Articles

Owner Of Charlotte Behavioral Health Company Sentenced To Two Years In Prison For $400,000 Medicaid Fraud Scheme

CHARLOTTE, N.C. – A Charlotte man and owner of a behavioral health company was sentenced on Thursday, July 11, 2013, to serve 24 months in prison for attempting to obtain nearly $400,000 in fraudulent reimbursement claims from North Carolina Medicaid. Gregory Benny Lassiter, Jr., 32, of Charlotte, was also ordered to remain under court supervision for two years, following his prison term.

Lassiter was the owner of VisionOne Health Services, Inc., (“VisionOne”), a Charlotte-based company approved by Medicaid to provide outpatient behavioral health services to Medicaid recipients. According to court records and yesterday’s sentencing hearing, Lassiter misappropriated Dr. M.T.’s Medicaid provider number and submitted fraudulent claims to Medicaid, falsely stating that Dr. M.T. had provided services to clients long after Dr. M.T. had terminated her relationship with Lassiter and VisionOne. These false and fraudulent claims were submitted to Medicaid between November 2009 and April 2011 and resulted in Medicaid payments to Lassiter exceeding $191,000.

Lassiter also admitted that he submitted false claims to Medicaid for services that his company never provided with co-conspirator Erika Holland. Holland was not approved by Medicaid to provide mental and behavioral health services and did not employ any licensed therapists. In exchange for submitting these false claims through his company’s Medicaid provider number, Lassiter kept 30% of the Medicaid reimbursement for the false claims. From late October 2010 to December 2010, Lassiter and Holland received approximately $93,000 from Medicaid based upon these false claims.

Co-conspirator Erika Holland was sentenced on March 2, 2012, to serve 54 months in prison for her role in the scheme, and was ordered to pay $1,585,093 in restitution.

Read the entire article here.

July 15th, 2013

WellPoint pays HHS $1.7 million for leaving information accