants Plead Guilty to “Arthritis Kit” Medicare Fraud Scheme - July 04, 2010
Mitchell–Straughter, 43, and Quinteros, 28, each pleaded guilty before U.S. District Court Judge Gray Miller in the Southern District of Texas to conspiracy to commit health care fraud. Mitchell–Straughter was an administrative assistant at two Houston–area durable medical equipment (DME) companies.

American Association for Homecare Alarmed by Provisions in Health Reform Law tha - July 04, 2010
The American Association for Homecare expressed alarm about provisions in the new health reform law that will harm homecare patients and providers. The cumulative impact of the provisions aimed at the home medical equipment sector will reduce the ability to provide the level of services that homecare patients and physicians expect in Medicare.

Rehab center may lose options - July 04, 2010
The skilled nursing facility at Bingham Memorial Hospital may lose payment options through Medicare and Medicaid if he facility fails to come into compliance with federal guidelines.

Fix health care - First ferret out the crooks who make present system so expensi - June 21, 2010
The continuing increase in the cost of health care is damaging to all of us. In our current economy many of us worry whether we will be able to afford the health care our families need in the event of everyday sickness or catastrophic illness. While there may be valid reasons for many of these increases purposed by our insurance carriers, much of the increased cost of health care can be attributed to simply greed.

State candidate suggests adding (another) waste hotline - June 21, 2010
Rebecca Kleefisch, the former TV newswoman–turned–political candidate, says Wisconsin should follow the lead of other states by creating a hotline so public employees and concerned citizens can report abuse and fraud in state government.

Whistleblower Kickback Case Against Alpharma Results In $42.5 Million Recovery f - June 20, 2010
Alpharma Inc. has agreed to pay $42.5 million to the federal government and certain states to settle a whistleblower lawsuit that exposed an alleged kickback scheme by the pharmaceutical company to boost its sales of Kadian, a prescription painkiller.

Obama announces attack on Medicaid, Medicare abuses - June 14, 2010
President Barack Obama announced Wednesday a new federal initiative aimed at recouping some of the billions of dollars estimated to be lost each year to Medicare and Medicaid fraud.

Proposed law targets Medicaid fraud - June 14, 2010
A bill introduced in the Florida Legislature would give the state’s attorney general more powers to fight Medicaid fraud.

White House Announces Plan to Crack Down on Medicare Fraud - June 10, 2010
President Obama announced a new effort to crackdown on waste and fraud in Medicare and Medicaid and other programs through expanded use of payment recapture audits.

White Hall nursing home faces state fine - June 10, 2010
A White Hall nursing home is in line for a $35,000 state fine after a February survey of the facility concluded there were deficiencies in care, including the death of a resident who suffered from septicemia.

CIGNA's Intracorp Earns Full Accreditation from URAC for Case Management and Uti - June 10, 2010
Intracorp has earned full accreditation from URAC for the company's case management and utilization management programs. The accreditations, which are effective for three years, recognize the quality of these programs.

Three nursing homes fined for serious deficiencies - June 10, 2010
Three Syracuse area nursing homes have been fined for deficiencies that regulators say harmed patients.

How Much Fraud and Abuse Is There in U.S. Health Care? - May 16, 2010
One of the more remarkable proposals put on the table at last week’s bipartisan summit on health care reform was an idea from Senator Tom Coburn, an Oklahoma Republican, to deploy undercover agents posing as patients in an effort to ferret out fraud and abuse by doctors and hospitals.

Power wheelchair supplier convicted of fraud - May 16, 2010
The owner of a durable medical equipment (DME) supplier was properly convicted and sentenced for health care fraud because she submitted false prescriptions for power wheelchairs on behalf of Medicare beneficiaries, provided those beneficiaries with power scooters which were less expensive than power wheelchairs, and pocketed the substantial cost difference between the two.

CERT Report Uncovers CMS Problems; OIG Studies RAC Results - May 16, 2010
New medical record review methodologies, not fraud, helped pump up the DME MAC error rate to 51.9 percent in 2009, CMS said in a recent Comprehensive Error Rate Testing report.

Logicworks Compliance Cloud Offers Effective Solution for Hosting Healthcare App - May 16, 2010
Today, Logicworks announced hosted and private cloud solutions that address the compliance concerns of companies doing business in highly regulated industries, including new private cloud customer nextEMR. The offering is a breakthrough for the growing number electronic medical records (EMR) and electronic health records (EHR) companies with its shared nothing architecture with built–in advanced security.

Tampa police say staged crashes on the rise - April 29, 2010
Baez was one of the hundreds of people arrested statewide last year in staged crashes; most incidents were in South Florida, but police say staged crashes are increasing in Tampa.

Tampa police say staged crashes on the rise - April 29, 2010
Baez was one of the hundreds of people arrested statewide last year in staged crashes; most incidents were in South Florida, but police say staged crashes are increasing in Tampa.

Five Ways Health IT Leaders Can Fight Medicare Fraud - April 29, 2010
Fair warning to health IT professionals: Harry Markopolos, the man who infamously warned the government that Bernie Madoff was up to something fishy, is setting his sights on Medicare fraud. And the first place he'll look for evidence is in your system's e–mails, documentation, and databases.

Justice Officials Push for Expansion of Health Care Strike Forces - April 29, 2010
With Congress shifting its attention to the fiscal 2011 budget, Justice Department officials on Thursday made a case for more resources to tamp down on health care fraud.

Medicaid fraud plan under fire from Maryland businesses - April 29, 2010
Gov. Martin O’Malley’s plan to recoup millions of dollars lost each year in Medicaid fraud — one of his top legislative priorities in an election year — faces stiff opposition from health care professionals and business lobbyists who hold clout in Annapolis and sway with large chunks of voters.

Miami Medicare fraud scheme and threats lead to prison - April 29, 2010
A Hialeah medical equipment supplier who owned two pharmacies is headed for prison for not only bilking Medicare, but also for threatening a fraud investigator and government official.

Three plead guilty in Houston Medicare fraud case - April 29, 2010
The owner and two employees of a Houston medical supply company pleaded guilty in federal court today for bilking the government out of almost $1 million in fraudulent claims.

Prominent New York City Real Estate Investor, Attorney and Atlanta Nursing Home - March 17, 2010
Two prominent figures in the New York City real estate market, a Long Island associate and two Atlanta–based nursing home chains have paid the federal government and certain state Medicaid programs a total of $14 million to settle a whistleblower lawsuit alleging Medicare and Medicaid fraud involving a kickback and a cover–up.

Discount health plan firm accused of fraud - March 17, 2010
State regulators on Monday cracked down on an Arizona company that issued discount health plan cards to California consumers, accusing the firm of fraudulently claiming the products being sold were insurance and offering services that didn't exist.

Two San Diego Men Plead No Contest to Workers' Comp Fraud - March 17, 2010
David Wayne Fish of San Diego and Birger Greg Bacino of Rancho Santa Fe, Calif., have plead no contest to felony charges of compensation or inducement for referring clients for profit in a workers' compensation scheme and agreed to release $60 million in medical liens and bills prior to entering their plea.

Does HIPAA really protect your privacy? - March 17, 2010
From social security numbers to details about personal medical procedures, the risk of your private information going public could be on the rise. While the federal law HIPAA is meant to protect your privacy, we’ve uncovered why the law may be falling short and what you can do if you feel your privacy has been violated.

New Lumension Webcast Highlights Key Steps to Prepare Healthcare Firms and Busin - March 17, 2010
Expert Outlines how Healthcare Entities Secure Electronic Protected Health Information and Ensure Data Privacy and Security Regulations under HITECH Compliance.

New HIPAA Regulations Drive Demand for Accellion Managed File Transfer - March 17, 2010
With stricter HIPAA privacy regulations introduced this week, it is more important than ever for healthcare organizations to demonstrate they conform to the law.

Seattle physical therapist restricted from treating females - March 15, 2010
The license of a Seattle physical therapist has been immediately restricted by the Board of Physical Therapy and the state Department of Health. Michael J. Shannon (PT60014317) is accused of inappropriately touching two patients during treatment sessions.

Proposed budget cuts to senior care would hit families - March 15, 2010
Gov. Arnold Schwarzenegger has proposed cutting $104 million from the 2010–2011 budget by eliminating adult day health care services beginning March 1. If the cuts to the $76 daily Medi–Cal reimbursements, which provide the majority of the program's funding, are approved, roughly 37,000 people would lose services by June.

Medicare settlement costs Mercy nearly $3 million - March 15, 2010
Three years after the hospital brought the violations to the federal government's attention, Mercy Medical Center has agreed to pay nearly $3 million to settle claims it violated the False Claims Act in connection with a number of Medicare cases.

Jackson Health System union wants probe into 'mismanagement' - March 15, 2010
Facing the possibility of widespread layoffs, the Jackson nurses union came out swinging Thursday –– demanding a grand jury investigation into "gross mismanagement that has caused the public hospital to teeter on financial ruin and that is putting patients at risk.''

Nursing home owners have had prior trouble - March 15, 2010
The Villa Campana Health Care Center – a Tucson nursing home featured in today's Arizona Daily Star – is owned by a corporation that has been the subject of scrutiny by government officials before.

Ex-Hospital Execs Pay Big Fine In Skid Row Scam - March 13, 2010
They were accused of recruiting the homeless on Skid Row for unnecessary medical treatments and then fraudulently billing the Medicare and Medi–Cal systems. Now the two former hospital executives must pay a $10 million fine to the federal government.

Local agency teams with state to warn of Medicare fraud - March 03, 2010
The local Area Agency on Aging District 7 is teaming with the Ohio Department of Aging to educate the public about Medicare fraud and how to prevent it.

New Fraud Efforts By New York Office of Medicaid Inspector General May Hinder It - March 02, 2010
In fiscal year 2009, New York state exceeded the amount of recovered improper third–party liability payments federally mandated under the Federal–State Health Reform Partnership (F–SHRP).

Medicare anti-fraud rule disrupts South Florida senior care - March 02, 2010
The new rule caps how much home–care companies can make from Medicare patients who need more than one visit a day. The change prompted the family of Jacbobson's patient to move him, out of fear that his home–care company would drop him.

Offshore HIPAA Business Associates Pose Extra PHI Risks, but Have Incentives to - March 02, 2010
As providers move to cut operational costs, many are taking their business associate (BA) dealings offshore. And while sending protected health information overseas can be a risky endeavor for patients and health care organizations, one expert says the process has built–in safeguards.

Va. Senate passes mandated autism coverage - March 02, 2010
Legislation that would compel insurers to pay for expensive but effective treatments for children with autism won overwhelming passage Tuesday in the state Senate despite opposition from mighty insurance and business lobbies.

Home Health Agency Owner Pleads Guilty in Connection with Detroit Fraud Scheme - March 02, 2010
Detroit–area resident Muhammad Shahab pleaded guilty today for his role in organizing a Detroit–area home health care fraud scheme.

Medi-Cal Fraud Hurts All Californians - March 02, 2010
Medi–Cal fraud costs everyone –– legitimate businesses, and patients who need services and taxpayers all pay. The Department of Health Care Services estimates in 2007, $400 million in claims may have been fraudulent.

Ex-Darnall therapist suspected in assault - February 28, 2010
A former physical therapist assistant at Carl R. Darnall Army Medical Center at Fort Hood is suspected of following a patient home and sexually assaulting her.

Rehab service providers brace for TennCare cuts - February 28, 2010
Hospitals aren’t the only health care providers bracing for effects to their bottom lines from changes planned to TennCare.

UTMB says former patients' data possibly stolen - February 27, 2010
Confidential information about 1,200 University of Texas Medical Branch patients may have been stolen last year.

Avenues to correct medical billing problems - February 26, 2010
There are several state and nonprofit organizations that can help patients who feel they are victims of mistakes.

Technology can slash fraud in health care - February 26, 2010
Emdeon Inc. processes nearly half of all commercial medical claims nationwide, giving the Nashville–based company a bird's–eye view of billing and other health–care trends.

Feds to investigate allegations state hindered Medicaid fraud investigations - February 26, 2010
The U.S. Centers for Medicare & Medicaid Services (CMS)’s Medicaid Integrity Group intends to investigate allegations the Human Services Department (HSD) hindered Medicaid fraud and elder abuse investigations by the New Mexico Attorney General’s Medicaid Fraud & Elder Abuse Division, CMS spokeswoman Mary Kahn told The Independent.

The New ERISA Overpayment Appeals And Anti-Fraud Services Announced For Healthca - February 26, 2010
In Light of Increasing Frivolous And Debilitating Overpayment Refund Demand From Payers, ERISAclaim.com Announced The Nation's First ERISA Overpayment Appeals and Anti–Fraud Services to Help Healthcare Providers to Effectively Appeal All Alleged Overpayment Denials in Essence of Retrospective Benefits Denials and Increase Fraud and Abuse Prevention Compliance, As Federal Law ERISA Governs All Denials of Benefits From ERISA Plans and Prohibits Fraudulent Interference with ERISA Rights.

Many Small Practice Physicians Putting off Meaningful Use Guidelines - February 25, 2010
For many physicians in small office practices, the thought of adopting electronic medical records to meet federal "meaningful use" guidelines and timelines is a daunting one at best.

Does Anybody Care About HIPAA Anymore? - February 25, 2010
HIPAA got a big boost from the 2009 HITECH act, which extended privacy rules to business partners, threatened steeper penalties for violations, and promised periodic audits. But even with the beefed–up rules, these days HIPAA just doesn't seem to be that big a priority—to anyone.

Study shows how Medicare rewards MDs for overuse - February 25, 2010
Medicare's move in 2005 to pay doctors to do bladder cancer surgery in their offices rather than in hospitals dramatically raised the number of procedures and overall health costs, U.S. researchers said on Monday.

Hospital association opposes Medicaid fraud bill - February 17, 2010
The Iowa Hospital Association is opposing legislation that would provide Iowans with a financial incentive to report suspected Medicaid fraud.

Marlborough woman's Medicare fraud trial postponed to June - February 16, 2010
The California trial of a Marlborough woman accused of participating in a $4.6 million Medicaid fraud case, originally scheduled for last week, has been pushed back to June.

Detroit Clinic Manager Sentenced to 63 Months in Prison for Role in $2.3 Million - February 16, 2010
U.S. District Judge Ursula Ungaro in the Southern District of Florida also ordered Briceño to pay $1.8 million in restitution. Briceño was originally charged by indictment in the Eastern District of Michigan, but after her arrest in Miami, she consented to have her case transferred to the Southern District of Florida for her plea and sentencing.

Atricure to Pay U.S. $3.76 Million to Resolve Medicare Fraud Allegations - February 05, 2010
Atricure Inc., a medical device manufacturer, has agreed to pay the United States $3.76 million to resolve civil claims in connection with the alleged promotion of its surgical ablation devices.

Protection from prying eyes: Physician Medicare data stays confidential - February 05, 2010
A federal appeals court ruled against a company's request for Medicare claims data, saying that would violate a 31–year–old injunction against revealing individual payment information.

Los Angeles Business Owner Pleads Guilty to Submitting Nearly $1 Million in Fals - February 05, 2010
The owner and operator of a Los Angeles durable medical equipment (DME) company pleaded guilty today to submitting nearly $1 million in false claims to Medicare.

Citizens can police Medicare fraud - February 03, 2010
Billions of dollars are lost each year nationally to fraudulent Medicare and Medicaid claims. If only legitimate claims were paid, the savings could help pay for health care reform. The federal government has been unable to effectively police against such fraud –– but private citizens can make a difference.

Technosoft Corporation Announces General Availability of Healthcare IT Complianc - February 02, 2010
Technosoft Corporation a growing global provider of IT and Business Process services, today announced the availability of its Healthcare IT Compliance Services to address Healthcare entities' most pressing Healthcare Compliance planning, implementation and execution challenges.

Belmont woman to be sentenced in theft, Medicaid fraud case - February 02, 2010
A Belmont woman who provided personal care services for an elderly woman and was charged with stealing from her is expected to ask a judge to allow her to pay restitution and serve no jail time under the terms of a plea deal.

Medicaid fraud in Florida highest for home health services - February 02, 2010
Florida recovered hundreds of millions in fraudulent Medicaid payments, but that was probably still only a fraction of the total, according to an annual report released Jan. 7 by the Florida Agency for Health Care Administration.

State lifts probation for Lancaster Manor Rehabilitation Center - January 31, 2010
Lancaster Manor Rehabilitation Center –– the nursing home formerly known as Lancaster Manor –– is no longer on probation.

Panel suggests nursing and rehabilitation center sale - January 31, 2010
Butler County should sell its cash–bleeding nursing home or turn over its management to another operator, a committee told county commissioners Wednesday.

County nursing home seeks to replace therapists - January 31, 2010
The Cayuga County Nursing Home wants to replace its independently contracted therapy services with a private rehabilitation service provider because the IRS told the agency its therapists too closely resemble employees.

Fraud charges dropped, but doctor can't recoup costs - January 31, 2010
They say you can't fight city hall. A recent federal appeals court ruling shows just how difficult it is for physicians to take the government to task.

Connecticut sues Health Net over data security breach - January 31, 2010
Connecticut Attorney General Richard Blumenthal has filed a lawsuit against California–based Health Net, alleging the company violated federal laws protecting medical records when a portable data drive disappeared.

Docs to FTC: Change Red Flags Rule - January 31, 2010
The American Medical Association, American Dental Association and American Veterinary Medical Association have jointly written to Federal Trade Commission members asking that health professionals be excluded from the Red Flags rule.

‘Loose Lips’ Can Get HIPAA Covered Entities in Trouble, Now That Verbal Gaffes M - January 31, 2010
The caseworker probably thought she was doing the right thing by sharing with the patient’s daughter that the woman had become increasingly paranoid. But when the daughter confronted the mother with knowledge of her decline, the mother was rightfully outraged — the daughter was not authorized to receive protected health information about her.

Couple Indicted in $1.8 Million Health Care Fraud Scheme - January 30, 2010
United States Attorney John E. Murphy announced that a Federal grand jury in San Antonio this afternoon returned a 12–count indictment charging a San Antonio couple in connection with an alleged estimated $1.8 million health care fraud scheme.

Texas Medical Supply Company Manager Pleads Guilty to Health Care Fraud Charges - January 30, 2010
Manual Deluna has pleaded guilty to one count of conspiracy to commit health care fraud, announced Assistant Attorney General Lanny A. Breuer of the Criminal Division.

Most claims for power wheelchairs don't meet Medicare criteria - January 30, 2010
An oversight report cites $112 million in improper payments. But a medical device association says the problem lies in documentation complexities.

AG’s office wants direct access to state Medicaid data - January 30, 2010
The state’s stonewalling of the Attorney General’s Medicaid fraud investigations violates federal regulations, Attorney General’s office spokesman Phillip Sisneros said Friday.

Power wheelchair providers fight denials tooth and nail - January 30, 2010
Fed up with Medicare's regional carriers denying a majority of their claims for standard power wheelchairs, some providers are fighting back.

Top execs at Parkland hospital rake in nearly $2 million in incentive pay - January 30, 2010
Top executives at Parkland Memorial Hospital collected about $1.7 million in bonuses at the end of last year, according to records released recently to The Dallas Morning News.

CMS wants input on new self-referral rules - January 30, 2010
The comment period, which ends Jan. 25, could lead to further guidance for restructuring noncompliant physician–hospital arrangements.

CMS wants input on new self-referral rules - January 30, 2010
The comment period, which ends Jan. 25, could lead to further guidance for restructuring noncompliant physician–hospital arrangements.

No World Borders to Present at Health Care Industry Conference - January 30, 2010
On February 18th and 19th Michael Arrigo, CEO of No World Borders, Inc. will be participating in Health Care Education Associates’ "Strategically Transitioning to ICD–10 for Providers & Plans," a health care industry conference focused on helping the health care industry move to the new electronic health record standards.

Miami Medicare fraud ringleader, 6 others face prison sentences - January 30, 2010
A Miami man who used his chain of Medicare clinics to commit fraud and exported the business to four Southern states will be sentenced Wednesday along with six other people in federal court.

Physical Therapist Pleads Guilty in Connection with Detroit Home Health Care Fra - January 30, 2010
According to plea documents, Vigil, a licensed physical therapist, admitted that she began working in approximately September 2008 as a therapist at All American Home Care Inc., and associated entities (All American).

Texas and federal officials charge more health care embezzlers in Medicaid fraud - January 30, 2010
The FBI, Department of Health and Human Services Office of the Inspector General and the Texas Attorney General Medicaid Fraud Control Unit have been working together to successfully convict health care fraud schemes throughout Texas.

Former owners of medical center to pay $10-million settlement in alleged Medicar - January 30, 2010
The two former owners of City of Angels Medical Center will pay $10 million as part of a consent judgment over allegations that they performed unnecessary medical work on homeless people recruited from skid row shelters as part of a Medicare fraud scheme.

Nursing homes face lower Medicaid payments - January 24, 2010
Thousands of health–care providers will see a 3.25 percent reduction in Medicaid reimbursement rates after a vote Thursday by the Oklahoma Health Care Authority.

Jury Convicts Detroit Area Doctor of Health Care Fraud Conspiracy - January 24, 2010
After a week–long trial in Detroit, the jury convicted Dr. Myint of one count of conspiracy to commit health care fraud. The conspiracy count carries a maximum prison sentence of 10 years.

Insurance Groups Push Health Bill Changes - January 24, 2010
A number of insurance carrier and employer trade groups are asking that the effective dates for numerous changes in health place benefits and policies be extended in any healthcare reform legislation.

Bill would hold nursing home owners criminally responsible for abuse, neglect - January 24, 2010
State Sen. Edith Prague said she will re–introduce a bill this year that would make it easier to hold the owners of nursing homes criminally responsible for abuse and neglect of patients in their facilities.

N.J. Medicaid audit finds $13M in payments for mistakes over two years - January 24, 2010
A child lost her HMO health coverage through an administrative glitch by the state Medicaid office. Less than a month later, the child needed intensive hospital care for eight months. The cost to the state: $1.1 million.

Michigan's physical therapy assistants in limbo over new federal and state licen - January 24, 2010
A few weeks ago, Rebecca Stiff was happily working as the director of rehabilitation at a nursing home in southern Genesee County. Now she’s anxiously waiting by the mailbox at her Swartz Creek residence, worrying if her new license will arrive from the state in time to keep her job.

Man claims physical therapist injured his arm - January 24, 2010
Referred to Christus St. Michael Rehabilitation Hospital for physical therapy for fractured ribs, James Marshall claims he suffered an additional injury to his right shoulder because of the physical therapist's excessive and forcible manipulation of his arm.

Minnesota County Says State Plan To Cover Costs Of Health Care For The Needy Is - January 24, 2010
In Minnesota, Hennepin County officials are saying a plan to charge counties extra to "cover health care for their neediest residents would have an unfair impact on the state's largest county and biggest public hospital."

Thirteen Detroit-Area Individuals Arrested and Charged for $14.5 Million Medicar - January 24, 2010
Thirteen Detroit–area residents were arrested today by federal agents from the Department of Health and Human Services, Office of the Inspector General (HHS–OIG) and FBI in connection with an alleged home health care scheme to defraud the Medicare program of more than $14.5 million.

Connecticut AG uses HITECH to sue over patient data breach - January 24, 2010
Connecticut Attorney General (AG) Richard Blumenthal announced Wednesday that he is suing Health Net of Connecticut for failing to secure private patient medical records and financial information involving 446,000 Connecticut enrollees and promptly notify consumers exposed by the security breach.

Prime Healthcare Services Implements Zix Corporation's Email Encryption Service - January 24, 2010
Zix Corporation (ZixCorp®), (Nasdaq: ZIXI), the leader in email encryption services, has signed a three–year contract with Prime Healthcare Services, a leading California–based regional health system with 13 separate hospital facilities.

Feds reach settlement with MIMA in Medicare fraud case - January 19, 2010
The U.S. Department of Justice said it has reached a tentative settlement with Brevard County's largest physician group, which is accused of defrauding Medicare out of millions of dollars in unnecessary, duplicative and costly radiation treatments.

Seven Ways Hospitals Can Become ‘Smaller Losers’ Under Medicare’s Recovery Audit - January 18, 2010
There will be bigger and smaller losers in the national recovery audit contractor (RAC) program, experts say. Which category a hospital falls into will depend to a large extent on its command of the data and a willingness to appeal claims denials all the way to an administrative law judge (ALJ), they say.

HIPAATraining.net Launches HIPAA Certification Training for Certified HIPAA Priv - January 18, 2010
Hipaatraining.net announces the launch of Certified HIPAA Privacy Expert (CHPE) Certification training. This certification will be of great help to comprehend the HIPAA law requirement for Privacy rule & basic overview on HIPAA security rule and will provide all the necessary guidelines on how to make your organization HIPAA compliant.

Medically Unnecessary Admissions Alleged in Rural Hospital False Claims Settleme - January 18, 2010
Hospital admissions that allegedly were not necessary or were extended for no medical reason are at the heart of a False Claims Act settlement with Wheaton Community Hospital in Minnesota.

HHS Report Confirms that the Complicated Medicare Documentation Requirements for - January 17, 2010
A federal report released last week on Medicare claims for power wheelchairs confirms that the regulatory documentation requirements are confusing, onerous, and must be improved, says the American Association for Homecare, the nation's largest association representing providers of durable medical equipment and services, including wheelchairs.

Missouri was most efficient in 2008 of using federal aid to recover Medicaid fra - January 17, 2010
The Missouri attorney general’s office was the most efficient in the nation in 2008 in using federal funds to fight Medicaid fraud.

Lakeland couple faces charges of Medicare fraud - January 16, 2010
A Lakeland husband and wife have been indicted on federal charges they defrauded the U.S. government by fraudulently billing Medicare for physical therapy services.

How Ready Are Hospitals for Meaningful Use? - January 16, 2010
Every hospital leader that I have spoken with in the past six months or so has been confident that his or her organization is in a position to qualify for meaningful use and capture all of the incentive payments from the HITECH Act.

Industry Fires Back at OIG Report on PWC Documentation - January 12, 2010
In the wake of an Office of Inspector General report that indicated a significant percentage of early 2007 power wheelchair claims lacked proper documentation, the American Association for Homecare fired back last week with a message that put the blame squarely on CMS.

VPA to pay $9.5M to settle whistle-blower lawsuits - January 11, 2010
Voluntary Physicians Association, a Farmington Hills–based home health care company, has agreed to pay $9.5 million to settle four whistle–blower lawsuits.

MRO’s Audit Tracker Online Now Compatible with the American Hospital Association - January 11, 2010
MRO Corp., a developer of superior release–of–information (ROI), audit tracking and document management applications and services for healthcare providers, today announced that Audit Tracker Online, MRO’s request management program is compatible with the American Hospital Association’s (AHA’s) RACTrac application.

Appeals court rejects effort to sell Medicare physician claims data - January 10, 2010
The AMA had joined the federal government in appealing an earlier decision ordering release of data in four states for an Alabama firm's marketing purposes.

Medicaid cuts looming for Va. hospitals - January 10, 2010
Virginia's hospitals are attempting the delicate balancing act of asking legislators to spare Medicaid from deep cuts, while acknowledging the state faces a significant budget shortfall of $4.2 billion.

Health Care Providers Protest Zealous Auditing - January 10, 2010
Health care providers say they’re getting swept up in a Medicaid fraud dragnet and being forced to pay thousands and sometimes millions of dollars to the government, despite not having committing fraud.

The Robbinsdale facility has corrected the problems that led to ban, state says - January 10, 2010
Robbinsdale Rehab and Care Center can resume taking new Medicare and Medicaid patients, after state inspectors determined the nursing home corrected serious and persistent violations of patient care standards.

Medicare changes rules for home health care - January 10, 2010
Recently, Medicare said it found that some home health agencies may be ending services early for some patients, citing a new Medicare rule that changes how Medicare pays for some high cost episodes of home health care.

Families challenge cuts in funding for disabled - January 08, 2010
Both ARC and CP have been informed their state funding may be cut by 10 percent, which would result in staff layoffs and the elimination or reduction of services. Ten–percent cuts would cost both organizations more than $1.5 million each, officials said.

Avoid health care fraud with a compliance culture - January 08, 2010
Last spring, a Medicare Fraud Strike Force team, known as the Health Care Fraud Prevention & Enforcement Action Team, or HEAT, was formed by the U.S. Departments of Justice and Health and Human Services to investigate and prosecute health care fraud.

CMS modifies DRG validation in 2010, based on RAC input - January 08, 2010
In response to feedback from the Recovery Audit Contractors (RACs), providers/suppliers and their associations, the Centers for Medicare & Medicaid Services (CMS) has modified the additional documentation request limits for diagnosis–related group (DRG) validation purposes in the RAC program for FY2010

AG urges awareness, welcomes senior sleuths - January 07, 2010
The Senior Anti–Crime University is part of the Attorney General’s Senior Sleuths project, a volunteer program to help seniors protect themselves and prevent others from becoming victims of fraud and abuse.

American Business Solutions Announced the Launch of a New Service for Healthcare - January 07, 2010
Although physicians currently face a 21 percent cut in Centers for Medicare and Medicaid (CMS) fees in 2010, the government is looking to take more money back from physicians via the Recovery Audit Contractors (RACs).

Health care loophole causes concern - January 06, 2010
An ABC Action News investigation is raising questions about a loophole in a new Florida law aimed at combating Medicaid and Medicare fraud.

Hospital's treatment after death pours salt in wound - January 06, 2010
Shane Wertz, whose heart attack came from out of the blue, was unconscious when he arrived at the hospital's emergency room. He died shortly thereafter. Julie Wertz thought the way in which the family was informed of the death was out of whack, considering the severity of the trauma.

Residents, politicians differ on fixes for New York's budget crisis - January 06, 2010
Many residents pointed to the need to cut salaries of public employees to reflect those in the private sector, and reduce benefits for the chronically unemployed. Elected officials pointed to big programs, such as Medicaid, that they said need to be cut back.

OIG Finds PWC Documentation Lacking; Medical Necessity Next Up for Study - January 06, 2010
Those claims accounted for $112 million in improper Medicare payments out of the $189 million total allowed during the six–month period, the OIG said in a report posted Dec. 30.

Health Care Compliance Requirements - HIPPA OSHA Joint Commission Red Flag Rules - January 05, 2010
To ensure compliance with laws and regulations it is essential to raise awareness through education. Health care compliance education offers the solution.

Thoroughness, not haste, key in probe of clinic’s insurance billing practices - January 05, 2010
Several sources have said the clinic that caused the outbreak, Endoscopy Center of Southern Nevada, made a habit of overbilling insurance companies.

Senior Medicare Patrol exposes cases of benefit fraud - January 05, 2010
The 4,700 volunteers who serve as the government's eyes and ears have been credited with saving taxpayers more than $100 million since 1997. The program relies on elderly people to apply a lifetime's worth of common sense and skepticism.

Physical therapist suspended following allegations of sexual misconduct - January 05, 2010
A Bristol physical therapist has been barred temporarily from practicing in Tennessee for allegations that he sexually molested three patients in late 2008, according to recently filed state documents.

WellCare resolves to go after former executives following Medicaid fraud scandal - January 05, 2010
Tampa, Fla.–based managed care plan WellCare intends to file lawsuits against its former top executives, according to a filing in federal court as part of a shareholder lawsuit against the company.

Ohio Doctor Charged with Health Care Fraud - January 05, 2010
Steven M. Dettelbach, United States Attorney for the Northern District of Ohio, announced today that, on Wednesday, December 23, 2009, Dr. Hany M. Iskander, age 48, of Powell, Ohio, entered a plea of guilty to an information charging him with one count of Health Care Fraud before United States District Court Judge Solomon Oliver, Jr. in Cleveland, Ohio.

Former Bristol, Tenn., physical therapist suspended for sexual, ethical miscondu - January 05, 2010
A former Bristol, Tenn., physical therapist's Tennessee license has been suspended due to findings of alleged sexual, ethical misconduct and substandard patient care.

Medicare cuts cripple access to cardio care - January 04, 2010
Beginning Jan. 1, 2010, Medicare patients throughout New Jersey will find it more difficult to receive potentially life–saving heart tests and treatments.

6 charged in $1.2M medical-supply insurance scam - January 04, 2010
A Center City medical–supply company and the couple who own it were charged by a federal grand jury yesterday with bilking Medicare and other benefit programs out of more than $1.2 million.

Qualifying for Medicare coverage for power wheelchairs and scooters - January 04, 2010
For Medicare to cover a power wheelchair or scooter, your doctor must state that you need it because of your medical condition. Medicare won't pay for a power wheelchair or scooter only for your convenience or for leisure activities.

Will Reform Open the Flood Gates for Health-Care Fraud? - January 04, 2010
The reform bills moving through Congress commit more than $100 million to prevent fraud and strengthen enforcement practices. And by the time the Senate was finished working on its bill, it had adopted even tougher anti–fraud measures than the House had––increasing penalties for health–care fraud, expanding the definition of actionable offenses, and devoting greater resources to fraud detection.

Faribault nursing home death tied to medication error - January 04, 2010
The state cited a Faribault nursing home for neglect after a woman died of a massive stroke in June.

Hospital deaths lower in Utah than rest of nation - January 04, 2010
Utah had lower percentages of in–hospital deaths and injuries than for similar patients nationwide in the latest evaluation released by the Utah Department of Health.

Kan. AG says no laws broken in Medicaid decision - January 04, 2010
State officials bypassed their own procedures but didn't break any laws in giving extra Medicaid funds to a nonprofit group with ties to the state Democratic Party chairman, Kansas' attorney general said Tuesday.

Los Angeles Healthcare Fraud Defense Lawyers Announce Recent Results in Californ - January 04, 2010
The Criminal Defense Attorneys of Kestenbaum, Eisner & Gorin LLP, a premier Los Angeles Fraud Defense Firm, have successfully represented numerous clients accused of state and federal healthcare fraud offenses involving allegations of Medi–Cal and Medi–Care theft.

Senior-Citizen Volunteers Fight Medicare Fraud - January 04, 2010
Volunteer army of senior citizens is helping uncover Medicare scams, saves taxpayers' money.

Doctors studying hard on the beaches - December 29, 2009
Doctors at Santa Clara County's Valley Medical Center are working hard to stay up to date in their fields – spending hundreds of thousands of dollars a year at taxpayers' expense to attend conferences at five–star beach resorts from Maui to Barbados, according to a new county audit.

Qualifying for wheelchairs and scooters - December 29, 2009
For Medicare to cover a power wheelchair or scooter, your doctor must state that you need it because of your medical condition. Medicare won't pay for a power wheelchair or scooter only for your convenience or for leisure activities.

Two Indian-Americans Plead Guilty In Health Care Fraud Scheme - December 29, 2009
At sentencing, Thangarasan, who is a licensed physical therapist, and Smith face a maximum sentence of 10 years in prison and a $250,000 fine. Aggarwal faces a maximum sentence of 20 years in prison and a $500,000 fine.

Home Health Agencies Defrauded Medicaid - December 29, 2009
Three home health agencies have entered into a settlement agreement resolving the Attorney General’s lawsuit against one of them and three whistleblower lawsuits that alleged the agencies defrauded the Medicaid program.

Miami Man Sentenced to 12 Years Prison for $1.1M Georgia Medicaid Fraud Scheme - December 29, 2009
Varian. V. Scott of Miami, Fla., has been sentenced to 12 years in federal prison on charges of healthcare fraud and conspiracy to commit healthcare fraud for his role in a $1.1 million Medicaid fraud scheme.

New York Medicaid program used $92 million for improper payments: audits - December 29, 2009
New York's Medicaid program squandered $92 million in overpayments, billing errors and waste, three scathing state audits have found.

Allstate Sues Michigan Medical Billing Company - December 29, 2009
Allstate Corp. is suing a Michigan medical billing company and others for allegedly taking part in a "scheme" to commit insurance fraud that cost the insurers more than $680,000.

Amerigroup Plays Key Role in Fraud Conviction - December 29, 2009
Amerigroup Corporation today announced the successful conclusion of a key fraud case that helped recoup a significant amount of money for U.S. taxpayers.

Time to crack down on Medicaid fraud - December 29, 2009
But there’s a big difference between an error and a deliberate act of fraud. Those who knowingly and deceptively create a false medical claim in order to bilk the government out of large sums of money deserve no sympathy whatsoever.

Allstate Insurance Company Uncovers Alleged Insurance Fraud Scheme Against Globa - December 29, 2009
Allstate Insurance Company today filed a complaint in the United States District Court, Eastern District, Southern Division against Global Medical Billing, Sterling Heights, Mich., alleging insurance fraud, misrepresentation and unjust enrichment.

Steps to Consider When Preparing for RACs - December 29, 2009
Taking certain preventive measures can go a long way toward preparing your facility for RAC audits. One of the first steps is for you to make sure your staff understands the issues.

Medicare fraud crackdown brings 30 indictments - December 29, 2009
Physicians are among those charged with bilking millions from Medicare as federal strike teams expand their reach.

Detroit is focus of U.S. Medicare fraud probe - December 29, 2009
Since 2007, a joint task force from the U.S. Justice and Health and Human Services departments has indicted more than 460 people nationwide on charges of bilking the federal program out of more than $1 billion in fraudulent claims, particularly unnecessary medical tests.

DiNapoli: NY made $92M in Medicaid billing errors - December 29, 2009
The state Department of Health has made $92 million in overpayments and billing errors in administering Medicaid during the past three years, according to state Comptroller Thomas DiNapoli.

Lourdes reaches deal to pay back Medicare - December 29, 2009
Lourdes Health System has agreed to pay the federal government $7.9 million to settle allegations that its hospitals in Willingboro and Camden defrauded Medicare.

Medicaid faces major cuts - December 29, 2009
The state may be forced to cut more than $1 billion over the next 18 months from BadgerCare Plus and other health care programs for the disabled, elderly and low–income families.

About 30 arrested over Medicare fraud in 3 state - December 25, 2009
Federal agents arrested about 30 suspects in three states Tuesday in a major crackdown on Medicare fraud totaling $61 million in separate scams as the government targets waste in taxpayer–funded health care.

Three Detroit-Area Residents Plead Guilty to Health Care Fraud - December 25, 2009
Jackson, Mich., resident Terrence Hicks and Detroit residents Muhammed Al Mahdi and John Saunders pleaded guilty in U.S. District Court in the Eastern District of Michigan this week for their roles in a $4.2 million Medicare fraud scheme.

New York Announces Settlement With Three Home Health Agencies - December 25, 2009
New York Attorney General Andrew Cuomo has announced a settlement with three home health agencies that are alleged to have defrauded Medicaid by billing the system for hundreds of unqualified health aides.

Tighter rules sought for anti-psychotic drug use in nursing homes - December 25, 2009
Health advocates are calling for tough new rules on the use of anti–psychotic drugs in Illinois nursing homes, including tighter controls on doctors who prescribe the powerful medications.

Cost Controls Head PricewaterhouseCoopers' List of Top Issues for 2010 - December 25, 2009
Efforts to reduce healthcare costs are at the top of a new list of the biggest issues for the health industry in 2010 from PricewaterhouseCoopers’ Health Research Institute, according to a release from PricewaterhouseCoopers.

DMEPOS Bidding Presents Major Problems for Equipment Providers - December 25, 2009
The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program Round One Rebid window for bidding closes today.

Jesup doctor going to prison for health care fraud - December 25, 2009
A 43–year–old Jesup, Ga., family physician was sentenced Monday to 34 months in federal prison for conspiring to commit health care fraud.

Panacea Healthcare Solutions Announces New Partnership to Provide RAC Data Minin - December 25, 2009
Panacea Healthcare Solutions, LLC is now offering MedLearn's solution as the exclusive RAC Risk Data Mining module at Panacea's RACAuditor.com web site.

athenahealth Receives Top National Ranking for Small Physician Practice Category - December 25, 2009
athenahealth, Inc., a leading provider of internet–based business services to physician practices, today announced that it has received the top ranking for solo physicians as well as physician practices with two to five physicians in the practice management category in the annual 2009 Top 20 Best in KLAS Awards: Software & Professional Services report. athenahealth also ranked second in the six–25 physicians and 26–100 physician practice categories, highlighting the scale and wide adoption of athenahealth’s centrally–hosted software platform, athenaNet®.

Patient Photos Help Reduce Hospital's Medication Errors - December 25, 2009
After a medication error occurred on the adult inpatient unit resulting from the misidentification of a patient, Mason and the committee reviewed other patient identification practices on various units within the hospital's psychiatry department.

Medicare Fraud Strike Force Expands Operations Into Brooklyn, N.Y.; Tampa, Fla.; - December 20, 2009
Continuing Strike Force Operations Lead to Indictment of 30 Individuals Charged in Miami, Detroit and Brooklyn with more than $61 Million in Fraudulent Billing to Medicare.

Lee County residents keep an eye on plans that jeopardize home-care service - December 20, 2009
The U.S. House of Representatives is considering $54.7 billion in cuts to Medicare reimbursements for home health care services over 10 years. The Senate has been debating more than $40 billion in reductions.

Physical Therapist, Money Launderer and Patient Recruiter Plead Guilty in Connec - December 17, 2009
According to information contained in plea documents, Thangarasan, a licensed physical therapist, admitted that he began working in approximately September 2003 as a contract therapist for a co–conspirator.

Health care fraud still main focus of False Claims Act - December 15, 2009
Whistle–blowers continue to drive false claims recoveries. But increased federal scrutiny of health care fraud could have physicians playing defense.

RAC Tracking and Denials Management System, RAConciliation, Is Approved by AHA a - December 15, 2009
RAConciliation, the RAC Tracking and Denials Management system, exclusively available through RACauditor.com in partnership with H.I.M. ON CALL, has been approved by the American Hospital Association (AHA) as a RACTrac compatible product.

Insider Secrets About Recovery or Postpayment Audits - December 15, 2009
In June 2009, I had the privilege of attaining certified professional medical auditor (CPMA) certification as offered by the National Alliance of Medical Auditing Specialists. In a nutshell, I was trained to think, analyze and act in the role of a professional auditor.

CMS places limits on recovery audit contractors in 2010 - December 13, 2009
The Centers for Medicare & Medicaid Services (CMS) has placed limits on recovery audit contractors (RACs), regarding the number of medical and related claims record requests they may seek from hospitals and other providers during an audit in 2010.

CMS launches anti-fraud program - December 13, 2009
CMS and OIG are highlighting problems associated with medical identity theft and Medicare fraud as part of a broader effort to reform healthcare.

Robbinsdale nursing home loses funding - December 12, 2009
Officials have cut federal assistance to new patients at the Robbinsdale Rehab and Care Center because of the errors and failure in care that included those that led to two patient deaths.

Upcoming HIPAA changes catching some unaware - December 12, 2009
Expansions to privacy and security rules, mostly affecting business associates, go into effect next year.

Doctor pleads guilty to fraud - December 12, 2009
A Jacksonville doctor pleaded guilty Thursday in federal court to bilking $400,000 out of the government in Medicare fraud.

Couple charged in leading Medicare equipment fraud - December 12, 2009
Robert Saul and his wife allegedly thought they could get rich by giving people expensive power wheelchairs and other medical equipment – equipment they didn't need – and falsely billing Medicare.

Philadelphia Pair Charged with Fraudulent Billing for Medical Supplies - December 10, 2009
A Philadelphia couple and their medical supply company have been charged with defrauding Medicare and other health benefits programs out of more than $1.2 million.

Two Data Security Breaches Give State Attorneys General a Chance to Exercise The - December 10, 2009
In a sign that state attorneys general may be flexing the HIPAA enforcement muscle granted by the HITECH Act provisions in the Recovery Act, the Connecticut and Arizona attorneys general are investigating health plans that recently experienced data breaches that they failed to disclose for several months.

HIPAA's role in liability cases tested in Mich. - December 10, 2009
Courts have split over whether the federal privacy statute prevents informal discovery of certain patient information.

Nursing Homes With Physician Owners May Be Defying Stark Physician Self-Referral - December 10, 2009
Because some services provided at nursing homes are reimbursed outside Medicare’s prospective payment system for long–term care, physician–owners might run afoul of Stark if they treat the residents.

Anti-Kickback and Stark Investigations: Attention Intensifies - December 09, 2009
Health care providers, whether physicians or hospitals, should be critically reviewing their longstanding financial relationships to ensure compliance with recent revisions to the federal self–referral restrictions under the Stark and the Anti–Kickback laws.

Almac Clinical Technologies Announces Patient-Reported-Outcomes Partnership With - December 09, 2009
Almac announced today a unique partnership with FACIT.org for electronic distribution of the latter's Patient–Reported–Outcomes (PRO) and Quality of Life (QOL) assessments.

MDaudit™ Hospital, a New Healthcare Audit Software, Assists Hospitals with RAC A - December 07, 2009
MDaudit™ Hospital enables assessment of compliance risk with the click of a mouse, internal audit review on Recovery Audit Contractors (RACs) targets, and comparison of findings to determine appeal strategy.

‘Viral' patterns discovered in Medicare fraud - December 07, 2009
Medicare fraud, like the flu, can be communicable, and authorities have found it spreads among different ethnic communities in different cities.

Medicare Fraud Runs Rampant In Miami-Dade - December 07, 2009
Miami–Dade County received about half a billion dollars from Medicare in home health care payments intended for the sickest patients in 2008, which is more than the rest of the country combined, according to a report released Monday.

N.J. surgery center wins ruling in health plan fraud case - December 07, 2009
A New Jersey appeals court ruling is good news for the viability of ambulatory surgery centers in the state and reinforces physicians' rights to do what's best for their patients, according to the state's medical community.

Missouri broker pleads guilty in $700,000 Medicaid fraud probe - December 07, 2009
A Springfield, Mo., insurance broker pleaded guilty to 12 felony counts related to Medicaid fraud after misappropriating more than $700,000 from the program.

Durable Medical Equipment (DME) business owner in Dallas pleads guilty to aggrav - December 06, 2009
The owner of Beltline Medical Supplies, Inc., formerly in Dallas, Texas, pleaded guilty to an Information charging aggravated identity theft.

Hospitals’ worry over pay linked to Medicare - December 06, 2009
St. Alexius and Medcenter One share a worry about health care reform. Both face financial calamity if there are no changes in the way the health care and the health insurance system works.

Industry Experts to Discuss How Hospitals Can Utilize Process Automation to Achi - December 06, 2009
Ultimus, Inc., a leading provider of Business Process Management (BPM) Solutions, will host a webcast focusing on how Process Automation can help hospitals achieve compliance with Joint Commission and CMS Requirements in 2010.

Two Ways to Correct Safety Regulation Violators - December 06, 2009
Unless they work in a medical facility with perfectly compliant employees, safety directors and infection preventionists (IP) are usually forced into the unenviable, but inevitable job of confronting a healthcare worker who is not adhering to safety and infection control regulations.

Hospitals May Not Have Liability When Their Physicians Are Busted for Fraud - December 06, 2009
Hospitals’ Medicaid compliance officers likely needn’t panic if physicians who practice at their facilities get busted for fraud of their own. But they might want to dash off a quick “heads up” e–mail to their legal counsel, just to be safe.

Bruno arrested after hiring unlicensed therapists - December 06, 2009
Seven months after it was revealed that Care Point Services in Bedford Hills was using unlicensed therapists to treat local pre–school children, including some from Katonah and Lewisboro.

Inspector General Saved Billions in Healthcare This Year - December 05, 2009
The Office of Inspector General announced Thursday that it saved $20.97 billion for fiscal year 2009 and highlighted six of the cases that led to those recoveries or savings.

Plan would require license for Wisconsin massage therapists - December 05, 2009
State lawmakers are considering better regulation of massage therapists, by licensure instead of certification.

MDaudit™ Professional Users Top 50,000 Physicians - December 04, 2009
Hayes Management Consulting announced today that compliance auditors are now reviewing the billing of more than 50,000 providers with its MDaudit™ Professional compliance audit software.

Ky. nursing home called one of country's worst - December 03, 2009
A Richmond nursing home is being called one of the worst performing in the nation by a government agency.

Medicare, Medicaid spent $54 billion too much in 2009, White House says - December 03, 2009
OMB figures show an increase over 2008, some of which HHS attributes to stricter review.

1 Nurse, 2 Caretakers Indicted For Patient Neglect - December 03, 2009
Attorney General Jack Conway announced the indictments of a nurse and two caregivers in connection with the alleged neglect of a patient at Creekwood Place Nursing Home in Logan County, Ky.

Cost estimates from hospitals hard to get - December 03, 2009
Uninsured patients trying to price–shop among California hospitals for procedures may have a tough time getting the information they requested, according to a Rand Corp. study published Tuesday.

Claims Auditor Solution from Compliance 360 Earns ‘RACTrac Compatible’ Status fr - December 03, 2009
Industry Leading Software Solution for Managing Medical Claims Audits now Adopted by more than 500 Healthcare Facilities Nationwide.

Penalties urged for dismissing whistle-blowers - December 03, 2009
A nursing home worker who was fired after telling state inspectors about a resident's death says Iowa employers must be held accountable for firing whistle–blowers.

Hospital Policy: ‘Just Say No’ to Gifts From Vendors and Patients, but Some Exce - December 03, 2009
Hospitals walk a fine line with gifts from vendors, patients and post–acute providers, which risk corrupting medical decision making and harming a hospital’s reputation.

Medicare fraudsters rake in billions - December 03, 2009
Medicare fraud is a multibillion–dollar business preying on an ever–increasing number of retiring baby boomers who often are being charged for medical treatments and products they don't need and for services they don't receive.

Palatka supplier charged in fraud - December 03, 2009
A Palatka medical equipment supplier became a South Florida man's gateway to ill–gotten riches, according to a recently disclosed federal grand jury indictment.

Sickening spending - December 03, 2009
A statewide crackdown on Medicaid abuse has revealed $96.7 million in misspent funds, with New York City hospitals and health–care providers to blame for half of the hefty tab.

At UMC, audits show privacy lapses are not new - December 03, 2009
Past county audits found shortcomings in HIPAA compliance.

Stevens Hospital incentive pay for exec questioned - December 03, 2009
The base pay that Stevens Hospital’s chief executive Mike Carter received last year –– $383,900 –– is near the median, maybe a little below what other people in similar positions are paid, according to a state audit.

Treatment of elderly could be criminal - December 03, 2009
Employees at a Las Vegas assisted–living and Alzheimer’s facility may face criminal neglect charges in connection with an ongoing investigation into the horrific care of elderly residents — some of whom were hospitalized because they did not receive their medication.

Miami Strike Force is a model for Medicare fraud crackdown - December 03, 2009
South Florida’s rampant Medicare fraud and federal attempts to stop it have taken on new prominence as President Obama and Congress struggle to pay for health–care legislation to cover the uninsured.

"Cancer of fraud" permeates U.S. healthcare system - December 03, 2009
A U.S. Senate committee revealed last year that public health insurer Medicare had paid as much as $92 million from 2000 to 2007 for medical services or equipment ordered or prescribed by doctors who were dead at the time.

Occupational Therapist and Patient Recruiter Plead Guilty in Detroit-Based Medic - December 03, 2009
Detroit resident Jaquita Lovelace and Miami resident Timothy Pierce have pleaded guilty in U.S. District Court in Detroit to participating in conspiracies to defraud the Medicare program.

NY company used unlicensed therapists - December 02, 2009
Authorities say a New York company under contract with the Westchester County Department of Health was using unlicensed therapists to serve special–needs children.

Owner of child-therapy agency for Weschester schools charged with grand larceny - December 02, 2009
The owner of a Bedford Hills company that provided physical and occupational therapy under contract to the Westchester County Health Department was arrested today on charges she used several unlicensed therapists to serve special needs children.

Health Plans That Use Member Enrollment Data to Push Their Political Agenda Migh - December 02, 2009
Health plans could face stiff penalties under HIPAA if they use enrollment information to contact members without their permission and urge them to join grassroots advocacy campaigns or take a stance on a political issue.

Health Insurer Loses 1.5 Million Patient Records - December 02, 2009
A health insurer lost 1.5 million patient records last May but waited six months to disclose the incident.

Medicare scams are targeting senior citizens in Louisiana - December 02, 2009
Health care officials are asking citizens in Avoyelles, East Baton Rouge, Caddo, St. Martin and Terrebonne parishes to be on the lookout for health care scams that are targeting senior citizens.

Meta Health Technology Introduces PowerRAC Software Tool. New Hospital Software - December 02, 2009
Meta Health Technology, a leading provider of software solutions for health information management, has introduced PowerRac, its new web–based software tool that enables hospitals to effectively manage the Recovery Audit Contractor (RAC) process and protect their legitimate revenue. The software automates RAC processes and activities across all departments, and produces a seamless workflow for the hospital by integrating with Meta's chart abstracting and release of information software applications.

Two Detroit health care professionals plead guilty to Medicare fraud - December 02, 2009
A Detroit occupational therapist and a patient recruiter from Dearborn pled guilty in U.S. District Court in Detroit to participating in conspiracies to defraud the Medicare program.

Federal Report Finds Billions in Improperly Paid Medicare Claims - December 02, 2009
A new federal report has found that the government paid $47 billion in questionable Medicare claims in fiscal year 2009.

Medicare audits at full strength in 2010 - December 02, 2009
Congress developed the MIP as part of the Deficit Reduction Act of 2005 with an eye toward recovering improper payments made under the $300 billion–a–year Medicaid program.

Parkland Health & Hospital System Selects MRO’s Audit Tracker Online - December 02, 2009
MRO Corp., a leading provider of electronic release–of–information (ROI), document management and audit tracking solutions for healthcare providers, today announced a contract with Parkland Health & Hospital System (Dallas, Texas) to provide the public academic health system with Audit Tracker Online.

Checking the Right Boxes, but Failing the Patient - December 02, 2009
It has been 10 years since the Institute of Medicine’s seminal report on deaths caused by medical errors (numbering at least 44,000 a year). Since then, there has been tremendous focus on how many mistakes physicians and hospitals make, how much they cost and how to prevent them.

New laws on patient security breaches mean your associate contracts probably nee - December 02, 2009
Think your business associate agreements sufficiently protect your rights? Now figure in new laws on security breaches of patient information.

Kan. nurse resentenced in 'nude therapy' case - December 02, 2009
A Kansas nurse convicted of enslaving mentally ill residents of a Newton group home was sentenced to 15 years in prison Monday after a federal judge acknowledged the original seven–year term was too short.

Dover's Wentworth-Douglass Hospital now ID'ing patients - December 02, 2009
Wentworth–Douglass Hospital and all primary and specialty care practices affiliated with the hospital have implemented a new policy where patients must provide photo identification during their next visit, if they haven't done so already.

Joint Commission International Marks Ten Years of Global Accreditation - December 02, 2009
Joint Commission International (JCI) is marking the tenth anniversary of the first health care organization to be awarded accreditation under its globally developed international standards for hospitals.

Hidden Mistakes In Hospitals - December 02, 2009
A state law intended to protect patients by making them aware of hospitals' errors has ended up making it easier for hospitals to avoid scrutiny.

Hospitals owe state $2.5 million for overcharges - December 02, 2009
Six hospitals owe the state more than $2.5 million as the result of overcharges to the State Health Plan, according to preliminary audit results that the plan released today.

State says N.C. Baptist one of six hospitals that was overpaid for outpatient se - December 02, 2009
The State Health Plan said today that N.C. Baptist Hospital is one of six hospitals that was overpaid for outpatient medical services from July 2003 to June 2008.

Healthcare Organizations Select Plan-Smart™ for Ongoing Dependent Eligibility Au - December 02, 2009
78 Hospitals to date have choosen HRAdvance’s platform to manage their entire eligibility verification process and provide a cost–effective solution for reducing health plan costs.

Mission Hospital audit to look at workers' compensation program - December 02, 2009
Mission Hospital plans an outside audit of its workers' compensation program, but a spokeswoman says the move is not in response to findings by state officials that it had handled some cases improperly.

Medicaid fraud demo program falters in Orange - December 02, 2009
By this time, county officials planned to have audited 25 businesses they targeted through an initial screening of Medicaid bills. But to date, only two audits have been done, no funds have been recovered and the future of the investigation is uncertain.

HIPAA - Past, Present, and Future - December 02, 2009
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ushered in a new age of modernizing the United States healthcare system.

Justice Department Recovers $2.4 Billion in False Claims Cases in Fiscal Year 20 - December 02, 2009
This represents the second largest annual recovery of civil fraud claims in history, and brings total recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, to more than $24 billion.

Study Shows Most Healthcare Companies Are Not Ready for New Privacy and Security - December 01, 2009
A recent survey of healthcare organizations found that 94 percent believe they are not ready to comply with the privacy and security provision of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

HIPAA-Compliant Disaster Recovery and Business Continuity Guide Now Available Fr - December 01, 2009
The 2009 guide offers workers’ compensation professionals a quick reference to address HIPAA and SAS70 requirements for reducing business risk following a disaster.

Cyber sleuths catch scammers feasting on Medicaid dollars - November 30, 2009
The Medicaid Program Integrity (MPI) section of AHCA is a major computer sleuth group that scans the statistical horizon for suspicious billings. There are about 100 employees in this unit.

Govt: Medicare paid $47 billion in suspect claims - November 30, 2009
The government paid more than $47 billion in questionable Medicare claims including medical treatment showing little relation to a patient's condition, wasting taxpayer dollars at a rate nearly three times the previous year.

Warwick man reports apparent Medicare fraud on Fox News - November 30, 2009
Warwick resident Bill Stelz may be one of the few seniors who actually read the Medicare Summary Notice that the Center for Medicare and Medicaid Services periodically mails out.

Kaiser Permanente pays $1.8 million over billing flaws - November 30, 2009
Kaiser Permanente's Oregon–based unit has agreed to pay $1.8 million to settle charges of false billing brought by the federal Medicare program.

Federal rating system for nursing homes a glance, not a complete picture, Anders - November 30, 2009
The federal rankings look at the results of the homes’ state health inspections, the number of registered nursing hours spent with each patient each day and the care given to patients’ physical and clinical needs.

CMS: Supervising Physicians Can Be Anywhere on a Hospital’s Campus Under the Out - November 29, 2009
CMS has given hospitals more breathing room in terms of physician supervision of outpatient therapeutic services provided on hospital grounds.

Medicaid Fraud Mastermind Stole Over $1M - November 29, 2009
David Williams, an owner of a now–defunct Long Island medical supply company and said to be the mastermind behind a massive Medicaid fraud scheme, has been sentenced to three to nine years in prison for stealing over $1 million from Medicaid.

Feds ignored Medicare scam warnings for years - November 29, 2009
For three years, the federal agency in charge of preventing Medicare fraud repeatedly ignored internal watchdog warnings about swindlers stealing millions of dollars by scamming several programs, documents show.

Health Insurance Fraud Increases Cost - November 29, 2009
Health insurance fraud is one of many factors to have caused significant increases in group health insurance costs in the United States. The type of fraud involved in health insurance involves billing for services that were never rendered, charging for services that are not necessary, or charging unfairly.

Nursing home doctor's prescription record questioned - November 28, 2009
Neither state nor federal officials appear to have ever assembled a complete picture of Reinstein's thriving practice, built in part within Illinois' poorly regulated system of nursing homes serving the mentally ill. But an investigation by ProPublica and the Tribune found that Reinstein has compiled a worrisome record, providing assembly–line care with a highly risky drug.

AAPC Announces Collaboration With NAMAS to Offer Auditing Credential - November 27, 2009
The association, effective Jan. 1, 2010, will benefit AAPC members, medical coders, health care professionals and NAMAS customers through the availability of a nationally recognized audit credential.

New ChartMaxx(R) V5.5 with Recovery Audit Contractor (RAC) Manager Helps Hospita - November 27, 2009
With the new optional RAC Manager, ChartMaxx V5.5 helps health care providers tie together electronic forms, discrete data, color coded timers and e–mail alerts, dashboard reports, and release of information functionality to track, respond to, and report on, requests from RAC auditors.

AtriCure Announces Tentative Settlement with the Department of Justice - November 27, 2009
AtriCure, Inc. (Nasdaq: ATRC), a medical device company and a leader in cardiac surgical ablation systems, today announced that it has reached a tentative agreement, subject to completion and approval of a written settlement agreement, with the Department of Justice (DOJ) to resolve the issues raised in the DOJ’s investigation and the related qui tam complaint.

A Hospital Near-Death Experience: How Medicare Termination Can Push a Hospital t - November 27, 2009
Compass Clinical Consulting (http://www.compass–clinical.com) has released a new whitepaper, "Hospital Near–Death Experience: How Medicare Termination Can Push Your Hospital to the Brink of Closing," (http://www.compass–clinical.com/hospital–near–death/) giving hospital executives a rare look inside the process of Medicare termination and recertification.

19 New York, New Jersey residents indicted in Medicaid fraud scheme - November 27, 2009
Nineteen residents of New York and New Jersey have been indicted and arrested for fraudulently collecting Medicaid benefits totaling more than $350,000.

Nation's Largest Nursing Home Pharmacy and Drug Manufacturer to Pay $112 Million - November 26, 2009
Approximately $68.5 million of the settlement proceeds will go to the United States, while $43.5 million has been allocated to cover Medicaid program claims by participating states.

Company billed for $14,000 wheelchairs, handed out walkers - November 26, 2009
The head of a now–defunct D.C. medical supplies company has been indicted for health care fraud and is accused of falsely billing the government for hundreds of thousands of dollars for deluxe power scooters or high–end wheelchairs while giving Medicaid recipients cheaper wheelchairs or walkers.

Medical Equipment Company Owner Pleads Guilty to Fraud Scheme Involving Nutritio - November 26, 2009
The owner and operator of a Houston–area durable medical equipment (DME) company today pleaded guilty to defrauding the Medicare program.

Massive fraud makes Medicare a lousy model - November 26, 2009
The problems of health care – and the prospects for some effective reform of the systems we have to pay for it – are front and center as Washington's legislative geniuses work their magic behind closed doors, crafting "reform" they say will provide health insurance for those who lack it while somehow reducing the skyrocketing costs of providing it.

Cooperation Is Needed Between Compliance and Revenue Cycle Departments - November 25, 2009
Artificial divisions between the revenue cycle and compliance departments can hamper the effectiveness of hospital operations. Though each has its own role in the organization, there is “maximum impact and benefit” if compliance and revenue cycle work together.

Woman's wheelchair goes unfixed because of state's budget woes - November 25, 2009
Company refuses to repair it until Illinois pays for previous claims.

Picis Adds to Growing List of Hospital Systems Using LYNX E/Point to Improve Com - November 25, 2009
Healthcare revenue management solution to standardize and streamline emergency department coding and compliance in 64 hospitals across six major health systems.

Communities accuse Blue Cross of hiding $40 million in fees - November 25, 2009
A dozen Michigan communities say they were overcharged $40 million in hidden fees by Blue Cross Blue Shield of Michigan and are demanding that money back.

Texas a hotbed as authorities crack down on Medicare, Medicaid fraud - November 25, 2009
When federal agents arrived, the scooter was still covered in plastic. It should have been a fancy $5,000 power wheelchair for someone who needed it. That’s what Medicare paid for.

Slow payments cost United Healthcare 750k - November 20, 2009
United Healthcare Insurance Co., the state's fifth–largest health insurer by number of policies, has been ordered to pay $750,000 for failure to pay doctors' claims within 15 days of receipt as required by Georgia law.

Litigation stress: Being sued is personal as well as professional - November 03, 2009
Plaintiffs bringing medical liability cases commonly contend they have experienced pain and suffering. Many physicians could say the same about being dragged into the litigation process.

Care center owner held on fraud charges - November 03, 2009
The owner and the operator of the Care Center of Ormond Beach was charged today with Medicaid fraud, practicing medicine without a license and neglecting an elderly person under his care.

New state law denies, revokes licenses of some in medical field - November 03, 2009
A little–noticed provision in the 160–page measure is preventing doctors, nurses, pharmacists, lab technicians and others licensed by the state from working in Florida if they have old felony convictions for fraud or drugs.

Detroit-Area Physical Therapist Pleads Guilty in Medicare Fraud Scheme - November 03, 2009
Troy, Mich., resident Syed Aziz pleaded guilty today in U.S. District Court in Detroit to participating in a conspiracy to defraud the Medicare program.

Compliance 360 Launches Privacy Breach Management Solution to Address Requiremen - November 03, 2009
Compliance 360, a leading provider of Software–as–a–Service (SaaS) solutions for enterprise governance, risk management and compliance (eGRC) announced today the availability of the Compliance 360 HITECH Privacy Breach Management Solution.

Nursing home CEO pulls in hefty pay, patients' families 'frustrated' - November 03, 2009
Nursing homes in Pahokee, Gainesville and Bradenton that get most of their money from Medicaid and Medicare are funneling more than $1 million a year through a maze of nonprofit corporations that chiefly benefit an Okeechobee CEO, along with her daughter and son.

Texas Hospital Group Pays U.S. $27.5 Million to Settle False Claims Act Allegati - November 03, 2009
A hospital group based in McAllen, Texas, has agreed to pay the United States $27.5 million to settle claims that it violated the False Claims Act, the Anti–Kickback Statute and the Stark Statute between 1999 and 2006, by paying illegal compensation to doctors in order to induce them to refer patients to hospitals within the group.

The Malpractice Problem - November 03, 2009
Since physicians are not liable for the increased costs of care but are liable for any error or missed diagnosis, it would be foolish for them to act in any other fashion. The costs of this mindset cannot be easily assessed by surveys.

Suit alleges kickbacks at Hospital for Special Surgery - November 03, 2009
Manhattan's Hospital for Special Surgery is one of the nation's top–ranked centers for orthopedics, the official hospital for the Giants, Mets, Knicks and Nets. It's got Tiki Barber on its board and former patients playing on both sides of this year's World Series.

Planned background checks for in-home healthcare workers are criticized - November 03, 2009
County social service chiefs in California protest the Schwarzenegger administration's plan for prospective health aides, saying they aren't ready to enact the new application process.

Lawmakers Target Medicare and Medicaid Fraud - November 03, 2009
The federal government needs to further step up efforts to fight Medicare and Medicaid fraud to generate more savings to help pay for a health–care overhaul, lawmakers said Wednesday.

Woman arrested for operating assisted living facilities without license - November 03, 2009
Attorney General Bill McCollum announced on Wednesday that a Marion County woman has been taken into custody on charges she was operating an assisted living facility without a license.

Healthcare system wastes up to $800 billion a year - November 02, 2009
The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.

Health coverage 'plan' was no insurance at all - November 02, 2009
Mary Lloyd of East Bethel says she was "royally duped" into buying health coverage that wasn't insurance, and she's not alone.

Medicare Fraud: A $60 Billion Crime - November 02, 2009
A.G. Holder Tells 60 Minutes More Oversight Is Needed; Scammer Explains How Easy It Is To Steal Millions.

Medi-Fraud for Everyone - November 02, 2009
While it's shocking that government policing efforts are so lax for Medicare that even a convicted murderer can be granted a license to sell equipment and file claims, Gonzalez is actually a small player compared to other cheats.

Fla. fraud law may curtail some medical careers - November 02, 2009
A new state law designed mainly to crack down on Medicaid fraud is having unexpected consequences by keeping some health care professionals from getting or keeping their licenses at a time when the state is suffering a shortage.

Four Pharmaceutical Companies to Pay $124 Million to Settle FCA Claims - November 02, 2009
Last month, after a string of false marketing settlements with pharmaceutical companies, the Justice Department announced a record–setting $2.3 billion False Claims Act deal with Pfizer to resolve allegations that Pfizer illegally marketed the painkiller Bextra.

The 'Business' of Fighting Fraud - November 02, 2009
"Who's watching the DMEPOS industry?" was one of the big questions at a Medtrade session Tuesday called "Inside the Beltway." Short answer: everyone.

Organized crime's new target: Medicare - November 02, 2009
Experienced in running drug, prostitution and gambling rings, crime groups of various ethnicities and nationalities are learning it's safer and potentially more profitable to file fraudulent claims with the federal Medicare program and state–run Medicaid plans.

Medicare Fraud Strike Force Operations in Houston Lead to Charges Against Six Ar - November 02, 2009
Medicare fraud charges have been filed against six individuals in the continuing operation of the Medicare Fraud Strike Force in Houston.

Former Salt Lake nursing home employee gets year in jail in sex-abuse case - November 02, 2009
A former employee of a Salt Lake City nursing home has been sentenced to a year in jail for sexually abusing an elderly patient with Alzheimer's disease.

Nursing home cited, sued after elderly man's genitals disintegrate - November 02, 2009
An Everett nursing home is facing a lawsuit after an elderly resident's genitals disintegrated while staff allegedly failed to act.

Freehold man sentenced to 3+ years in federal prison - November 01, 2009
A Freehold man who admitted using his two medical billing companies to defraud insurance companies has been sentenced to 37 months in federal prison.

Organizer of Medical Equipment Scam Sentenced to 57 Months in Prison - November 01, 2009
Acting United States Attorney for the Southern District of Florida announced that defendant Maria F. Hernandez, 62, of Miami, Florida, was sentenced yesterday for her participation in a $5.7 million health care fraud scheme.

Hospitals Move Forward With Gainsharing, Pay-for-Performance Despite Absence of - November 01, 2009
Hospital incentive payments to physicians to reduce costs and improve quality continue to blossom, despite the lack of unequivocal fraud–and–abuse regulatory exceptions to protect them from enforcement actions or Medicare overpayment recoupment.

MN AG Sues Nursing Home Owner For Overbilling - November 01, 2009
Attorney General Lori Swanson is suing the owner of a Plymouth nursing home for fraud for allegedly overbilling the state.

Medicare and Medicaid make easy marks for fraud - November 01, 2009
Although Barack Obama might be shooting high with his estimate, even conservative estimates peg Medicare and Medicaid fraud at $60 billion a year.

American Hospital Association (AHA) Names OnBase 'RACTrac Compatible' - November 01, 2009
The nationwide launch of the Recovery Audit Contractor (RAC) program is looming. Healthcare providers of all sizes and types are busy preparing for it as not being ready will yield some pretty severe consequences.

HHS OIG Holds Ex-Hospital Exec Responsible for Alleged Stark Violations and Fals - November 01, 2009
A former California hospital CEO who doubled as the compliance officer has been held personally accountable by the federal government for the hospital’s alleged payments to physicians for referrals.

Kent County touched by three of Michigan's top five insurance frauds, industry g - November 01, 2009
It’s home to a city that has gone from being the furniture capital of North America to a fledgling hub of medical research. Now, Kent County has a new claim to fame: insurance fraud capital of Michigan.

Albany Judge Blocks Vaccination Rule - November 01, 2009
A New York State judge on Friday suspended a health regulation that would compel hundreds of thousands of health care workers and hospital volunteers to be vaccinated for seasonal and swine flu.

Patented Hand Wash Monitoring System Provides Full Accountability - November 01, 2009
HandGiene Corp. manufactures and offers a Patented RFID enabled Hand Wash Monitoring System that ensures compliance by all covered personnel with established hand wash protocols in a participating facility.

The National Association for Home Care & Hospice Announces the Completion of The - November 01, 2009
The National Association for Home Care & Hospice Announces the Completion of The BlackBerry Report – a Comprehensive Study on Technology and Home Care

Medicare Advantage cited as a culprit in rising health care costs - November 01, 2009
A rural resident who gets Medicare because of a disability, Rogers, 59, signed up through Humana in 2005. These days, he's no great fan of Medicare Advantage, a program in which the government pays private insurers to manage Medicare benefits for members.

Home-care system leaves elderly at risk, auditor says - October 31, 2009
A $332 million state program that oversees home health care services for about 18,000 elderly and disabled residents is vulnerable to fraud and has employed personal care attendants who have committed felonies, including manslaughter, assault, and threatening to commit murder, according to a report released yesterday by the Office of the State Auditor.

Sebelius, West Highlight New Tips to Prevent Medical Identity Theft and Medicare - October 31, 2009
Secretary of Health and Human Services Kathleen Sebelius and Assistant Attorney General Tony West today highlighted the Obama Administration`s work to fight Medicare Fraud and released new tips and information to help seniors and Medicare beneficiaries deter, detect and defend against Medical identity theft.

Home care program’s costs under scrutiny - October 31, 2009
The state’s personal care service program is designed to save taxpayers money in the long run, while caring for some of Nevada’s poorest and most vulnerable residents.

Risks call dialysis into question for nursing home patients - October 31, 2009
Some observers have questioned whether dialysis, which typically is performed three days a week for three or four hours at a time, is the best option for such patients.

Kentucky Attorney General Conway Announces $14.7 Million Verdict Against Drug Co - October 31, 2009
Attorney General Jack Conway today announced that a Franklin Circuit Court jury has handed down a $14.7 million verdict against global pharmaceutical giant AstraZeneca for defrauding the Medicaid program and Kentucky consumers by inflating the prices of their prescription drugs.

Doctor has been sued for Medicare fraud - October 31, 2009
A Montrose doctor whose offices and home Wednesday were raided by agents of the U.S. Drug Enforcement Administration has a history of being sued for Medicare billing fraud.

Medicare Fraud Crackdown in Louisiana - October 26, 2009
The health care debate has taken center stage in public awareness recently, but this is not the only pressing health care issue currently facing the government. In the Department of Justice (DOJ) and the Department of Health and Human Services (HHS), many eyes are turned to the problems of Medicare and Medicaid Fraud.

Crack down on Medicare, Medicaid fraud - October 25, 2009
For healthcare reform to work, more money is needed to nab scam artists.

Unclear Expectations - October 25, 2009
As flu season descends on North America, hospitalists from Boston to the San Francisco Bay are concerned about what might happen when normal seasonal influenza hospital admissions are added to new cases of the novel influenza A (H1N1) virus.

State checks on why few medical errors being reported - October 25, 2009
The Washington State Department of Health is canvassing hospitals to determine why so few have reported medical errors under a state law that says reporting is mandatory.

Medical Malpractice Insurance Market Stable But Faces Challenges Ahead - October 25, 2009
Recent trends have had an overall stabilizing impact on the medical malpractice market, but several emerging issues may present challenges for insurers and actuaries.

New Jersey Hospital Select MRO’s Audit Tracker Online - October 25, 2009
Shore Memorial Hospital integrates audit tracking and reporting application into existing release–of–information system.

Mass. Nursing Homes Earn Top Marks For Care - October 25, 2009
Massachusetts ranks No. 7 in the country for quality nursing homes, according to data reported by the Centers for Medicare and Medicaid Services.

Two locals arraigned in health-care fraud case - October 23, 2009
Two Mariettans were arraigned Friday on felony charges for allegedly defrauded Blue Cross Blue Shield and other insurers out of $11 million for physical therapy services that were not actually provided.

Virginia man charged with assault following alleged incident in Rockville clinic - October 21, 2009
Montgomery County Police charged a physical therapist who works in Rockville with second–degree assault and sexual contact without consent.

Medicaid Fraud More than $63 Million in 5 States Alone, GAO Report Finds - October 21, 2009
A California man took on the name of a dead person to receive taxpayer–funded health care for more than three years, charging $200,000 to the Medicaid system, including $2,870 to buy controlled substances under an assumed identity.

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'Facility Fees' Are Taking Man - October 21, 2009
Unlike other add–ons that have aroused public ire –– baggage charges on airlines, surcharges for concert tickets or resort fees tacked on by hotels –– outpatient facility fees, which range from about $25 to hundreds of dollars per visit, may involve a service that is a matter of life and death, such as chemotherapy.

Harborside Healthcare to Pay U.S. $1.375 Million to Resolve Allegations of Kickb - October 20, 2009
Harborside Healthcare and HHC Nutrition Services will pay the United States $1.375 million to resolve False Claims Act allegations that the company received kickbacks and assistance under the guise of a sham durable medical equipment (DME) provider.

MedAssets’ Claims Auditor Achieves Certification Status from Executive Health Re - October 20, 2009
Certification validates that MedAssets Claims Auditor provides seamless inbound and outbound data exchange between Executive Health Resources and its hospital clients

Regulations increase costs for doctor visits - October 20, 2009
Oftentimes, my patients ask me why it costs so much for a doctor visit. In fact, one of my patients stated when he was 10 years old, his parents went to a physician in town that only charged $10 for an office visit.

Spine Surgery Investigation Continues as Six More Hospitals Settle Fraud Cases f - October 18, 2009
The first national health fraud enforcement initiative in about a decade — over Medicare claims for kyphoplasty — took another step forward when six more hospitals recently agreed to pay a total of $8.3 million to settle false claims allegations.

US has no good system to track medical implants - October 15, 2009
Experts say such deaths are the result of a major weakness in the nation's system for recalling thousands of medical devices routinely implanted in people's bodies, ranging from screws and plates to artificial knees and hips.

State recovers $7M from Medicaid fraud - October 15, 2009
Wyoming's share of settlements in Medicaid fraud cases totaled $7 million between 1993 and 2009. In some of these cases, Wyoming collected more money than much larger states.

Five Detroit Residents Plead Guilty to Health Care Fraud Charges - October 15, 2009
Detroit residents Dierdre Teagen, Robert Wynn, Ernest Neal, James Harris and Steve Sherman pleaded guilty in U.S. District Court in Detroit this week for their roles in various Medicare fraud schemes

Hospital's $40M shortage stuns doctor shareholders - October 15, 2009
Pinnacle Hospital might either close or be sold within weeks, according to some of the for–profit hospital's physician owners.

Rex Rehabilitation and Nursing Care Center of Raleigh Rates Zero Deficiencies - October 12, 2009
Rex Rehabilitation and Nursing Care Center of Raleigh scored zero deficiencies on the annual quality survey to ensure they meet care standards mandated by Medicare and Medicaid.

Rehabilitation services needs to be part of health care debate - October 12, 2009
The health care debate often focuses on all the problems and frustrations associated with the current health care industry. What is typically overlooked is the discussion about what is working well in our existing health care system.

Eureka health care and rehab center settles race discrimination case - October 12, 2009
A private Eureka assisted independent living facility is denying allegations of employee racial discrimination after settling a case involving an African–American nurse for $80,000.

Detroit-Area Rehabilitation Facility Executive Pleads Guilty to $18.3 Million Me - October 12, 2009
Suresh Chand pleaded guilty today in U.S. District Court in Detroit to participating in multiple conspiracies to defraud the Medicare program and to launder the proceeds of the fraud.

New Annual Report Provides Objective, Independent Analyses of Quality Improvemen - October 12, 2009
Today the American Health Care Association (AHCA) and the Alliance for Quality Nursing Home Care (Alliance) publicly released the nursing, post–acute, short term and rehabilitative sector's first comprehensive report examining quality trends in the nation's nursing homes.

Georgia hospitals rated ‘weak’ - October 12, 2009
Twenty–two hospitals across Georgia stand out in the latest Medicare data for poor results for patients with pneumonia or heart trouble.

Folsom long-term hospital replacing itself - October 12, 2009
The only long–term acute–care hospital in the Sacramento region is quietly building a $43 million, 58–bed replacement facility on its campus in Folsom.

Pain clinic announcement expected - October 12, 2009
The Guelph General Hospital is expected to shed light today on the future of Dr. Kulbir Billing’s private pain clinic here, the fate of which has been in doubt since the spring.

HMS Acquires IntegriGuard to Expand Program Integrity Capabilities - October 12, 2009
HMS today announced that it has acquired the business of IntegriGuard LLC, an ISO–certified and URAC–accredited organization devoted to the prevention and detection of fraud, waste, and abuse in the healthcare system.

AHCA Combats Medicaid Fraud in Florida - October 12, 2009
AHCA Agency commits to visiting every home health agency in Miami–Dade County by the end of the year.

60 doctors took speaker fees from drug giant - October 11, 2009
At least 60 Massachusetts doctors collectively have earned more than a half–million dollars this year as speakers paid by pharmaceutical giant Eli Lilly & Co. – including two Boston Medical Center physicians whose participation is being reviewed for possible violation of a hospital policy against marketing activities by its doctors.

Investigated California Medical Firm Forgoes $70M Workers Comp Claims - October 11, 2009
A Southern California medical management company accused of fraudulent workers' compensation–related billing has dismissed $70 million worth of filed claims, the largest workers' compensation mass dismissal of liens in California history.

Davie man sentenced for Medicare fraud - October 11, 2009
A Davie man was sentenced to 12–and–a–half years in prison and ordered to make restitution for his role in a $20 million health care fraud and money–laundering scheme.

St. Vincent's to pay $2M in Medicare fraud case - October 11, 2009
St. Vincent’s Health System has agreed to pay nearly $2 million to the federal government to settle a Medicare fraud case.

Man admits health care fraud - October 11, 2009
From 2003 to 2007, Chand admitted he and his associates filed false claims worth $18,379,300.

Health reform advocates targeting Medicare fraud - October 11, 2009
Government administrators and senior advocates say there is no way to know how much money is sucked in via wheelchairs billed to the government for people who can still walk, services that aren’t delivered and treatment that’s not needed.

Six Hospitals in Indiana and Alabama Pay $8.3 Million to Settle Whistleblower La - October 10, 2009
hree hospitals in Indiana and three hospitals in Alabama have agreed to pay the federal government a total of $8.3 million to settle a whistleblower lawsuit that alleged the hospitals deliberately overcharged Medicare for routine, minimally–invasive back surgery.

Former Bedford clinic owner surrenders therapy license - October 10, 2009
The owner of a former pediatric clinic that's accused of allowing unlicensed therapists to treat special–needs children has surrendered her New York state occupational therapy license.

Stricter self-referral rules may end some physician contracts with hospitals - October 10, 2009
As of Oct. 1, physicians will have to restructure or unwind many hospital arrangements to avoid federal penalties. Some doctors worry patient care will suffer.

Utah's Medicaid wants a big boost - October 09, 2009
With its enrollment fast approaching 200,000 Utahns –– an all–time high –– the state's Medicaid program is poised to ask the Legislature for $17 million in additional funding to keep it afloat through fiscal 2010.

3 women suspected of Medicaid fraud - October 09, 2009
Three women from Franklin County face Medicaid fraud charges in Penn Township after the state Attorney General's Office alleged they filed false time sheets accounting for more than 1,000 hours of work at the local office of United Cerebral Palsy of South Central Pa.

Stearns Nursing and Rehab Center named in med mal complaint - October 09, 2009
The administrator of the estate of a recently deceased woman alleges the woman developed decubitus ulcers while living in Stearns Nursing and Rehabilitation Center, which caused her pain and suffering until her death.

Arizona Heart Hospital to pay $675K to settle Medicare claim case - October 09, 2009
Because there was no billing code for this procedure, the hospital used a comparable billing code to cover costs of the procedure, said Dr. Edward Diethrich, medical director of the Phoenix heart hospital.

Critics see home health care boom as wasteful, but others tout benefits - October 09, 2009
From 2004 to early 2008, Medicare paid her two agencies more than $6.5 million to care for elderly Dallas–area patients. A federal investigation found that much of the care never was given.

Is your nurse an ex-con? - October 08, 2009
While there were no cameras at the Florida Board of Nursing meeting, the hearing was recorded. Waiting to have their cases heard were dozens of applicants hoping to become nurses for the first time or applying to have their license restored.

Two Kansas lawmakers seek probe into whether officials committed Medicaid fraud - October 08, 2009
Two Kansas lawmakers have asked Attorney General Steve Six to investigate whether state officials committed Medicaid fraud by giving extra funding to a politically connected Johnson County nonprofit.

State leaders trade accusations on Medicaid - October 08, 2009
Mississippi’s Medicaid director told lawmakers Wednesday that Attorney General Jim Hood has refused to prosecute a possible case of $24 million in fraud by a man paid to provide behavioral services to patients.

LA may shut medical pot dispensaries - October 07, 2009
A Los Angeles City Council committee Tuesday began considering a proposed permanent ordinance to require the immediate closure of hundreds of medical marijuana dispensaries that operate for profit.

Thousand of patients warned about theft of personal information - October 07, 2009
Thousands of patients at a Kern County health clinic have been warned their personal information could have been stolen.

Miami Medicare fraud defendant gets 8 years - October 07, 2009
A local medical equipment supplier convicted of Medicare fraud is sentenced to eight years in prison after having fled South Florida to evade prosecution.

Free Webinar on Helping Hospitals Control Healthcare-Associated Infections by Im - October 07, 2009
A free 40–minute webinar, Hand Washing for Healthcare Providers: A Critical Factor in HAI, is being sponsored by Compirion Healthcare Solutions, a hospital process improvement firm headquartered in Elm Grove, Wisconsin.

Obama's Expert on Medicare Fraud - October 06, 2009
Health–care czarina Nancy–Ann DeParle built a career at companies that have had to defend themselves against federal investigations.

Nationally Recognized "Qui Tam" Attorney Michael I. Behn Discusses Billion Dolla - October 06, 2009
Whistleblowers' lawyer Michael I. Behn of Behn & Wyetzner, Chartered, Chicago, Illinois will participate on a panel discussing new amendments to the False Claims Act, recent billion dollar Medicaid Fraud settlements against Lilly and Pfizer, and other developments concerning whistleblower lawyers.

Hospitals' charity care under scrutiny nationwide - October 06, 2009
One bill includes a proposal to improve community service, transparency, billing practices of nonprofit hospitals.

Two Buffalo hospitals among six seeking exemption from reform - October 05, 2009
Six hospitals in the state, including two in Buffalo, are asking lawmakers to exempt them from a bill to reform New York’s public authorities.

AG asks retirees to join sleuth program - October 05, 2009
Retired folks, often the target of con–artists, are now being recruited by the state of Arizona to help catch the swindlers in action.

Warrant issued for caretaker who billed state even after grandpa died - October 05, 2009
Medicaid recipient Lawrence Whitish died on Aug. 12, 2008. But a state’s attorney says his granddaughter – a government–funded care provider – continued to bill Medicaid for his ongoing care and claimed he was “fine.”

UHC Develops Resource for Recovery Audit Contractor Reviews - October 05, 2009
University HealthSystem Consortium (UHC) has announced the development of the Clinical Documentation Audit Profile, designed to assist hospitals with Recovery Audit Contractor (RAC) reviews.

Hospital Settles Civil Monetary Penalty Case Over Gifts to Physicians and Medica - October 05, 2009
For the first time, a hospital has settled a civil monetary penalty (CMP) case stemming from the gifts and travel expenses it gave to referring physicians. Memorial Hospital of Union County in Dayton, Ohio, has agreed to pay $31,202 to resolve an alleged Stark law violation over nonmonetary compensation that exceeded the law’s annual $355 per–physician cap.

CareMedic`s RAC Audit Solution Achieves Platinum Certification Status From Execu - October 04, 2009
Certification validates that Audit Management provides seamless inbound and outbound data exchange between Executive Health Resources and its hospital clients

SourceMedical's Therapy Software Division Takes a Leading Role in Therapy Docume - October 02, 2009
SourceMedical, a leading provider of outpatient information management solutions, announced today that it is taking a leading role in providing industry education to prepare therapy clinics for Medicare audits.

Three charged with Medicaid fraud - October 02, 2009
Three Jackson County individuals have been arrested on charges of defrauding Medicaid, Attorney General Bill McCollum announced in a news release Wedesday morning.

Nursing-home residents urge state to reconsider new Medicaid billing system - October 02, 2009
A little–noticed change in how the state pays for wheelchairs, physical therapy and other care has caused some Ohio nursing–home residents to lose services and others to fear that they could be next.

Sacramento-area hospitals use simple ways to cut mistakes - October 01, 2009
In this story about cutting–edge innovation in hospital care, you won't read about robots or nano–devices so small you need a microscope to see them. These next best things in health care are socks, sashes, work sheets and cards; homely items are transforming hospital care in Sacramento and around the country.

Hospitals Should Utilize Their In-House Data to Fight Auditors’ Fire With Fire - September 30, 2009
As recovery audit contractors (RACs) and other program–integrity contractors bear down, it’s becoming increasingly important for hospitals to analyze claims before and after they’re prepared for submission to determine what edits their claims are hitting repeatedly and what systemic changes would improve claims accuracy.

CMS to Stop Payment on Claims for Services Ordered by Non-Enrolled Providers - September 30, 2009
CMS is cracking down on claims for services that are ordered or referred by physicians who don’t participate in Medicare, even if the services themselves are Medicare–approved.

Marrero woman among three convicted of Medicaid fraud - September 28, 2009
A Marrero woman could face up to 270 years in prison and more than $7 million in fines after she was convicted in federal court Wednesday along with two other New Orleans women of Medicaid fraud.

A Hospital Hand-Washing Project to Save Lives and Money - September 28, 2009
While President Obama deals with the big picture, the chief hospital accrediting agency is turning its attention to what should be the most mundane of details: persuading health care workers to wash their hands.

Unfair labor practices charge dropped against hospital - September 28, 2009
A second charge of unfair labor practices against Boulder City Hospital has been dropped, but a union vote among its 300 nurses, housekeepers and other workers appears to be on hold while previous charges are appealed to the National Labor Relations Board in Washington.

Home health care firm owner sentenced in MA fraud case - September 28, 2009
The owner of a Braham–based home health care business will be required to pay $30,000 restitution as part of her Sept. 3 sentence for Medical Assistance (MA) fraud and can no longer be employed anywhere MA funds are received.

Federal Procurement Fraud Claims Likely to Rise - September 28, 2009
In this type of distressed economic situation, it is more important now than ever before for businesses to ensure they have effective and efficient corporate compliance procedures in place to protect themselves from federal procurement fraud claims.

Thousands Of Patients Affected By Hospital Burglary - September 28, 2009
Kern Medical Center Sends Out Notices To 30,000 Patients.

The Nursing Home Complaint Center Wants To Team Up With Personal Injury Law Firm - September 28, 2009
The Nursing Home Complaint Center Wants To Team Up With Personal Injury Law Firms To Stop Nursing Home Abuse & Medicare Fraud The Nursing Home Abuse Center intends to go after nursing homes, that abuse their patients, and wants to assist law firms that also have an interest in Medicare–Medicaid fraud, Class actions, and employee wage and hour issues.

Medicaid Fraud Unit increases its efforts - September 28, 2009
Wyoming's Medicaid Fraud Control Unit is looking for more business. But the agency cannot go shopping for cases of fraudulent Medicaid claims and instead must depend on outside referrals.

Audit: Expenditure controls inadequate in Va. program for disabled children - September 27, 2009
A state program for disabled children has inadequate internal controls over millions of dollars in benefit expenditures, according to an audit released yesterday.

Payment Reduction Policy For 'Efficiencies' Could Limit Patient Access To Care, - September 27, 2009
The American Physical Therapy Association (APTA) is urging against the adoption of payment policies outlined in a Government Accountability Office (GAO) report1 released Monday that recommends the Centers for Medicare and Medicaid Services (CMS) reduce Medicare payments for physical therapists and other health care providers who perform multiple procedures on the same patient on the same day.

Blue Cross sleuth says health care fraud is increasing - September 27, 2009
At Blue Cross Blue Shield of Michigan, Greg Anderson, vice president of corporate and financial investigations, has been tracking down health insurance fraud for more than 27 years.

Expanded team gets tougher on health care cheats - September 27, 2009
It is well known that Michigan and metro Detroit have a great national reputation for health care quality and innovation. Many top providers — including the University of Michigan Health System and Henry Ford Medical Group — are based in the state.

Nursing home worker claims she was fired after reporting abuse - September 23, 2009
An East St. Louis woman says she was fired from her job at a nursing home after persistently reporting a fellow employee's abuse of patients.

Tom C. Maynor Rehabilitation Center awarded three-year CARF accreditation - September 23, 2009
CARF International announced that Tom C. Maynor Rehabilitation Center at Riley Hospital has been accredited for a period of three years for its rehabilitation programs.

State fines Mercy San Juan hospital - September 23, 2009
Mercy San Juan Medical Center in Carmichael is one of 12 state hospitals recently hit with administrative penalties from the California Department of Public Health, state officials said today.

Adult day care worker sentenced for role in Medicare, Medicaid fraud plot - September 23, 2009
The manager of a Harlingen adult day care center was sentenced Wednesday to two years of government supervision for illegally referring patients to a corrupt doctor in exchange for bribes.

State assesses administrative penalties to county's hospitals - September 23, 2009
The state Department of Public Health said Thursday that it is assessing administrative penalties against 12 hospitals around the state – including Lake County's two hospital facilities – for noncompliance with licensure requirements.

Federal Study on Power Wheelchair Costs in Medicare Is Misleading and Ignores Co - September 23, 2009
In a study released yesterday, the Health and Human Services Office of Inspector General (OIG) ignored the substantial costs of services related to providing power wheelchairs, including complex rehab, to seniors and people with disabilities who require mobility assistance.

Motorized scooters frequently part of Medicare fraud cases - September 22, 2009
Wheelchairs and motorized scooters have become big business in the world of Medicare fraud.

Use of Interim Compliance Officers Meets Need for Internal Reviews and Buys Time - September 22, 2009
Hospitals and physician practices are increasingly hiring interim compliance officers (COs) for periods of six to 18 months. Usually they are lawyers or consultants hired to satisfy the sometimes overlapping needs of providers.

Medicare RAC Audit Preparation Identifies and Corrects Errors, Saving Thousands - September 21, 2009
Payment Automation Network, Inc. announced the launch of a new service for physicians, home health agencies, hospitals and durable medical equipment providers in preparation for the upcoming Medicare audit by the RACs.

3 Nashville-area hospitals join program to audit patient care, costs - September 21, 2009
At three Nashville–area hospitals under Saint Thomas Health Services, patients are being evaluated more closely to make sure that they get the right treatment plan and to determine if an overnight stay is necessary.

Hospital Corporation of America Joins Practice Greenhealth - September 21, 2009
Hospital Corporation of America, (HCA), which is composed of locally managed healthcare facilities that include 163 hospitals and 112 outpatient centers in 20 states and England, has joined Practice Greenhealth, the nation's leading group for organizations in the healthcare community that have made a commitment to sustainable, eco–friendly practices.

Pfizer Concludes Previously Disclosed Settlement Agreement With U.S. Department - September 21, 2009
Pfizer Inc today announced that it has finalized a previously reported agreement in principle with the U.S. Department of Justice (DOJ) to settle an investigation regarding past off–label promotional practices related to Bextra, which Pfizer voluntarily withdrew from the market in 2005.

Two Lehigh Valley Healthcare Leaders Collaborate to Deliver Safer, High-Quality - September 21, 2009
Good Shepherd Rehabilitation Network Improves Safety and Medication Accuracy with B. Braun Medical Inc.'s Industry–Leading, Safety Infusion 'Smart Pumps'

Rehab institute earns accreditation - September 21, 2009
The Orlando Health Rehabilitation Institute has received a three–year accreditation from the Commission on Accreditation of Rehabilitation Facilities for each of its 13 programs.

AAMC revamps cardio rehabilitation program - September 21, 2009
A rehabilitation program at Anne Arundel Medical Center has been so busy that the staff was forced to make some changes to accommodate everyone.

Raleigh couple accused of Medicare fraud - September 20, 2009
A Raleigh couple is under federal investigation for allegedly pocketing nearly $13 million since 2007 from false Medicare claims for motorized scooters, powered wheelchairs and other medical equipment.

GT Alert: New Provision in Medicare Program Integrity Manual is Effective on Sep - September 20, 2009
The Centers for Medicare & Medicaid Services (CMS) has published a new manual provision that will severely restrict the use of consignment closets in physician offices by suppliers of durable medical equipment, orthotics and supplies (DMEPOS).

Study Says Privacy Rule Costs Underestimated and Questions to Ask Your Vendor Ab - September 20, 2009
The final privacy rules for hospitals and health systems could cost $22.5 billion over five years –– far exceeding original government projections, according to research prepared by First Consulting Group for the American Hospital Association (AHA).

Claims Auditor Solution from Compliance 360 Chosen by More Than 200 Hospitals - September 20, 2009
Increasing Financial Threats from Medicare and Medicaid Recovery Audits Drives Rapid Adoption of Industry–Leading Solution for Defending Legitimate Revenues.

State physical therapy board chief resigns - September 20, 2009
The state Board of Physical Therapy's chief administrator and an office assistant have resigned amid an investigation into a $475,000 phone bill charged to the agency by a Taiwanese scammer.

VA Compensation will be Paid for Medical Notification Error - September 19, 2009
The U.S. Department of Veterans Affairs has promised to compensate veterans who were mistakenly notified that they have Lou Gehrig’s disease due to a VA medical mistake acknowledged earlier this week.

Negligence Suits Likely Over VA Procedures - September 18, 2009
A problem with sterilization practices at a VA facility in Tennessee was discovered in December, and the department has notified more than 11,000 veterans who had endoscopic procedures at three of its facilities that they may have been exposed to cross–contamination.

Phony patients facing charges - September 18, 2009
Hospital patients who gave false names were once merely a headache for hospital administrators. Now, those who are discovered are likely to face criminal charges.

Detroit Area Physical Therapist Pleads Guilty to Causing More Than $1.6 Million - September 18, 2009
Detroit area physical therapist Jay Jha, 45, pleaded guilty today to participating in a conspiracy to defraud the Medicare program of approximately $18.3 million.

Waterloo hospital pays feds $4.5 million - September 18, 2009
A Waterloo hospital has agreed to pay $4.5 million to the federal government to settle allegations that it overpaid physicians in an illegal scheme to boost its business.

Operators of Assisted Living Facilities Charged - September 18, 2009
A trio from Jacksonville is busted for operating illegal assisted living facilities.

Two women fined thousands for Colorado Medicaid wheelchair fraud - September 18, 2009
Two employees of wheelchair companies have been ordered to pay thousands of dollars in restitution for running Medicaid fraud scams.

Health plan examines payments - September 17, 2009
Officials say some hospitals did not notify them of rate changes and may have been overpaid.

Cleveland hospital warned about corruption - September 17, 2009
Officials at the city's public hospital were warned five years ago about problems with construction contracts approved by a former executive accused of taking more than $600,000 in bribes, a newspaper reported Sunday.

Crackdown on workers' comp billing fraud is dealt a setback - September 17, 2009
California's powerful insurance lobby has quietly scuttled an effort to combat fraudulent medical billing that drains hundreds of millions of dollars from the state's workers' compensation insurance system.

Medicare pay for services by nonphysicians comes under scrutiny - September 17, 2009
OIG finds the "incident to" rule is allowing care to be provided by nonphysicians who lack the necessary qualifications.

Physical therapy agency chief hired husband as maintenance worker - September 17, 2009
Two years before the West Virginia Board of Physical Therapy got stuck with a $475,000 phone bill after a Taiwanese scammer stole the board's conference call access code, the agency's chief administrator was cited for hiring her husband as a part–time maintenance worker.

Data From HHS Office of Inspector General Reveal Excessive Billing for Services - September 14, 2009
For the first time, the HHS Office of Inspector General has determined that a significant number of services billed by certain physicians are performed by unqualified nonphysicians.

Compirion Hosts Free Webinar on Achieving JCAHO-Compliant Quality Outcomes - September 14, 2009
A webinar on JCAHO Emergency Department Core Measures: Achieving Successful Quality Outcomes is being presented by Compirion Healthcare Solutions to aid Hospital Emergency Departments in instituting treatment standards as defined by the Joint Commission, for AMI, CHA and CAP patients.

New York fines one limited benefit plan, reviewing others - September 14, 2009
New York officials are examining the marketing practices of companies selling limited benefit health insurance plans in the state, after fining one company $700,000 for violations of state insurance law.

California Attorney General Arrests Individuals for Medicare Fraud and Rip-off - September 13, 2009
Attorney General Edmund G. Brown Jr. announced that agents from his office late last night arrested two individuals who bilked Medicare out of $678,000 by submitting phony bills for walkers, wheelchairs, diabetic shoes and even body braces and canes, using the proceeds for luxury goods including a gold–colored Hummer H200.

Auditors warn Utah Medicaid is likely wasting millions of taxpayer dollars - September 12, 2009
Millions of tax dollars are likely being wasted in Utah's Medicaid program on procedures –– including a breast augmentation and nose jobs –– that aren't covered by the government insurance program, according to a scathing legislative audit released Tuesday.

Durable Medical Equipment Company Owner Convicted in Medicare Fraud Scheme - September 12, 2009
According to the Indictment and evidence admitted at trial, defendant Ortiz controlled and operated Daky Medical Supply, Corp. ("Daky Medical"), located in Miami, FL. Daky Medical purportedly provided durable medical equipment to Medicare beneficiaries.

Stop the Medicare scams
Medicare must cut payments for fake diabetic treatme - September 12, 2009
This particular scheme involves home visits to inject insulin for elderly patients with diabetes –– a rare service in most of the nation.

Promises of Better Care Baffle Hawai‘i’s Elderly and Disabled - September 10, 2009
Concerns continue to plague state’s switch to HMO plans to manage Medicaid benefits for the blind and elderly. “There’s a lot of frustration, confusion, nobody responding to your calls.”

Medical errors ignored 10 years - September 10, 2009
Long–term research and studies are meaningless if the findings are casually tossed aside and ignored.

National Pharmacy Omnicare Pays ‘Unusual’ Settlement to Resolve Charges of Gener - September 08, 2009
Omnicare, Inc., which calls itself “the nation’s leading provider of pharmaceutical care for seniors,” paid $283,000 to settle Medicaid fraud charges by the State of Delaware. Delaware alleged that the pharmacy had committed Medicaid fraud by illegally switching the drugs of senior citizens in nursing homes and other facilities.

How to prepare for your next Medicare audit - September 08, 2009
With potential changes coming in Medicare, there are important things that skilled nursing facilities need to do to prepare themselves. It is not just about prevailing through an audit—it is about improving patient care and improving outcomes.

Technology enlisted to reduce errors
Scanning systems are said to work well, - September 08, 2009
Both of these systems were designed to fix the two places where medication errors commonly occur in a hospital –– the doctor's prescription pad and the nurse's morning medication rounds. Some research suggests that hospitals using both systems could catch most medication errors.

Settlement in fraud case against Shelby County couple is $1.44 million and priso - September 08, 2009
A 2008 federal investigation sparked by a whistleblower complaint led to a $1.44 million civil settlement against a Shelby county couple in a Medicare fraud case, U.S. Attorney Joyce White Vance announced late Friday.

Health care fraud widespread -- in public and private sectors - September 05, 2009
Health care entities have been found responsible for 80% of fraud, as federal officials crack down on fraud as part of health system reform.

In-house Compliance Hotlines Can Provide a Wide Range of Assistance to Employees - September 05, 2009
Rather than outsourcing to a hotline vendor — a common practice in the health care industry — Carilion’s compliance department takes its own calls and keeps the hotline (called “ComplyLine”) open for all types of employee inquiries.

Florida Investigating Use of Health Insurance Databases Linked to Fraud - September 05, 2009
Florida insurance regulators are investigating health insurers' use of scandal–tarred databases used in billing for out–of–network medical care.

Healthcare Chronicles: Crime Doesn't Pay - It Gets Reimbursed - September 05, 2009
Health care fraud costs our society between $70 billion and $300 billion per year. The government is aware of the problem but evolutions in our government and social developments have shifted resources from one area of interest to another.

Hospitals Risk False Claims Cases for Not Reporting Adverse Events - August 28, 2009
Adverse–event reporting is a hot topic on the state and federal level, and where reporting is required, failure can result in criminal or civil penalties and licensure problems. Now it turns out that the Department of Justice sees fertile grounds for False Claims Act cases in this area as well.

Physical therapist accused of assaulting patient - August 25, 2009
An Austin physical therapist has been accused of sexually assaulting a patient during an office visit.

Medicaid fraud crackdown pays off - August 25, 2009
South Carolina recovered $4.4 million more in Medicaid fraud and abuse collections from health–care providers in fiscal 2009 than it did the year before.

Woman Accused Of Striking Elderly Patient - August 25, 2009
A Broward woman is charged with abuse on a nursing home resident who was under her care.

Lawmaker Says State Needs Background Checks For Nurses - August 25, 2009
A 7NEWS investigation has found a nurse accused of stealing medications from a Denver hospital lied on her nursing license application, and now a state lawmaker says the law should be changed.

State of Washington Awards Program Integrity Contract to Ingenix - August 23, 2009
The Washington State Department of Social and Health Services (DSHS) has awarded a $19 million, five–year contract to fight and prevent Medicaid fraud, waste and abuse to Ingenix, a leading information, technology and consulting services company.

CMS Moves to Ease Outpatient Compliance by Allowing Supervision by Non-Physician - August 23, 2009
CMS’s recently proposed changes to physician supervision requirements for outpatient services should allow hospitals to achieve compliance with less financial strain, lawyers and compliance officers agree.

Physical Therapy Clinic Owner Charged in Multi-Million Dollar Fraud Case - August 22, 2009
The owner of City Nursing Services of Texas Inc., an alleged Houston physical therapy clinic, has been indicted for conspiring to commit health care fraud, health care fraud, mail fraud and money laundering arising from an alleged multi–million dollar health care fraud scheme.

DiNapoli nails medical providers on billing - August 19, 2009
Comptroller Tom DiNapoli has found three medical providers have overbilled the state about $1.3 million. The firms, in Nanuet, Albany and Warrensburg provided routine physical therapy but charged them for the costlier TENS or Transcutaneous Electrical Nerve Stimulation, according to audits.

Watertown whistleblower gets $10 million in Medicaid fraud suit against New York - August 19, 2009
A former Watertown woman will pocket $10 million in a record–breaking settlement of a Medicaid fraud whistleblower suit against the state and New York City, the Justice Department said today.

$Billions in Medicare/Medicaid lost to fraud, abuse - August 19, 2009
Missing from President Barack Obama's health care program pitch last night was the likelihood that increased government control will also mean increased fraud, corruption and abuse of the system.

New York State and New York City to Pay Record $540 Million to Settle Allegation - August 18, 2009
The state of New York and New York City have agreed to pay $540 million to settle allegations that they knowingly submitted, or caused to be submitted, false claims for reimbursement for school–based health care services, primarily speech therapy and transportation, provided to Medicaid eligible children from 1990 to 2001.

New Federal, State Laws Raise the Stakes When Dealing With Employees Who Snoop I - August 12, 2009
The law also requires CMS and the HHS Office for Civil Rights to investigate complaints where a preliminary inquiry shows that “willful neglect” is the cause. And the law raised the penalties the government can hand down.

Ads about free medical scooters often lack wheels - August 12, 2009
Used to, The Scooter Store guaranteed it was free. But after the federal government cracked down on the firm over its billing practices, including false promises about what Medicare or Medicaid would cover, the wording changed.

Six Are Charged in Medicaid Fraud Scheme - August 12, 2009
Six people have been charged with stealing more than $47 million from Medicaid in the past 10 years, accused of using an elaborate system of corporations to mask their involvement while collecting the funds in New York State, Attorney General Andrew M. Cuomo’s office announced in a news release on Thursday.

Local man sought in Medicaid fraud - August 11, 2009
Authorities are seeking a former nursing home employee they believe falsified patient records in order to get drugs for himself.

Physician Hospitals (PHA) Responds to TIME Magazine Article: Filled With 'Incorr - August 05, 2009
The TIME Magazine article "How Healthcare Reform Could Hurt Doctor–Owned Hospitals" (7/13/09) correctly states that physician owned hospitals would be hurt by pending health reform legislation; however, there is little else in the article that can pass as anything more than incorrect assumption and innuendo says Physician Hospitals of America (PHA).

Billing dispute leaves naval families without therapy for children - August 04, 2009
A billing dispute between a military health benefits contractor and a rehabilitation services company has left scores of First Coast naval families scrambling to find new therapists for their children.

Nursing aide charged with voyeurism for phone picture incident - August 04, 2009
State prosecutors charged a male nursing aide last week with voyeurism for allegedly taking a picture of an exposed patient at a Salt Lake rehabilitation center.

Medicaid problems swell in new system
Rollout delayed as private firm works - August 04, 2009
Indiana's nearly 2–year–old experiment with a privatized welfare system appears to be failing. The backlog of pending Medicaid applications has ballooned in counties where welfare is handled by private contractors.

Stolen Medicare cash may have been sent overseas - August 04, 2009
In a probable cause hearing Tuesday, Umawa Oke Imo, 54, of Nigeria was accused of operating a multimillion dollar health care fraud scheme at a physical therapy clinic at 9888 Bissonnet in Houston.

Fifty-Three Indicted in Health Care Fraud Investigation - August 04, 2009
Fifty–three people have been indicted for schemes to submit more than $50 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Detroit.

Brooklyn Doctor Charged With Workers’ Compensation Fraud - July 27, 2009
Federal prosecutors charged in an indictment Friday that a Brooklyn doctor defrauded workers’ compensation insurers by seeking reimbursement for procedures he did not perform, including some that he said he had done in his office at times when he was actually in Latin America.

Court rejects physician challenge to change in self-referral rule - July 27, 2009
A federal trial court turned down a challenge brought by a group of physicians and physician–owned entities to a recent change in the federal self–referral rules that doctors worry could harm patient care.

Medicare fraud suspect from Miami-Dade flees country - July 26, 2009
Two Miami–Dade men were charged in one of the region's biggest Medicare fraud cases. One was arrested; the other fled the country.

Surprises Arise as Hospitals Struggle With FTC's Red Flags Rule - July 22, 2009
As hospitals and health systems implement the FTC Red Flags Rule, they are confronting unanticipated challenges. These challenges include unforeseen compliance angles involving post–acute care and the National Patient Safety Goals, and patient misrepresentation that can set off alarm bells but isn't necessarily what it seems.

New York Charges Doctors, Hospital Employees with No-Fault Fraud - July 21, 2009
New York Attorney General Andrew M. Cuomo announced the indictment of 12 people and 9 corporations across New York City for their roles in an alleged criminal enterprise that paid hospital employees for confidential patient information, lured patients into receiving unnecessary treatment, and then submitted more than $1 million in phony personal injury claims to insurance carriers.

Fear of nursing homes shouldn’t thwart rehab - July 20, 2009
It is important to recognize the benefits of rehabilitation for someone who is recovering from a medical problem such as a stroke, hip fracture, knee replacement or injuries from a fall.

Tennessee Medical Assn. sues collections firm - July 17, 2009
Health Research Insights has contacted physicians in several states this year trying to collect alleged overpayments.

Five-Star makes complaints against nursing homes even more serious - July 16, 2009
The Centers for Medicare & Medicaid Services showcases the Five–Star Quality Rating System as an excellent source of information to aide the public in selecting a nursing home. But many believe that it will soon serve as the platform for public and private ratings programs such as "pay–for–performance."

Physicians snared by growing Medicare fraud strike team - July 16, 2009
The indictments are the first major actions since the Depts. of Justice and HHS expanded a joint Medicare fraud initiative last month.

Stop Medicare scammers - July 16, 2009
Last month, the U.S. Department of Justice busted a Medicare fraud ring in Miami, indicting eight suspects who allegedly cheated the government out of $30 million. That same week, the agency arrested 40 people in Detroit and Miami on similar charges of defrauding Medicare out of $50 million.

Department of Justice charges 16 in multi-million dollar Medicare fraud schemes - July 11, 2009
In the span of less than a week, the U.S. Department of Justice secured indictments on 16 Miami–Dade County, Fla., individuals linked to Medicare fraud schemes totaling more than $120 million.

Government moves to staunch massive Medicare fraud - July 11, 2009
Since 2006, U.S. taxpayers have paid nearly $155,000 to send home health nurses to inject twice–daily insulin shots for an elderly, diabetic Miami man.

Optimizing Asset Management, Equipment Utilization More Essential Than Ever - July 08, 2009
If you’re a biomed, then chances are you know firsthand the frustrations associated with trying to track down medical equipment and maintain a consistent, reliable preventive maintenance schedule.

Consumer Action / Proposal would require hospitals to screen patients for MRSA - July 08, 2009
Legislation recently introduced in Congress would require hospitals to screen patients to identify those who are carriers of MRSA, to help prevent the spread of the infection by identifying which patients need special handling.

Medicare fraud suspect a no-show in court, is declared a fugitive - July 08, 2009
A Miami man charged in a $100 million Medicare scam stretching across five southern states has been declared a fugitive after he failed to show up for a pretrial bond hearing Friday morning in federal court, authorities said.

Calculating insurance interests - July 08, 2009
LAST WEEK, three insurance executives made starkly clear why President Obama is right to insist on a public–plan option in any health reform package. The three stood before Congress and refused to stop the practice of canceling coverage of sick policyholders for unrelated medical reasons, even in cases where the firms can’t show intentional fraud by the policyholders.

Using Your ECM System To Simplify RAC Audits - July 08, 2009
If you are involved in any way with the administrative end of a healthcare facility, you are well aware that there are many factors that have to converge behind the scenes in order for a facility to operate effectively. A critical component to smooth operations and stellar patient service is the ability to locate, access, and disseminate information.

AMA meeting: Physician supervision of nurses sought in all practice agreements - July 08, 2009
AMA delegates also debated the National Board of Medical Examiners' role in a new doctor of nursing practice certification exam.

Justice Department Intervenes in Americans With Disabilities Act Lawsuit Against - July 08, 2009
The Justice Department today announced that it has moved to intervene in a lawsuit filed in federal court in Jackson, Miss., challenging inaccessibility in Jackson's public transportation system.

Eight Miami-Area Residents Charged in $22 Million Medicare Fraud Scheme Involvin - July 07, 2009
Eight Miami–Dade County, Fla., residents have been indicted in connection with an alleged $22 million Medicare fraud scheme operated out of Miami businesses purporting to specialize in home health care services.

Glenwood review finds progress - July 07, 2009
The Glenwood Resource Center is one step closer to complying with a 2004 court order to improve resident care. The U.S. Department of Justice says the state–run care facility's clinical care and nutritional services are now in substantial compliance with the standards spelled out in the court order.

HCPC Calls for Greater Healthcare Savings Through Improved Adherence to Prescrip - July 07, 2009
With today's announcement that the Pharmaceutical Research and Manufacturers of America (PhRMA) has offered to voluntarily grant some $80 billion in discounts to Medicare beneficiaries over the next decade in an effort to reduce overall healthcare costs, the Healthcare Compliance Packaging Council (HCPC) noted that far greater savings can be achieved if immediate steps are taken to help people take their prescription drugs properly.

Justice Department Files Complaint and Reaches Settlement to Improve Conditions - July 07, 2009
The Justice Department announced today a simultaneous lawsuit and settlement with the state of Texas concerning the care given to residents of the state's 13 facilities for persons with developmental disabilities.

Medicare Fraud Strike Force Operations Lead to Charges Against 53 Doctors, Healt - July 07, 2009
Fifty–three people have been indicted for schemes to submit more than $50 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Detroit.

8 Miami-Dade home healthcare providers jailed in Medicare fraud scam - July 07, 2009
FBI agents arrested eight Miami–Dade residents at their homes early Friday on charges of fraudulently billing Medicare for $22 million by charging for nurses to treat mostly homebound diabetic patients –– many of whom didn't have the disease or didn't receive the services.

How to Eliminate Fraud From the Health-Care System - July 07, 2009
If the U.S. can cut out fraud from the health–insurance system, we can all save a lot of money and get better care. That’s something just about everyone can agree on. What’s tougher, of course, is actually trying to root out the fraud, or even defining what exactly “fraud” is.

Atlantic Financial Consulting Launches a Nationwide Physician Coding Audit Servi - July 05, 2009
With Medicare audits on the rise due to the Medicare Recovery Audit Contractor (RACs) audits that have been implemented in all 50 states by the Centers for Medicare and Medicaid Services (CMS), it's essential that physician practices have a compliance plan in place and that they are properly coding and documenting their patient encounters in accordance with Medicare guidelines.

Florida probes Miami-area medical-equipment kickbacks - July 05, 2009
Medicaid investigators are targeting fraud in Miami–Dade County, zeroing in on questionable billing for medical equipment.

Public Comment Period Open for HIPAA Privacy and Security Standards - July 04, 2009
As part of its commitment to a comprehensive review of its standards, URAC, a leading health care accreditation and education organization, today called for public comment on revisions to its Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security standards.

Healthcare owner convicted of Medicare fraud gets jail sentence; whistle-blowers - July 04, 2009
Two whistle–blowers who reported a business owner for Medicare fraud left Wednesday for an island vacation while Janice Davis of West Monroe prepares to spend time in a federal prison.

Patients fume over Cleveland Clinic fee; hospital not alone in levying facility - July 04, 2009
The Clinic isn't the only hospital that charges the "facility fee" or "hospital services fee" for doctor visits and other services it provides at its outlying medical centers. MetroHealth Medical Center, University Hospitals Case Medical Center, and Lake Health (formerly Lake Hospital System) charge them in some cases, too.

State wants Oak Lawn nursing home closed - June 30, 2009
Illinois public health officials plan to try to close an Oak Lawn nursing home despite the fact that Regal Health and Rehab Center now is complying with state regulations.

Multiple personality raised at LI woman's fraud trial - June 28, 2009
Michel is charged with operating a $26–million Medicaid fraud and violating the privacy of patients at nursing homes around Long Island by stealing their records.

Workers' comp insurance about to jump - June 27, 2009
Five years after California reined in skyrocketing workers' compensation insurance rates, employers are facing another round of rate increases, blamed largely on rising medical costs.

HCCA Web Conference Offers Forum on Medicare's Nationwide Rollout of the Recover - June 27, 2009
As the Centers for Medicare and Medicaid (CMS) Recovery Audit Contractors (RAC) prepare to contact health care providers as early as late June or early July, the Health Care Compliance Association (HCCA) announced it will hold a critical and timely web conference on June 23, 2009, Advance RAC Forum: Questions and Answers with CMS and Leading Providers about the New RAC Rollout. Click on the following link to register: http://www.hcca–info.org/RAC.

Versus Introduces Automated, Real-Time Hand Hygiene Compliance Solution - June 27, 2009
Hand Hygiene Compliance (HHC) is paramount to patient safety and the reduction of hospital acquired infections –– but monitoring adherence to HHC policies has traditionally been done through observation, which is difficult and inaccurate, if not downright impossible.

Day programs for seniors and Alzheimer's patients may be eliminated - June 26, 2009
Caregivers throughout California are up in arms over proposed state budget cuts that would eliminate day programs for seniors and those with Alzheimer's disease.

Families plead for disabled program
Board challenged to look beyond numbers - June 26, 2009
Dozens of anguished families and caregivers begged top state officials not to cut in–home services such as adult companions and respite care Thursday and blasted the state Department of Disabilities and Special Needs for failing to tell them of the proposed changes and the public hearing until cuts were imminent.

How Safe Are Your Medical Records? - June 24, 2009
In October 2008, hackers broke into a data goldmine at the University of California, Berkeley. They infiltrated 20 separate databases kept on a server at the health services center and over a span of six months, stole Social Security numbers, birth dates and addresses.

Insurers ranked on payment records
Bay State doctors waited longest for Mass - June 22, 2009
The state government Medicaid plan known as MassHealth, which covers low–income patients who can't afford insurance, was the slowest payer of health claims to Massachusetts doctors last year, averaging 56 days, and denied the highest share of claims, 23.8 percent, according to rankings set to be released today.

Family claims fraud in nursing home lawsuit - June 22, 2009
The family of an elderly Bridgeton woman claims a Millville nursing home intentionally misled them by promising she could remain in the facility after she depleted her personal savings, and then threatening her with eviction when she did, according to a lawsuit.

Cahokia Nursing and Rehabilitation Center sued over resident's care - June 22, 2009
Velma H. Penberthy filed a lawsuit May 18 in St. Clair County Circuit Court against Cahokia Nursing and Rehabilitation Center.

Blowing whistle pays off big for fortunate few - June 22, 2009
Since 1986, more than $20 billion has been paid out in fraud lawsuits brought by whistleblowers. It has made some midlevel bureaucrats very rich.

Turning a Blind Eye: Hospitals Fail to Discipline Doctors, Exploit Loopholes to - June 22, 2009
Though a federal law requires hospitals to report physicians who have had their admitting privileges revoked or restricted for more than 30 days, a Public Citizen report released today found that in addition to inadequate discipline of physicians, hospitals routinely exploit loopholes to avoid government requirements, with nearly half of all hospitals not submitting a single doctor's name to the National Practitioner Data Bank (NPDB) in the more than 17 years it has existed.

Vanguard Healthcare Solutions Acquires Rights to Rehab Integrity Pro Software - June 22, 2009
Vanguard Healthcare Solutions today announced it has acquired the rights to Rehab Integrity Pro, the health care industry’s leading physical medicine compliance software.

Hospitals Set Strict Limits on Employees Accepting Gifts Amid Greater Government - June 22, 2009
The goal of gift and entertainment restrictions is to avoid the appearance of impropriety and to prevent improper influence over decision makers at the hospital, according to compliance experts who were interviewed by RMC and who spoke in a May 12 HCCA/SCCE audioconference.

Healthcare challenge:Administrative ripple effects - June 21, 2009
The sheer complexity of health insurance fosters myriad cost ripples at the provider level almost like the tsunami that follows an earthquake on the ocean floor. Almost half of staff members (43.6 percent) at a typical physician’s office are devoted to clerical rather than clinical tasks.

Texas-Based Regency Nursing and Rehabilitation Centers to Pay U.S. $4 Million to - June 21, 2009
Regency Nursing and Rehabilitation Centers Inc. nursing home chain will pay the United States $4 million to settle allegations that Regency submitted false claims to Medicare and the Texas Medicaid program.

Occupational therapist has license suspended - June 21, 2009
A Forest City occupational therapist has lost her license to practice for 14 days, agreed to complete continuing education and received a fine of $1,000 in disciplinary action by the Iowa Board of Physical and Occupational Therapy.

11 home healthcare providers charged with fraud - June 21, 2009
Eleven home healthcare providers from Long Beach and surrounding communities were facing felony charges Thursday after investigators caught them reportedly billing the state on behalf of dead and imprisoned clients.

Panama City Office Under Investigation by Medicaid - June 21, 2009
Florida’s Agency for Health Care Administration (Agency) today announced an investigation into Medicaid billings by Durable Medical Equipment (DME) providers in Bay County.

Surprise man pleads guilty in wheelchair fraud case - June 20, 2009
The owner of a Cave Creek medical–supply business pleaded guilty to Medicare fraud after filling unnecessary prescriptions for motorized wheelchairs, making about $2,000 profit from each chair.

Feds claim fraud by health care CEO - June 20, 2009
Major donor to local causes, from a family renowned in Nashville business lore, is at center of $18M suit over alleged scheme to overbill Medicare for nearly 20 years

Hospital strains to cut elder care costs - June 20, 2009
Massachusetts General Hospital launched a pathbreaking effort to cut medical costs by reducing hospital stays and emergency room visits by the frail elderly – an initiative that underscores just how hard it will be for the medical industry to make good on its promise to President Obama to pare healthcare spending by $2 trillion over the next decade.

Accounting for Disclosures in Electronic Health Records Could Be a Time Bomb Wai - June 18, 2009
The new accounting of disclosures requirements for EHRs under the HITECH Act dictates that providers log all disclosures made through EHRs — including those made for treatment, payment and health care purposes — and report them to patients when requested.

U.S. and 16 States Join Suits Against Pharmaceutical Giant, Wyeth - June 17, 2009
Drug Company Allegedly Failed to Pay Hundreds of Millions In Rebates to Medicaid Program

Grand jury indicts woman on Medicaid fraud - June 17, 2009
A federal grand jury has indicted a former preschool owner from Eagle on 51 felony counts of defrauding state and federal Medicaid programs out of at least $100,000.

In patients' hunt for care, doctor database 'a place to start' - June 17, 2009
The company's approach exploits a wealth of commercially available information. Unbeknownst to most patients and many physicians, countless details of a doctor's professional activities — from procedures to referrals to prescribing records — are readily available, at a price, to marketers, medical information firms and drug companies.

Nursing Home Sexual Abuse Committed by One Nurse Aid at Two Facilities - June 15, 2009
A New York nursing home worker, who was already facing criminal charges for sexually abusing residents last summer, now faces new charges related to alleged abuses that occurred at another nursing home where he worked months earlier.

Care Point had state OK, Westchester says - June 15, 2009
A pediatric clinic accused of using unlicensed special–education therapists was on a list of state–approved providers, Westchester County officials said this week.

Medicare DME bidding program set to relaunch in 2010 - June 15, 2009
The White House gives the green light to competitive bidding over vigorous objections from equipment suppliers and some lawmakers.

Improve Medicare oversight, Miami's U.S. attorney tells Senate - June 15, 2009
Miami's R. Alexander Acosta told a U.S. Senate panel that fixes need to be made at the top to stem the tide of Medicare fraud.

Illegal physical therapist gets jail - June 08, 2009
An Industry man changed his plea to guilty and was sentenced Monday on charges stemming from his practice of physical therapy without a license at a Farmington nursing home.

West Tennessee Healthcare Adopts Quality and Compliance Solution from MedeAnalyt - June 05, 2009
MedeAnalytics, a leading healthcare performance analytics company, announced the successful adoption of its Quality and Compliance Analytics solution at West Tennessee Healthcare.

Former New Albany couple sentenced in wheelchair scam - June 05, 2009
The wife and business partner of a former Worthington businessman connected to a wheelchair insurance scam were sentenced today in a Virginia courtroom.

Former HealthEssentials business manager indicted - June 05, 2009
A federal grand jury has indicted the former business manager of bankrupt Louisville company HealthEssentials Solutions for health–care fraud.

Care Facility Operating Without License - June 05, 2009
A Broward County woman has been arrested for operating an assisted living facility without a license and abusing a disabled adult in her care.

Government-Run Health Insurance Program Made Almost $19 Billion in Improper Paym - June 04, 2009
Medicaid, the government–run health insurance program for low income people that is administered by state governments and funded by federal taxpayers, made almost $19 billion in improper payments in 2008.

Healthcare IT Provider MedPlexus Releases “Three Things Every Doctor Should Know - June 02, 2009
Following the stimulus bill’s passing, the medical community is seeking to understand how the more than $19 billion in healthcare IT implementation incentives will be distributed and what is required to receive them. Based on queries from its customers, MedPlexus, a leading provider of software solutions to medical practices, released today a brief guide entitled “Three Things Every Doctor Should Know About the Stimulus Bill Incentives.”

Six in Ten Say Family Put Off Medical Care Due to Cost - June 02, 2009
Public continues to support action on health reform, including public plan and some tax changes. But argument testing shows opinion is malleable and will hinge on actual debate

Glendale therapy whistleblower case settled - May 21, 2009
A Glendale physical therapy company that contracts with Southern California Hospitals to operate hospital therapy departments, as well as its owners and operators, have paid the government $233,345 to resolve allegations in a "whistleblower" lawsuit that they caused the submission of false claims to Medicare.

Assisted living homes assailed - May 21, 2009
The 48–page report tells the stories of several elderlyresidents like Hunisch, who were allegedly involuntarily discharged or threatened with discharge from the company's facilities when they drained their personal savings and became eligible for Medicaid.

9 arrested in Medicaid fraud scheme - May 21, 2009
Nine people were arrested Wednesday in an alleged Medicaid fraud scheme that cost the federal program thousands of dollars for services not rendered, state Attorney General’s Office officials said Thursday.

Therapy company to pay in fraud claims - May 16, 2009
Business’ resolution represents growing number of cases in which health–care fraud is suspected.

Legislation Aims to Increase Access to Physical Therapist Services By Eliminatin - May 06, 2009
Medicare beneficiaries who need physical therapist services would find it easier and more efficient to obtain treatment under legislation introduced yesterday in the US House of Representatives.

Nursing Home Abuse Continues to be a Scourge - May 06, 2009
Last inspected on May of 2008, Pinelake was given an overall five–star rating, which translates into 'much above average.' However, the same cannot be said for many other nursing homes across the country, or the nursing home industry as a whole.

Cases involving Houston physical therapy clinics show scope and cost of Medicare - May 06, 2009
The United States Court of Appeals for the Fifth Circuit has affirmed the sentence of Wesley Alford Boyd, Jr., in a criminal case that arose out of Medicare and Medicaid fraud at six Houston–area physical therapy clinics.

Synergy Physical Therapy raises awareness about plight of uninsured - May 06, 2009
There is a national call to health–care reform, and locally, Synergy Physical Therapy and Wellness, 4510 Collins Blvd., is leading the charge to raise awareness during Cover the Uninsured Week.

Costly Home Health Care - May 06, 2009
Health care reformers have long advocated providing more care to patients in their own homes or communities instead of treating them in costly institutions like hospitals and nursing homes. The problem is compounded by fraud.

Fraud, abuse up cost of Medicare - May 06, 2009
Fraud and abuse helped boost Medicare spending on home–health services 44 percent over five years because some providers exaggerated patients' medical conditions and others billed for unnecessary services or care they did not provide, a Government Accountability Office report out today says.

The five-star nursing home rating system is bad policy, hastily implemented - May 06, 2009
CMS intended for this system to make it easier for residents and their families to shop for care based on a “quality rating.” Unfortunately, the hastily implemented system is far from easy to understand and, based on our analysis, it often does a poor job of accurately identifying “quality” facilities.

Nava Spearheads Legislation to Increase Access to Health Care Services - April 23, 2009
AB 721 will allow physical therapists to act within their scope of practice and initiate immediate treatment to patients seeking relief from pain and injury without the need for a physician diagnosis.

'Direct Access' Can Save Patients Time, Money For Physical Therapy - April 23, 2009
Under Direct Access, a patient can go directly to a physical therapist without a doctor's referral, and in most cases, insurance will pick up the tab.

More abuse by care-givers - April 22, 2009
As reported in Sunday's Saginaw News, state inspectors determined this really happened to a resident at St. Francis Home in Thomas Township, leaving him with a mark on his nose and in a state of "increased anxiety." It also left his family "amazed."

Family of abused patient forgives living center fined $129,000 - April 11, 2009
Now, his family, who asked The Saginaw News not to use names out of concern for the patient's privacy, is forgiving the nursing home after learning that two workers abused him in December.

Inspections revealing -- State Web site posts ratings of Saginaw County nursing - April 11, 2009
Choosing a nursing home is an emotional decision, and families should do so using state inspection data as well as their eyes and ears, professionals advise.

Individual Sentenced for Practicing Physical Therapy Without A License - April 11, 2009
An investigation initiated by special investigators with the Ohio Bureau of Workers’ Compensation (BWC) ended with today’s federal sentencing of Michael W. Stinson, owner of Reconditioning & Exercise Physiology Specialists (REPS) in Loveland.

Man Sentenced For Illegally Performing Physical Therapy - April 11, 2009
A man who pleaded guilty to performing physical therapy on injured workers without a license will spend more than three years in prison.

3 charged in Medicare fraud, identity theft case - April 11, 2009
A husband and wife who ran a physical rehabilitation center in San Diego allegedly defrauded Medicare of more than $1.3 million by stealing the identities of seniors and filing false claims under their names, state regulators said yesterday.

Hundreds of disabled Nevada children at risk of not getting therapy they need - April 11, 2009
Right now the fight is on to make sure hundreds of disabled children across Nevada get the Physical Therapy and other specialty services they need. This, after recent state budget cuts could force many to shut their doors.

Former therapy assistant denies charges - April 11, 2009
An Industry man pleaded not guilty Tuesday to charges that he practiced physical therapy without a license at a Farmington nursing home.

Physical therapists, chiropractors square off over bill - April 06, 2009
The campus is heating up today with supporters and opponents Senate Bill 5230 descending on the Capitol. The bill sponsored by Sen. Fairely, D–Lake Forest Park, would allow physical therapists in Washington to perform spinal manipulation, which chiropractors currently perform.

State clears nursing home
Texan Nursing and Rehab in compliance, says report - April 06, 2009
Texan Nursing and Rehab of Amarillo has been cleared by the state after a trouble–filled August inspection put the home in jeopardy of closing.

Lawsuit May have Implications for Medical Collection Agencies - February 15, 2009
It’s not uncommon for medical debt collectors to inform patients that they are responsible for the full charges sent to the agency for collection. However, if the trend of states adopting laws to provide discounts to the uninsured continues, more agencies may have to revise their statements or they could be setting themselves up for a lawsuit similar to the one facing Audit & Adjustment Co.

A profession on the upswing - February 13, 2009
According to the U.S. Department of Labor employment of physical therapists (PTs) is expected to grow 27 percent from 2006 to 2016, which it characterizes as "much faster than the average" for all occupations. Much of the increase can be attributed to aging baby boomers.

Massage bill could increase profession\\\'s legitimacy - February 13, 2009
Legitimate massage practitioners and their clients, devotees of therapeutic, not sleazy, touching are the intended beneficiaries of legislation that takes effect later this year.

CompHealth Earns The Joint Commission Certification
Rehab and Respiratory Th - February 13, 2009
CompHealth, a CHG Healthcare Services company and one of the leading providers of temporary and permanent healthcare staffing services in the United States, announced today its rehab and respiratory therapy staffing division in Grand Rapids, Mich., has achieved The Gold Seal of Approval™ for Health Care Staffing Services by The Joint Commission.

Nursing home checkup - February 13, 2009
More than half of San Joaquin County's nursing home residents eligible for Medicare or Medi–Cal live in facilities considered below average in quality ratings released in December by the Centers for Medicare & Medicaid Services.

Nursing homes: Rating system a positive step - February 12, 2009
A rating system for nursing homes begun by the Bush administration may be revealing more about their quality – or lack of it – than many may wish the public to see.

Grand Junction man receives \'Stanley Cup\' of physical therapy awards - February 12, 2009
Smith was awarded Colorado’s Outstanding Physical Therapist for 2008 in October by the American Physical Therapy Association. A plaque, engraved with his name along with honorees preceding Smith, arrived Saturday to Grand Junction.

New technology strives to heal injuries faster - February 12, 2009
Powell’s program, ARPwave, stands for Accelerated Recovery Performance. The program claims to get to the root of an injury, help cure that injury 30 percent faster than any physical therapy, and get people back into the shape they once were.

Meadows unveils new rehab facility - February 12, 2009
Helping more nursing home patients return home is the purpose of the greatly expanded center.

Physical therapists in demand - February 12, 2009
Therapists like March help people learn how to recover the use of injured parts of their bodies. They treat people of all ages, from kids to athletes to aging baby boomers.

Pediatric center specializes in treatment of special needs children - February 12, 2009
Before beginning therapy Jhordan couldn’t walk and didn’t want to use her right hand. Now, she is walking and starting to use her right hand more and more.

Fort Collins nursing homes generally rank high - February 12, 2009
Some for–profit nursing homes in Fort Collins are bucking the national trend that indicates higher–quality care is received at their nonprofit counterparts, according to a newly released federal five–star rating system.

Rehab Center Moves; Not Everyone Is Happy - February 12, 2009
Those who have ever had to resort to physical therapy know that between the stretches, bends, massages, heat packs and ultrasound, there is plenty of time to schmooze.

Putnam nursing homes run the gamut of scores in survey - February 12, 2009
Only three other states have a higher percentage of one–star nursing homes, and less than seven percent of Tennessee nursing homes received the five star rating.

The benefits of ‘Wiihab’ - February 12, 2009
Physical therapists see great promise in the video game, which uses a motion–sensitive controller to allow players to simulate golf and tennis swings, among other movements.

The Ensign Group, Inc. Responds to DOJ Inquiry - February 09, 2009
The Ensign Group, Inc., the parent company of the Ensign(TM) group of skilled nursing, rehabilitative care services and assisted living companies, announced today that representatives of the U.S. Department of Justice served search warrants on its Service Center and six of its Southern California skilled nursing facilities.

Robotic knee can reprogram brain - February 09, 2009
Now, a laboratory in Mountain View is about to release a robotic knee that can reprogram the brain while providing physical therapy.

Physical therapy offers evidence-based solution to musculoskeletal pain - February 09, 2009
The American Physical Therapy Association (APTA) is urging patients with musculoskeletal pain to consider treatment by a physical therapist, in light of a new federal survey showing that more than one–third of American adults and nearly 12 percent of children use alternative medicine – with back and neck pain being the top reasons for treatment.

2 men indicted for nursing home embezzlements - January 27, 2009
Two men have been indicted by a federal grand jury in Amarillo for allegedly using a Pampa nursing home to steal $28,492.41 from the U.S. government or their employer.

Wii-hab? - January 27, 2009
Herz’s research team used this system along with more traditional rehabilitation methods in a group of 30 patients with Parkinson’s disease and found that it helped slow the progression of this debilitating disorder that affects an individual’s ability to walk, speak and maintain balance.

Board disciplines therapist - January 27, 2009
An occupational therapist who formerly practiced in Burlington has been disciplined by the Iowa Board of Physical and Occupational Therapy.

Physical therapist motivates disabled to push boundaries - January 27, 2009
Leach is a physical therapist who teaches physically and cognitively handicapped students full time at Matheny School in Peapack, and is a personal trainer for similar individual clients at the Morris Center YMCA in Hanover. She also works individually with infants and toddlers who, by reason of birth defect or medical condition, cannot perform the usual activities of children that age.

CMS Issues Historic Star Quality Rating System for Nursing Homes - January 13, 2009
For the first time in history, the Centers for Medicare & Medicaid Services (CMS) today released quality ratings for each of the nation's 15,800 nursing homes that participate in Medicare or Medicaid.

PricewaterhouseCoopers Identifies the Top Nine Issues for Health Industries in 2 - January 13, 2009
The report is an annual review of the most pressing issues for health executives and policy makers. According to PricewaterhouseCoopers' Health Research Institute, the top nine health industry issues in 2009 are:

Speech patholigist\'s assistant arrested for medicaid fraud - January 13, 2009
Attorney General Bill McCollum announced Dec. 8 that a St. Petersburg woman has been arrested for her role in a scheme to defraud the Florida Medicaid program.

SMC Home Care ranked as one of the state’s best - January 13, 2009
Sibley Medical Center Home Care in Arlington recently ranked as one of the state’s best in a federal survey of Minnesota’s 202 Medicare–certified home health care agencies.

Nursing Home Employee Arrested for Abusing 88 Year-old Resident - January 11, 2009
Attorney General Bill McCollum today announced the arrest of a Broward County woman on charges she abused an elderly nursing home resident under her care. Karlene Brown was arrested this morning by law enforcement officers with the Attorney General's Medicaid Fraud Control Unit.

Retrain Your Brain After Stroke - December 31, 2008
Stroke patients often have to overcome a number of challenges before they can get back on their feet. Physical therapists are using a new tool to help patients not only retrain their bodies but also rewire their brains.

Rehab facilities finding many uses for Wii Fit - December 31, 2008
While Nintendo stresses that the Wii and Wii Fit are not meant to replace normal exercise, the console and its games are starting to be investigated as a possible means for helping people with rehabilitation and physical therapy.

Addressing pain with massage
Therapeutic sessions are used to help headaches - December 31, 2008
Massage therapy is gaining ground as a legitimate medical discipline, and it's used for more than relaxation, massage therapists say.

Medical business, employees charged with health care fraud - December 31, 2008
Medic Management billed Medicaid, Medicare and private insurance for thousands of physical therapy sessions, despite the fact that the clinic never employed a licensed physical therapist, and treatment was provided by unsupervised personnel who had no physical therapy training, but all the physical therapy sessions were billed as if they were performed by Dr. Anabtawi.

To brace or not to brace
Consider knee rehab before accessories - December 28, 2008
Physical therapist Winston Purkiss at Sun Valley Sports Rehab said the resumption of activity is often "significantly shortened by the wish to return to the playing field. Rehabilitation for nine months to a year is what I recommend. With pros it's maybe six months."

Health care fraud still a key target of federal False Claims Act - December 28, 2008
Physicians are seldom named in false claims cases but are often in a position to blow the whistle on fraud they observe

Therapy center for special needs children a real leap - December 28, 2008
Three years ago, special–needs children at Intermediate School 180 in Co–Op City had just a single room and a tattered mat for their physical therapy.

New Medicaid plan could open state to home care fraud - December 24, 2008
Home care providers are worried a new state Medicaid program will leave seniors vulnerable to fraud and abuse, and will cut into their business.

License probe leads to indictment - December 23, 2008
An Industry man has been indicted by a Franklin County grand jury for allegedly passing himself off as a licensed physical therapist at a Farmington nursing home by using a license obtained with bogus information.

Guilty plea in nursing home neglect case - December 23, 2008
The corporate owner of a Forest Park nursing home pleaded guilty today to felony gross neglect that resulted in the death of a long–term patient.

Oklahoma state agency puts focus on abuse by caretakers - December 20, 2008
The patient abuse unit receives about 250 referrals a year from police departments, the State Health Department and private citizens, unit chief Don Brown said.

East Moline nursing home sued for negligence - December 20, 2008
An East Moline nursing home is facing a lawsuit from a widow who is accusing the facility of negligence that led to her husband’s death.

Therapist frees folks from pain - December 20, 2008
Harmeling and his staff have contributed much to a practice that boasts more than 50 percent repeat patients, including many families. Not only do the therapists work on getting the patients better, they encourage their patients to also want to get better by helping themselves and following up with exercises at home.

Nursing home physical therapist faces charges - December 06, 2008
Dellarma was licensed as a physical therapist assistant in 1995 and has continued to renew that license, which he currently holds, said Doug Dunbar, assistant to the commissioner for the Department of Professional and Financial Regulation.

Special program helps MHS physical therapy patients - December 06, 2008
Dartfish has been used for years as a way to help Olympic athletes improve their performances by pinpointing every flaw. Now it is helping patients overcome their pain.

State officials defend licensing oversight process - December 06, 2008
According to the department, which licenses more than 100,000 people in Maine in about 40 professional occupations, Dellarma had a legitimate license as an assistant physical therapist.

Piriformis Syndrome won't go away without therapy - December 06, 2008
PS does not have a natural lifespan and will most likely stay until treated. Once it has settled in it can be a difficult tenant to evict. Also, PS will increase stiffness in the hip and perpetuate the problem, so don't wait too long to be seen.

More Than $1 Billion Recovered by Justice Department in Fraud and False Claims i - December 05, 2008
The United States secured $1.34 billion in settlements and judgments in the fiscal year ending Sept. 30, 2008, pursuing allegations of fraud against the federal government, the Justice Department announced today.

Stroke patients soon may have fun, high-tech tool
Virtual program may aid in - December 01, 2008
The University of Central Florida will immerse stroke survivors in a virtual world full of flying insects to help expand their range of movement.

Nursing home sells for $3.3 million
Springfield Manor plans changes, more r - December 01, 2008
Lynne Bailey, director of marketing and admissions for the home, said the buyers were a godsend to the building, which had been in danger of closing since filing for bankruptcy.

Left untreated, Carpal Tunnel Syndrome can do irreversible damage - December 01, 2008
One of the fastest growing diagnoses in the country, Carpal Tunnel Syndrome affects millions of Americans each year.

Miami Physician Sentenced to 84 Months in Prison for $26.2 Million Medicare Frau - November 30, 2008
Clinic Administrator Sentenced to 70 Months for $11 million Medicare Fraud

State probes fraud at adult day cares - November 30, 2008
State investigators suspect nearly one–third of New Jersey's adult day care centers have committed Medicaid fraud and recently revoked 41 operators' authority to determine if senior citizens are eligible for the program.

Partnership reached : Mercy and Cornerstone Healthcare will keep outpatient ther - November 30, 2008
Kilgore, president of Cornerstone Healthcare, which currently has 70 therapists in its various locations and manages Highland Health and Rehabilitation Center in Bella Vista and Ashley Health and Rehabilitation Center in Rogers, was interested in finding a solution that would keep those services from dissolving.

New Research Shows That Combining Aerobic Exercise With High-Force Eccentric Res - November 30, 2008
Physical therapy is a cost–effective form of treatment for Americans with diabetes.

The Physical Therapy Profession Remains in High Demand - November 30, 2008
October is National Physical Therapy month and to celebrate the Michigan Physical Therapy Association (MPTA) is encouraging Michigan residents to "Become a Physical Therapist or Physical Therapist Assistant."

Massage provides relief for fibromyalgia sufferers - November 30, 2008
Because of this extreme sensitively to touch, working on clients with fibromyalgia requires a whole different approach to massage, Yoder said.

OIG Official Lays Out Plan for Combating Fraud to Help Prepare Next Administrati - November 30, 2008
A top official with the HHS Office of Inspector General (OIG) recently unveiled a five–point strategy for fighting fraud and abuse in anticipation of the transition to a Barack Obama or John McCain presidential administration.

Nursing home's residents abused - November 30, 2008
Residents of a Sapulpa nursing home were subjected to immediate jeopardy because of verbal and mental abuse by its former administrator, state investigators report.

American Association for Homecare Proposes Aggressive 13-Point Plan to Stop Medi - November 29, 2008
Tough new steps must be taken to prevent fraud and abuse in Medicare, says the American Association for Homecare, which today announced 13 specific recommendations that could eliminate most of the Medicare fraud attributed to the home medical equipment (HME) sector.

Researchers Study Effectiveness of Robotic Gait-Assisted Therapies for Stroke Vi - November 29, 2008
(PhysOrg.com) –– When it comes to recovering mobility after a stroke, therapists say that every step counts. Two University of Missouri researchers recently studied robotic gait–assisted therapy to see if it is the best way to make steps count for patients with neurological injuries.

Cancer patients finding hope in physical therapy - November 29, 2008
After the shock of diagnosis, the trauma of surgery and the grueling months of chemotherapy and radiation, many breast–cancer survivors still face difficult physical problems.

Pediatric therapy helps little ones overcome big obstacles - November 29, 2008
The Pediatric Therapy Department at Sacred Heart handles more than 28,000 patient visits a year, from newborns to age 17. Patients have traveled from as far away as Panama City for therapy. Common diagnoses of the young therapy patients include cerebral palsy, autism, juvenile rheumatoid arthritis, spinal cord injury, burns, sensory integrative dysfunction, orthopedic injuries, learning disabilities, cleft palate, voice pathology, hearing loss, stuttering, failure to thrive and swallowing disorders.

ACHILLES TENDONITIS Rehab with mobility, stretching - November 29, 2008
Achilles tendonitis affects a broad spectrum of people. It is common in runners and walkers, hikers and people participating in sports. However, it is not limited to athletes. In fact, athletes make up less than 20 percent of the cases of Achilles tendonitis.

Employment security: Some jobs will always be in demand, despite economy - November 29, 2008
For a 10–year period that began in 2006, employment of physical therapists is expected to rise 27 percent, reports the U.S. Department of Labor.

Editor of Today in PT Presents Groundbreaking Physical Therapy Book Offering Hum - November 29, 2008
Naked Elbows: A Physical Therapist’s Reflections on Patient Care, Intuition, and Healing, by Anne Ahlman, MPT, was just published by Gannett Healthcare Group, offering a fresh personal and professional look at the world of physical therapy.

Team approach for ALS patients - November 29, 2008
Amyotrophic lateral sclerosis, often called Lou Gehrig's disease, is a progressively degenerative neuromuscular condition that paralyzes the muscles of the body, even those that affect the ability to swallow and breathe.

Pasadena Doctor With Orange County Practice Indicted in $2.3 Million Medicare Fr - November 29, 2008
A doctor has been indicted for fraudulently billing Medicare for approximately $2.3 million in physical therapy services.

Doctors Pay Up to Settle Fraud Claims - November 29, 2008
Six Las Vegas doctors have agreed to pay over $600,000 to the federal government to settle claims of Medicare fraud.

Wichitans indicted on Medicare fraud charges - November 29, 2008
Two Wichitans and three Texans were indicted on federal charges of conspiracy to commit health care fraud and violations of anti–kickback statutes, the U.S. Attorney’s office said Thursday.

Government enforcement of health care fraud increasingly aggressive - November 28, 2008
For years, health care enforcement has been driven by the extraordinary power of the False Claims Act. A violation of the act triggers liability of three times the amount of damages, plus a penalty of $5,500 to $11,000 per claim. Although early False Claims Act cases focused on prosecuting providers for submitting claims that were false, such as upcoding, billing for a non–covered service as if it were a covered service or billing for a service not performed at all, government theories of liability under the statute have expanded dramatically.

California Physical Therapists Promote Nintendo Wii for Core Strength and Fitnes - November 21, 2008
With October being National Physical Therapy Awareness Month, expect Nintendo Wiis to be flying off the shelves. Among the first in line will be members of the California Physical Therapy Association (CPTA), who stand by the video game console and its accompanying sports and fitness games as one of the best therapeutic technology inventions to roll out in a long time.

Physical therapist assistant program proposes expansion
SIU School of Medici - November 21, 2008
That proposal calls for PTA classes in Carbondale to be simultaneously taught at the SIU School of Medicine in Springfield, said Jan Rogers, the program's director. Students in Springfield would perform clinical work at Memorial Medical Center of Springfield, the teaching hospital attached to the School of Medicine and participate in Internet–based classes.

EntireCare helps athletes get back on their feet - November 21, 2008
The EntireCare department has expanded its facilities. Besides the facility located at the VVMC, the EntireCare department opened a location in Camp Verde. David Castillo and a small staff provide help with current patient needs as well as preventative programs in the area.

Trying to put a halt to falls - November 21, 2008
With an aging population and more people remaining in their homes into the twilight years, those who care for seniors are bracing for the difficult task of trying to catch seniors before they fall.

Exercise Rehab Appears Useful and Safe After Lumbar Disc Surgery - November 21, 2008
A review of 14 randomized controlled trials showed that performing some type of exercise after surgery was associated with significant improvements in pain and functional capability in the short term, without increasing the risk of another operation, Raymond Ostelo, Ph.D., of VU University Medical Center here, and colleagues reported in a Cochrane Review.

Criminal past is no bar to nursing in California - October 07, 2008
Times investigation finds the state nurse licensing board allowed sex offenders, drug users and convicts to retain and renew their permits.

Hospital Settles With Deaf Patients on Communication ; It Will Be Required to Pr - September 30, 2008
Concord Hospital will pay $100,000 in a settlement with six deaf people who say the hospital did not provide them with the services they needed to communicate with hospital staff, the U.S. Attorney's Office said.

Therapist convicted of assault wants new trial - September 20, 2008
A former Limerick physical therapist convicted of having inappropriate contact with two female clients wants a new trial, alleging his lawyer didn't properly prepare him to testify.

St. John's Mercy Medical Center focus is on efficiency - September 20, 2008
When executives at St. John's Mercy Medical Center in Creve Coeur noticed patients in wheelchairs lining the halls as they waited for physical and occupational therapy, they thought there must be a better way.

New scams targeting Medicare Part D - September 20, 2008
Seniors in Oregon and Washington have been hit with a new Medicare scam. A fake company called National Medical Office in Washington, D.C. has been contacting seniors in these states saying they need bank account information to send Medicare cards to those being called.

Feds probing complaint at Champaign County Nursing Home - September 20, 2008
The U.S. Department of Health and Human Services sent investigators from a Medicare/Medicaid fraud unit to the nursing home on Friday, said Administrator Andrew Buffenbarger.

Lawmakers Probe Problems At State Schools - August 22, 2008
After investigations by the federal government and hearing a growing number of concerns raised by advocacy groups, state legislators hold a series of hearings and studies into problems at Texas State Schools.

Physical Therapists Applaud President Bush For Signing Legislation To Renew High - August 20, 2008
Members of the American Physical Therapy Association (APTA) applaud President Bush for signing into law the Higher Education Opportunity Act(HR 4137). This new law amends and extends the Higher Education Act of 1965.

Pet Rehabilitation Business Gains Strength: California Animal Rehabilitation Fac - August 20, 2008
Two Los Angeles area doctors are showing pet owners and veterinarians that rehabilitation gets their pet's paws moving better. Since opening in June 2007, California Animal Rehabilitation, Southern California's first physical rehabilitation center for pets as rehabilitation and the only facility of its kind in the U.S. owned and operated by both a veterinarian and a doctor of physical therapy, is fast becoming a welcome option in pet healthcare.

'Never events': Utah hospitals saw nearly 60 serious errors in 2007 - August 20, 2008
Utah started tracking never events, also called sentinel events, in 2001, after a landmark study by the Institute of Medicine titled "To Err is Human: Building a Safer Health System." The IOM estimates medical errors may cause 98,000 deaths a year.

Birth to 3 program changes worry providers, parents - August 13, 2008
Proposed changes to the Birth to 3 program have parents and service providers nervous about what those changes will mean for kids like David Drolc, as well as what effect they’ll have on the pocketbooks of the speech, occupational and physical therapists who work with them.

Physical therapists offer low-cost solution to high-cost expenditures for acute - August 12, 2008
New research shows that the type of physical therapy care provided for low back pain may impact subsequent health care costs

Three Indian students score top physical therapist awards - August 11, 2008
The MGH Institute of Health Professions, an academic affiliate of Massachusetts General Hospital in Boston, recently gave its top three physical therapist awards to international students from India.

Foundation Awards $292,500 In Doctoral Scholarships To 25 Physical Therapists - July 28, 2008
The Foundation for Physical Therapy Board of Trustees recently awarded a total of $292,500 in Promotion of Doctoral Scholarships (PODS I & II) to 25 physical therapists.

Wii Fit Nintendo game makes physical therapy fun - July 22, 2008
Physical therapy is best served with a little camaraderie and light conversation, but therapist Nancy Ditzel also dished out some fun to recovering stroke patient Marilyn Smigelski recently. The LakeEast Hospital therapist put Smigelski to work on the latest Nintendo Wii video system game, called Fit. While the American Physical Therapy Association magazine recently reported widespread use among members of Wii games that simulate sports like tennis and bowling, the Lake hospital system is the first locally to use the Fit game in physical therapy.

Audit: Special Ed Students Not Getting Services - June 29, 2008
The New York City Department of Education must improve the timeliness of its evaluations and placements of special education student applicants, according to report released by New York State Comptroller Thomas P. DiNapoli. The report also noted that the number of students who do not receive recommended support services, such as speech or physical therapy, doubled between 2003 and 2007.

New York state to start registry of home health aides - June 15, 2008
After a series of scandals in New York's home–health–care industry, legislative leaders and Attorney General Andrew Cuomo agreed on Wednesday to start a state registry of home health aides.

Utah's Nursing Homes: Compromised Care - June 15, 2008
A Salt Lake Tribune investigation of Utah's 91 nursing homes shows that ownership is probably the best predictor of quality care. But the public has no easy way to identify who owns the homes, particularly when names are changed to hide a troubled past.

AG Cuomo charges two Rochester area nursing home aides - May 29, 2008
Today Attorney General Andrew Cuomo announced his office has filed charges against two Rochester area nursing home employees: one who allegedly used patients' personal information to secure utility services for her home and another who allegedly falsified paperwork to cover up his prior criminal background.

Springfield nursing home cited after resident dies - May 04, 2008
Springfield nursing home was cited after investigators determined employees had not adequately addressed the needs of a patient who later died.

DPT: Preventing Foreign Trained Physical Therapists to Work in The U.S.; New Web - May 04, 2008
Website Forum goers Weigh In: Credentialing Agencies are saying that Bachelor's Degree is not equivalent. Hospitals and clinics find it difficult to sponsor foreign–trained physical therapists for H1–b or greencard. PTSponsor.com has created an online job board where hospitals and clinics can hire foreign physical therapists directly without going through agencies. Foreign physical therapists can research articles and ptsponsor.com directory in order to get a U.S. physical therapy license.

Michigan Company May Buy Haven Nursing Homes - May 04, 2008
A Michigan company that operates 21 nursing homes and assisted–living facilities in California and the Midwest is the leading contender to buy the bankrupt Haven Healthcare nursing–home chain — a bid that would preserve all 15 Haven homes in Connecticut, but that is contingent on its ability to secure Medicaid rate increases from the state.

Therapists question referral laws - May 04, 2008
Michigan doesn't allow direct access to physical therapy, unlike 44 other states plus the District of Columbia. However, it is ahead of Indiana and Alabama, which prohibit an individual from seeking an evaluation without a referral, according to Mike Shoemaker, legislative director for the Michigan Physical Therapy Association and an assistant professor in Grand Valley State University's physical therapy program.

Feds: Taxpayers paid for lavish life - May 04, 2008
The new title paid off big when Stinson collected more than $2 million in fees. The problem, federal prosecutors say, is that Stinson isn’t a physical therapist, didn’t get a license to run his business and failed to report his earnings to the IRS.

Physical therapist indicted - May 04, 2008
A Spotsylvania physical therapist assistant was indicted on sexual assault charges yesterday following a patient's complaint that she was inappropriately touched during a therapy session.

Confusion Surrounds Medicare Wheelchair Policies; AAHomecare Sponsors Workshop A - May 04, 2008
Even though the Medicare National Coverage Determination for Mobility Related Equipment was revamped in 2005, many providers and suppliers continue to be perplexed by complex policy requirements and strict protocols for physician and clinician documentation using the algorithmic approach to qualify the appropriate level of Mobility Assistive Equipment (MAE).

Mountain View Assisted Living receives ‘no deficiency’ rating - April 17, 2008
Representatives with the Arizona Department of Health Services gave a "no deficiencies" rating to Mountain View Assisted Living Facility during an inspection performed Feb. 26. The ADHS has a 20–page checklist for inspections of assisted living facilities. As a result of the inspection, Mountain View had its license extended until December 2009.

Business owners charged in fraud - April 13, 2008
YOUNGSTOWN — A federal grand jury has indicted the owners of six businesses that transport patients in vans equipped for wheelchairs and charged them with health care fraud.

Medicare bidding disqualifies 100+ South Florida suppliers - April 11, 2008
His Miami–based durable medical equipment (DME) company is one of more than 100 in South Florida disqualified from the new bidding procedures for Medicare contracts as the government tries to cut costs and curb fraud. Brant's City Medical and others were rejected for incomplete applications.

Arizona fails to protect nursing home residents - April 10, 2008
The inspectors who license Tucson–area nursing homes showed a consistent pattern of weak enforcement, an Arizona Daily Star investigation finds. Only 15 percent of the time did they substantiate allegations of abuse, neglect or other problems in how the homes cared for some of our most vulnerable people.

Attorney General Conway Announces Indictments Of Three Therapists - April 04, 2008
Attorney General Jack Conway announced Thursday, that three Kentucky therapists from Letcher County have been indicted for Medicaid fraud.

A matter of compassion - April 04, 2008
De los Santos – whose office covers the Orange County area – makes a point of checking out the condition, setting and overall quality of service at each of the assisted living and skilled nursing facilities before recommending them to clients.

Protect aid to those living with disabilities
We must protect this aid, avoi - March 31, 2008
More than 500 people with intellectual and developmental disabilities, their family members and advocates descended on Capitol Hill this month to educate federal lawmakers on issues important to people with disabilities – from young children to adults.

Woman sentenced in health fraud case - March 28, 2008
Prosecutors said that Hayes and more than a dozen employees and family members falsified time sheets or received pay for home health care work they didn't do.

Hayes sentenced for health-care fraud - March 27, 2008
Hayes, 53, of St. Louis, pleaded guilty in January to a broad scheme to defraud the Medicaid program, which provides health–care services for the indigent. From 1999 to 2005, Hayes operated Complete Care of American, which provided homemaker and personal care services to elderly and disabled clients in their homes, according to a release.

Tax abatement for new nursing home in line for future approval - March 25, 2008
No one spoke against allowing a tax abatement for the future site of the expanding Garrison Nursing Home and Rehabilitation Center at a public hearing held Tuesday prior to the Nacogdoches County commissioners court meeting, and commissioners are likely to approve the request next month.

State settles lawsuit over placement of disabled - March 21, 2008
More than 600 mentally retarded or developmentally disabled individuals will leave nursing homes in the next four years, to live more independently in an apartment, family home, or group setting, state officials announced yesterday. Services the state will provide to the individuals in their new homes include personal care assistants, nurses, and physical therapists. Many also will have access to recreational activities, educational opportunities, and job training.

Software Helps Insurers Profit from Denials - March 21, 2008
For the past couple years, Martin Jensen has been sounding an alarm, shouting to doctors and hospitals about the biggest danger they probably don't know about. As an independent information technology consultant to hospitals, Jensen warns that health insurers are increasingly devising more sophisticated means of denying services either upfront or sniffing out money they believe to have "mistakenly doled out."

Therapist’s Office Manager Arrested For Larceny - March 19, 2008
GLENS FALLS—The former officer manager for a Glens Falls physical therapist has been charged with stealing $2,000 from the business.

Interprofessional Collaboration Between Physical Therapy and Special Education F - March 12, 2008
This pilot study investigated a model for interprofessional collaboration between physical therapists (PTs) and early childhood special education (ECSE) teachers. The purpose of the study was to investigate whether a series of sessions in sensorimotor development taught by a physical therapy education program faculty member enhanced intervention planning and classroom instruction for teachers enrolled in a graduate course on child development.

Cleveland Clinic representative visit local pain management center - March 12, 2008
An Overland Park clinic specializing in behavioral pain management was visited recently by representatives of the prestigious Cleveland Clinic in Ohio who wanted to learn from the local operation.

Middlesboro ARH unveils new physical rehabilitation center and MRI - March 11, 2008
The rainy weather couldn’t keep community supporters away on Friday, March 7, as Middlesboro Appalachian Regional Healthcare (ARH) dedicated its new Physical Rehabilitation Center and MRI. A flood of supporters filled a tent constructed just outside of the center, where several individuals remarked upon the significance of the occasion.

Sunset passes retest from state health dept., has new administrator - March 11, 2008
Problems with paperwork led to the health department revisiting the local facility recently, and that visit went well, McGaugh said. “There were compliance issues,” said Deb McGaugh, the new head of the Brush nursing home. “Care was never compromised.”

Federal Jury Convicts Former Nursing Home Executive - March 11, 2008
Specifically, the jury convicted Ewing, 60, on one count of conspiracy, seven counts of tax evasion, five counts of mail fraud, seven counts of making false statements to government agencies and seven counts of making false statements regarding health care. The maximum statutory sentence applicable to the conspiracy, false statements and tax evasion counts are five years in prison and a $250,000 fine, per count; the maximum statutory penalty applicable to the mail fraud counts is 20 years in prison and a $250,000 fine, per count. Restitution could be ordered. Sentencing has been set for July 21, 2008.

Stephen Michael Ewing Has Day In Court Over Massive Payroll Tax Fraud Nursing Ho - March 07, 2008
U.S. Attorney Richard Roper said, “This case is the one of the largest payroll tax fraud cases ever prosecuted in the U.S. Mr. Trebert admitted evading more than $34 million in payroll taxes – this is nothing short of egregious. Nursing homes should be safe havens for the elderly and vulnerable, not vehicles for criminals to commit fraud.”

Rehab program charged with filing false claims - March 06, 2008
A federal grand jury on Wednesday indicted a Wichita woman on charges that she bilked Medicaid out of $3.76 million by filing false drug and alcohol treatment claims on behalf of 81 children under the age of 12.

Arrest warrant issued for man who hid camera in massage room - March 03, 2008
PORTSMOUTH — A maintenance man who was court–ordered to undergo a sex offender evaluation, after pleading guilty to hiding a video camera in a Newington chiropractic massage room, did not have the evaluation, then failed to appear in court Monday for breaching that bail condition, police allege.

Surgery 'rorts' to be probed - March 03, 2008
The Alfred hospital and its suspended trauma chief are being investigated by the Victorian Ombudsman over claims of excessive surgery and suspicious billing.

Missouri board revokes license of Wentzville physician - March 03, 2008
The Missouri Board of Healing Arts revoked one local doctor's license and suspended the license of another in the last half of 2007. In addition, two other medical doctors and a physical therapist were disciplined in that time period, according to documents recently released by the board.

Ipswich woman sent to jail on fraud charges - March 03, 2008
BOSTON — An Ipswich woman was sentenced yesterday to a year in federal prison and ordered to pay or forfeit almost $128,000.

Capozzi seeks county Medicaid bills investigation - March 03, 2008
A former special counsel for Dauphin County who has been accused of padding his bills has asked the U.S. attorney's office to investigate the county for Medicaid fraud.

Ex-CEO from Orange admits to using rehab clinic for scheme authorities say raked - March 03, 2008
A former chief executive officer from Orange could serve more than three years in federal prison after pleading guilty Tuesday to federal health–care fraud charges.

Bucyrus anesthesiologist in court as part of FBI fraud investigation - March 03, 2008
CLEVELAND –– Bucyrus anesthesiologist Dr. Hany Maurice Iskander Ibrahim, 47, of Powell, appeared in United States District Court here Tuesday for a detention hearing.

New Jersey court sends blow to doctor-owned surgery centers - March 03, 2008
A New Jersey trial court ruling puts most, if not all, of the 200 physician–owned ambulatory surgery centers there in violation of the state's anti–referral law.

Corporate Whistleblower Center Says Medicare/Medicaid Fraud Out Of Control - March 03, 2008
Americas Watchdog's Corporate Whistleblower Center is releasing its annual report on Medicare & Medicaid fraud, and according to the group things have never been worse. The report focuses on nursing homes, drug/medical device companies, not for profit, and boutique hospitals. The group referred to its findings as grim with respect to Medicare and Medicaid over billing & fraud.

More allegations surface against therapist - March 03, 2008
KALKASKA –– Another woman is alleging wrongdoing by a local physical therapist whose state license was suspended after he admitted to sexual contact with a patient. Mark Melton, 38, filed an appeal this week to get his license reinstated, but remains under investigation for potential insurance fraud after a state probe into an alleged sexual relationship with a patient and an employee.

Medicare Anti-Fraud Measures are Way Overdue, Says Durable Medical Equipment Ind - March 03, 2008
ARLINGTON, Va., Jan. 8 /PRNewswire–USNewswire/ –– The American Association for Homecare welcomes and supports efforts to crack down on Medicare fraud announced today in another of a series of press conferences held by the Centers for Medicare and Medicaid Services (CMS) on the same subject. The Association continues to work with federal agencies and Congress to prevent fraudulent activity in the durable medical equipment (DME) sector.

Deering vindicated by Justice probe - March 03, 2008
Kerry Deering was in California when contacted Friday for his reaction to the conclusion of a United States Department of Justice investigation that exonerated him of any wrongdoing in a four–year long probe of Physiotherapy Associates.

Speech pathologist practicing in Coral Springs arrested for false Medicaid claim - March 03, 2008
A speech pathologist practicing in Coral Springs was recently charged with stealing more than $20,000 from the Florida Medicaid Program. Amy Heather Spielman, 32, was taken into custody by the Attorney General’s Medicaid Fraud Control Unit after investigators revealed a scheme of submitting false billing claims to the Medicaid program for speech pathology services never rendered.

Maryland Attorney General: Bell Pleads Guilty to Felony Medicaid Fraud Company R - March 03, 2008
BALTIMORE, MD –– Maryland Attorney General Douglas F. Gansler announced today that Guy Anthony Bell, 44, of the 2700 block of Tallow Tree Road in Woodstock, pled guilty in the Circuit Court for Baltimore City to two counts of felony Medicaid Fraud for his role in billing the Medicaid program for more than $4,000,000 for services that were never performed. In all, Mr. Bell knowingly directed his employees to submit over 20,000 false statements to the Medicaid Program. As a result of the plea agreement, Bell will receive a jail sentence of between 24 and 30 months and will be required to make restitution payments. Sentencing is set for November 15, 2007.

Feds Fight Infusion Therapy Fraud - March 03, 2008
HHS Secretary Mike Leavitt has announced an initiative designed to protect Medicare beneficiaries from fraudulent providers of infusion therapy. This two–year project will focus on preventing deceptive providers from operating in South Florida. Providers there will be required to reapply to be a qualified Medicare infusion therapy provider.

Fraud case based on CPT® codes proceeds - March 03, 2008
Billing guidance provided under the current procedural terminology (CPT®) codes was not unconstitutionally vague and, therefore, it could properly serve as the basis of health care fraud allegations, according to the Illinois district court. The complaint alleged that a psychiatrist submitted claims that did not meet CPT® code requirements because he spent little or no time with the patient; billed for individual psychotherapy services during the time that he was out of the country; and billed for services when the patient was not present.

Medicare and Its Contractors Have Failed to Combat Medicare Fraud Effectively Sa - March 03, 2008
ARLINGTON, Va., May 15 /PRNewswire–USNewswire/ –– The American Association for Homecare restated today that the homecare industry, which provides medical equipment and therapies in the home, supports stepped–up efforts to crack down on Medicare fraud and looks forward to continuing work with federal agencies and Congress to prevent fraudulent activity. At the same time, the Association said Medicare has failed to effectively exercise its already ample authority to combat fraud and abuse.

MARYLAND ATTORNEY GENERAL: Baltimore County Woman Charged with Medicaid Fraud - March 03, 2008
Attorney General Douglas F. Gansler announced today that Siddi Jon, 48, of the 8900 block of Greens Lane in Randallstown was indicted by a Baltimore County grand jury with 18 counts of felony Medicaid fraud and felony theft.

Dr. Solis named in scam; Rael posts bond - March 03, 2008
Dr. Rafael Solis, a psychiatrist with offices in Del Rio and San Antonio was named in an indictment alleging 14 counts related to health care fraud this morning before U.S. Magistrate Victor Garcia.

Psychiatry’s Diagnostic Manual Exposed For Its Links To Pharmaceutical Industry’ - March 03, 2008
USPRwire, Mon May 22 2006 The Citizens Commission on Human Rights (CCHR), a psychiatric watchdog group, said that a study published in this month’s journal Psychotherapy and Psychosomatics revealing the incestuous financial relationship between the pharmaceutical industry and the American Psychiatric Association’s (APA) “billing bible,” The Diagnostic and Statistical Manual of Mental Disorders (DSM), is a vindication. For over a decade the group has called on governments to eliminate the DSM as a valid diagnostic manual for insurance reimbursement or for the basis of any legislation or court testimony. “It is an unreliable, pseudoscientific document with enormous power to damage lives, while being used to rake in $76 billion a year in international psychiatric drug sales,” CCHR’s national U.S. president Bruce Wiseman stated.

Accused physical therapist may settle
Mark Melton allegedly had sexual conta - March 02, 2008
KALKASKA –– A potential settlement caused the adjournment of a hearing over local physical therapist Mark Melton's state license suspension.

Freehold man, father are indicted in health care fraud - February 28, 2008
NEWARK — A Freehold man, his father and two others were named in a 22–count federal indictment Thursday on charges of health care fraud that included the participation of several unidentified doctors to further the scheme, the indictment says.

Peabody stressing over massage regulations - February 27, 2008
PEABODY–The State’s new responsibility involving the regulation of massage therapists and establishments has rubbed the Peabody Board of Health the wrong way.

Two care homes under scrutiny - February 27, 2008
The future of two homes in Eastbourne is under the spotlight as part of a review by East Sussex County Council.

Washington state doctors, physical therapists battle over referrals - February 25, 2008
A legal dispute in Washington state has doctors worried that their ability to employ other licensed medical professionals –– and ultimately compete in health care –– may be compromised.

Audit finds purchasing issues at Remsenburg-Speonk - February 23, 2008
District officials paid $32,633 for physical and occupational therapy and special education and $6,900 in teacher aid without written contract or board approval, said to the audit, released Thursday by Comptroller Thomas P. DiNapoli.

Audits hit skilled nursing providers
Caregivers join rehabilitation hospital - February 19, 2008
WASHINGTON – Concerns about a Medicare auditing program that have California rehabilitation hospitals screaming about denials of claims have spread to the skilled nursing sector.

Theft case dismissed against therapist - February 18, 2008
Theft charges have been dropped against a Lakewood physical therapist who was accused of overbilling the city of Wheat Ridge for his services two years ago.

HEALTH-AIDE SCAM
PROBE TARGETS $100M MEDICAID FRAUD - January 04, 2008
August 20, 2007 –– ALBANY – The state Attorney General's Office is in the midst of an investigation into widespread Medicaid fraud in the home health–care industry, The Post has learned.

Firm Charged With Medicare Fraud - January 04, 2008
The federal government charged a South Florida company with fraudulently billing Medicare $170 million for infusions of HIV drugs.

Settlement-Resolves-Investigation-of-Hospital’s-Claims-'>Saint Joseph's Hospital of Atlanta Pays $26 Million To Settle False Claims Act A - January 04, 2008
12/21/2007 – Atlanta, GA – The United States Attorney's Office today announced that Saint Joseph's Hospital of Atlanta, Inc. and Saint Joseph's Health System, Inc. have agreed to pay $26 million to settle allegations raised in a so–called "whistleblower" lawsuit that the hospital violated the federal False Claims Act with regard to billing for inpatient admissions and other services.

STATE: $5M overpaid for Medicaid work - January 04, 2008
Two state comptroller's audits found New York State made $5 million in Medicaid overpayments to 135 home health care providers or medical labs statewide, including 10 on Long Island.

New York AG, DA Charge LI Home Care Agency Operators With Medicaid Fraud, Wide R - January 04, 2008
MINEOLA, NY (October 1, 2007) – New York Attorney General Andrew M. Cuomo and Nassau County District Attorney Kathleen M. Rice today announced the arrest of a home care agency operator and an associate for a litany of Medicaid–related crimes that were committed to bankroll extravagant lifestyles. The arrests were the result of an investigation by the Medicaid fraud task force Attorney General Cuomo and the District Attorney Rice launched in January.

CUOMO VS. MEDICAID FRAUD - January 04, 2008
October 29, 2007 –– State Attorney General Andrew Cuomo seems to be proving the worst fears about Medicaid fraud all–too–true: For prosecutors, it's a target–rich environment.

DEFENDANT IN FAKE FLU VACCINE CASE CONVICTED - January 04, 2008
HOUSTON, TX – Iyad Abu El Hawa, 36, of Houston, was convicted of health care fraud and misbranding of a drug, United States Attorney Don DeGabrielle announced today.

Five facing charges in body-parts scam - January 04, 2008
FOR MORE than 18 months, three "unscrupulous" funeral–home operators stole diseased body parts from the corpses of 244 Philadelphians and sold the tissue for nearly $250,000 to two "predatory" operators of a New Jersey company, a Philadelphia grand jury found yesterday.

THREE PEOPLE INDICTED FOR DEFRAUDING MEDICARE THROUGH BILLING SCHEME
ONE ARR - January 04, 2008
Two of three people indicted earlier this month for their roles in the operation of a fraudulent Medicare billing scheme at a Rancho Palos Verdes agency are currently being sought by the FBI, announced J. Stephen Tidwell, Assistant Director in Charge of the FBI in Los Angeles.

Lab owner gets prison time - January 04, 2008
A judge has sentenced a laboratory owner who pleaded guilty in connection with a $2.5 million Medicare billing fraud scheme involving two medical labs to 57 months in prison.

Health Care Trio Busted For False Timesheets - January 04, 2008
ALBANY—Two Rochester area health care workers have been arrested for allegedly stealing taxpayers by submitting false timesheets for work they never performed. A third health care worker who was paid over $12,000 by a nursing home for hours she did not work was also charged.

U.S. Joins Case Against Healthessentials Solutions for Alleged False Claims Bill - January 04, 2008
WASHINGTON, April 26 /PRNewswire–USNewswire/ –– The United States has intervened in three qui tam suits accusing HealthEssentials Solutions Inc. (HES) of false claims billings to Medicare, the Justice Department announced today. Specifically, HES is accused of upcoding –– the practice of improperly assigning a diagnosis code to a patient discharge that is not supported by the medical record for the purpose of obtaining a higher level of reimbursement. Additionally, it is alleged that the Kentucky–based provider of geriatric care knowingly charged Medicare for medically unnecessary services.

Nursing Home Horror: The Dark Side Of Fraud - January 04, 2008
ST. LOUIS–––The 88–year–old woman at Claywest House nursing home near St. Louis was totally reliant on staff for her care. There was nothing she could do about the ants crawling all over her. Or the waste she helplessly waited in during the weeks leading up to her death.

LAB OWNER RECEIVES 57- MONTH PRISON SENTENCE AND AGREES TO FORFEIT $2.8 MILLION - January 04, 2008
(Media–Newswire.com) – R. Alexander Acosta, United States Attorney for the Southern District of Florida, and Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, announced the April 18, 2007 sentencing of defendant Marcelo de Jesus Serrano, a laboratory owner, who previously pled guilty in connection with a $2.5 million Medicare billing fraud scheme involving two medical laboratories.

Nursing Home Owner Stole $6 Million For Illegal 'Bed Holds' - January 04, 2008
BRONX–––The former owner of two Bronx County nursing homes has pleaded guilty to defrauding the Medicaid program of millions of dollars by overcharging for services at two facilities over a six–year period.

Nurse Draws 57 Months Prison For Health Care Fraud Costing $3,000,000 - January 04, 2008
Los Angeles, California – LawFuel – IRS News – Yesterday afternoon, United States District Judge Dale S. Fischer sentenced Haydee Parungao to 57 months in federal prison for her role in a health care fraud scheme that cost Medicare over $3,000,000. Additionally, Parungao was sentenced for the structuring of cash transactions, conducted to avoid IRS reporting requirements, totaling $613,710.

Fraud and Florida's multimillion-dollar wheelchair - January 04, 2008
MIAMI, Oct 22 (Reuters) – One Miami–area medical equipment supplier managed to bill the U.S. government so often for a wheelchair it ended up costing $5 million.

How To Use The False Claims Act To Prevent Nursing Home Fraud And Patient Abuse - January 04, 2008
As the baby boom generation moves from middle age to retirement, tens of millions of Americans will be entitled to Medicare benefits. Nursing home care and home health care are two of the fastest rising areas of Medicare spending.

Hatboro nursing site accused by U.S. Attorney’s office - January 04, 2008
The U.S. Attorney's office today issued a complaint against a Holland–Glen nursing facility in Hatboro, which it said operated without a nursing license.

Ex-Chatham doctor settles fraud claims - January 04, 2008
CHATHAM — A physician who has practiced in town has paid $200,000 to settle allegations he defrauded Medicare by submitting false claims from 2001 to early 2007, according to the U.S. Department of Justice.

Fayette Co. facility under investigation - January 04, 2008
State Auditor Mary Taylor said Thursday a Medicaid provider audit for a Fayette County nursing facility revealed the facility may have incorrectly billed the state more than $95,000.

Auditor finds billing errors at local nursing home - December 29, 2007
The state auditor claims that the Burlington House, a Cincinnati nursing home, incorrectly billed the state for nearly $288,000 in Medicaid payments.

Four Chemical Dependency Treatment Providers Arrested in Houston on Medicaid Fra - December 29, 2007
August 21, 2007 –– HOUSTON – Four Medicaid providers who offered chemical dependency treatment were arrested today for defrauding the Medicaid system. A Harris County grand jury indicted the suspects last Friday. Texas Attorney General Greg Abbott’s Medicaid Fraud Control Unit officers were assisted in the arrests by the Houston Police Department. The suspects will be prosecuted by the office of Harris County District Attorney Chuck Rosenthal Jr.

Mental health reform goals unclear, some say - December 29, 2007
HIGH POINT — Six years into North Carolina's effort to remake its mental health safety net, the system still struggles to fix the problems that came with the overhaul.

Midland doctor indicted for fraud - December 29, 2007
A Midland doctor has been arrested for charging for medical procedures that never were performed.

Suit accuses United Healthcare of fraud
It says the company enrolled a woman - December 29, 2007
ST. PETERSBURG – Like many older people, Charleen Edge finds today's smorgasbord of Medicare plans confusing. Last year, she says, she found herself in a private health maintenance organization she neither requested nor desired. Her repeated requests to switch back to regular Medicare went for naught.

Mom of 15 avoids jail in fraud case - December 29, 2007
A 49–year–old physician's assistant and mother of 15 children avoided jail time yesterday for stealing more than $50,000 in phony billing hours from local hospitals.

Ex-WNY doc admits $2M billing scam - December 29, 2007
A former Hudson County doctor admitted in state court yesterday that he bilked insurance companies out of more than $2 million by billing them for tests he never performed on patients involved in automobile accidents.

Testimony: Jesup doctor reguarly overbills public funds - December 29, 2007
lA Jesup physician billed Medicare at six times the proper sum for treatment not called for, a government witness testified in federal court Monday.

Texas Medical Board Disciplines Doctors - December 29, 2007
At its November 29–30 meeting, the Texas Medical Board took disciplinary action against 63 licensed physicians.

Four Miami Health Care Company Owners Sentenced to 57 Months in Prison For Medic - December 29, 2007
WASHINGTON, Nov. 9 /PRNewswire–USNewswire/ –– Four members of the same family, who owned and operated a series of Miami Durable Medicare Equipment (DME) companies and Comprehensive Outpatient Rehabilitation Facilities have each been sentenced to 57 months in prison for Medicare fraud, Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.

Sugar Land Man, Three Others Busted In Drug Counseling Medicaid Scam - December 29, 2007
Houston police and Texas Attorney General Medicaid Fraud Control Unit officers arrested four people Tuesday, including a Sugar Land man, for their part in an alleged Medicaid scheme.

Bucks therapist charged with Medicare fraud - December 29, 2007
PHILADELPHIA–– A Yardley, Pa., physical therapist was charged yesterday with health care fraud for allegedly billing Medicare for $1.3 million in work that wasn’t performed.

Autopsy report shows doctor died of natural causes - December 29, 2007
Toxicology results from an autopsy performed on a former Palestine physician who passed away earlier this year indicate that he died of “natural” causes, according to a Cherokee County sheriff’s investigator.

American Association For Homecare Continues Partnership With Medicare To Prevent - December 29, 2007
The American Association for Homecare today stressed its zero tolerance for Medicare fraud and abuse of any kind in a statement of support to the U.S. House of Representatives Committee on Ways and Means Subcommittees on Health and Oversight after the two subcommittees conducted a joint hearing this morning regarding Medicare program integrity. The statement follows.

Billing practices result in arrest - December 29, 2007
A six–month investigation into the billing practices of a Midland chiropractor has resulted in criminal charges.

Judgments against New Jersey Chiropractic Clinics, Owners and Doctors Brings Lib - December 29, 2007
MOUNT HOLLY, N.J.––(BUSINESS WIRE)––A lawsuit against an intricate auto insurance fraud network uncovered by Liberty Mutual investigators in the late 1990s came to a costly end last week for the owners of two now–defunct New Jersey chiropractic and rehabilitation clinics.

Federal grand jury indicts physician, chiropractor - December 29, 2007
A Savannah physician and a chiropractor have been indicted by a federal grand jury in Savannah on charges of conspiring to defraud Medicare and Medicaid.

Baltimore County Woman Charged with Medicaid Fraud - December 29, 2007
Attorney General Douglas F. Gansler announced today that Siddi Jon, 48, of the 8900 block of Greens Lane in Randallstown was indicted by a Baltimore County grand jury with 18 counts of felony Medicaid fraud and felony theft.

Investigative Report: Remade board treads gently
State chiropractors' overse - December 29, 2007
In this two–part report, we take a closer look at the state Board of Chiropractic Examiners. Stocked with a roster of the governor's appointees, the new state Board of Chiropractic Examiners has been slower to yank licenses and quicker to soften previous sanctions.

Allstate Insurance Company Wins $3 Million Judgment Against Broe Rehabilitation - December 29, 2007
FARMINGTON HILLS, Mich.––(BUSINESS WIRE)––Aug. 21, 2006––Allstate Insurance Company has been awarded a jury verdict of $3 million against Broe Rehabilitation Services, Inc., a Farmington Hills, Mich.–based rehabilitation facility, and the owners, Timothy and Eleanor Broe. The Oakland County jury found in favor of Allstate and against Broe regarding payment by mistake of fact, insurance fraud, breach of contract and unjust enrichment.

Bell Pleads Guilty to Felony Medicaid Fraud
Company Received More Than $4,00 - December 29, 2007
BALTIMORE, MD (September 20, 2007) – Maryland Attorney General Douglas F. Gansler announced today that Guy Anthony Bell, 44, of the 2700 block of Tallow Tree Road in Woodstock, pled guilty in the Circuit Court for Baltimore City to two counts of felony Medicaid Fraud for his role in billing the Medicaid program for more than $4,000,000 for services that were never performed. In all, Mr. Bell knowingly directed his employees to submit over 20,000 false statements to the Medicaid Program. As a result of the plea agreement, Bell will receive a jail sentence of between 24 and 30 months and will be required to make restitution payments. Sentencing is set for November 15, 2007.

Stokes sentenced to less than maximum - December 29, 2007
GRAND RAPIDS –– Dr. Robert Stokes must serve 10.5 years in prison as well as three years supervised release for health care fraud, a federal judge ruled about 7 p.m. tonight.

Hammond health firm to settle in billing allegation - December 29, 2007
A Hammond health–care firm will pay $750,000 to settle allegations of filing improper Medicare claims. United Medical Services provided outpatient physical therapy services to Medicare beneficiaries at a clinic owned by John E. Mills.

Doctor Indicted in Verizon Billing Scam - December 29, 2007
NEW YORK – A physician whose wife vanished and was later found dead in the East River was arraigned Thursday on charges of running a "medical mill" that cheated the Verizon Communications Inc. health plan by fraudulent billing.

Boston Area Medical Providers Named In Multimillion Dollar Healthcare Fraud Sche - December 29, 2007
BOSTON––(BUSINESS WIRE)––November 6, 2007––Owners and employees of Boston Regional Physical Therapy, Inc., and its sister corporation, Central Metropolitan Billing Services, Inc., have been named as defendants in a multi–million dollar lawsuit before the United States District Court for the District of Massachusetts; recoveries in the lawsuit could top $5 million. This lawsuit is the culmination of an eighteen–month investigation spearheaded by the Special Investigations Unit of Metropolitan Property and Casualty Insurance Company (MetLife Auto & Home ®). In recent years, MetLife Auto & Home has been one of the most active insurance companies in the Commonwealth in the fight against insurance fraud.

Businessman gets 15 years in jail for Medicare fraud
Defendant is accused of - December 29, 2007
A Houston man was sentenced to 15 years in prison Wednesday for stealing more than $900,000 from the Medicare program.

Man Convicted for Automobile Insurance Fraud, Reports U.S. Attorney - December 29, 2007
BOSTON, Dec. 15 /PRNewswire/ –– A federal trial jury today convicted a Shrewsbury man of mail fraud, health care fraud, and conspiracy to commit money laundering, in connection with false billings to automobile insurance companies for medical tests.

Health care fraud charged - December 28, 2007
Three men who operated two physical therapy centers on Long Island were arrested yesterday by FBI agents on charges of defrauding dozens of insurance companies and the federal Medicare program out of $2.5 million, according to officials.

1st arrest made in Medicare fraud case - December 28, 2007
Federal agents on Wednesday brought the first criminal charge in what they say is a series of complex, multimillion–dollar schemes across Metro Detroit to bilk Medicare through fraudulent billing.

Clinic owner admits Medicare fraud - December 28, 2007
TRENTON – The owner of two physical therapy clinics, including one in Cherry Hill, admitted defrauding Medicare of about $3.8 million, U.S. Attorney Christopher J. Christie announced.

Houston Man Investigated By Medicaid Fraud Control Unit Receives 15 Years In Pri - December 28, 2007
December 6, 2007 –– HOUSTON – A Houston durable medical equipment provider was sentenced to 15 years in state prison Wednesday for stealing more than $900,000 from the Medicare program. Texas Attorney General Greg Abbott’s Medicaid Fraud Control Unit investigated the case, along with the FBI and Office of Inspector General of the Health and Human Services Commission (HHSC–OIG). The Harris County District Attorney’s Office handled the prosecution.

Chiropractor charged with Medicaid fraud - December 28, 2007
HARRISBURG — The state Attorney General's Office charged a Bartonsville chiropractor with money–laundering and medication fraud Thursday as part of an ongoing investigation into illegal pain killer prescriptions in Luzerne County.

Chiropractor, Clinic Owner and Doctor Sentenced for Health Care Fraud Reports U. - December 28, 2007
BOSTON, Jan. 11 /PRNewswire/ –– Three men from Gloucester, Newton and Marblehead were sentenced late yesterday in federal court on charges of conspiracy to commit mail fraud, wire fraud, health care fraud, and money laundering.

Federal grand jury indicts physician, chiropractor - December 28, 2007
A Savannah physician and a chiropractor have been indicted by a federal grand jury in Savannah on charges of conspiring to defraud Medicare and Medicaid.

Bakersfield clinic operator charged with insurance fraud - December 28, 2007
BAKERSFIELD – Three members of a Bakersfield family have been charged with insurance fraud, according to the state insurance commissioner's office.

Newport News chiropractor charged with health care fraud
The U.S. attorney's - December 28, 2007
NEWPORT NEWS — – The U.S. attorney's office has charged a Newport News chiropractor with health care fraud, saying he intentionally billed health management companies for services he never performed.

Physical therapist pleads to fraud scam
His seven-month scheme stole more th - December 28, 2007
A physical therapist has admitted scheming with his wife, a Wayne County doctor and the doctor's wife to steal more than $700,000 in government health–care reimbursements over a seven–month period.

Medsphere’s OpenVista EHR Goes Live at State Hospital in West Virginia First Sit - December 27, 2007
ALISO VIEJO, Calif.––(BUSINESS WIRE)––Medsphere Systems Corporation today announced the successful deployment of its OpenVista® electronic health record (EHR) platform at William R. Sharpe Jr. Hospital, the first of seven state–operated hospitals in West Virginia that will be equipped with the system under a contract signed last year. More than 280 physicians, nurses, pharmacists, dietitians and other staff at Sharpe Hospital, a 150–bed acute care psychiatric facility in the city of Weston, are now using OpenVista to record and retrieve patient information electronically.

JUSTICE RECOVERS RECORD $1.6 BILLION IN FRAUD PAYMENTS - HIGHEST EVER FOR ONE YE - December 25, 2007
WASHINGTON, D.C. – The United States collected a record $1.6 billion in civil fraud recoveries during the past fiscal year, Assistant Attorney General Robert D. McCallum, Jr. of the Justice Department's Civil Division announced today.

Electronic Medical Billing Software and Service Compliance in Physical Therapy O - December 15, 2007
According to BillingWiki, thirteen articles and news items were published on the topic of medical billing fraud, during May of 2006. An environment of high volume of patient encounters creates thousands of possibilities to deviate from normal distribution of services and trigger an audit. Real time analysis requires powerful technology infrastructure and competent legal coverage. Such infrastructure must handle all compliance aspects together, which necessitates modern Vericle–type integrative approach, combining billing, monitoring, and medical record management components in a single and comprehensive system.

Businessman gets 15 years in jail for Medicare fraud - December 09, 2007
Defendant is accused of stealing around $900,000. Testimony in state District Judge Devon Anderson's court also showed that Onwuegbusi overbilled Medicaid for physical therapy services, some that were never provided.

Bakersfield clinic operator charged with insurance fraud - December 03, 2007
Three members of a Bakersfield family have been charged with insurance fraud, according to the state insurance commissioner's office.

Newport News chiropractor charged with health care fraud - December 03, 2007
The U.S. attorney's office has charged a Newport News chiropractor with health care fraud, saying he intentionally billed health management companies for services he never performed.

Monroe county chiropractor arrested on money laundering and Medicaid fraud charg - November 23, 2007
A Monroe County Chiropractor was arrested Thursday on money laundering and Medicaid fraud charges in connection with an ongoing investigation into the illegal prescription of painkillers in the Wilkes–Barre area, Attorney General Tom Corbett said Thursday.

Former physical therapist admits fraud - November 23, 2007
A former Richmond Hill physical therapist pleaded guilty Monday in federal court to scheming to commit health care fraud.

Doctor indicted in Verizon billing scam - November 23, 2007
A physician whose wife vanished and was later found dead in the East River was arraigned Thursday on charges of running a "medical mill" that cheated the Verizon Communications Inc. health plan by fraudulent billing.

Physical Therapist Charged with Medicaid Fraud - November 23, 2007
A Newington physical therapist was arrested today and charged with billing the state's Medicaid program for services he never provided to residents of a Newington group home.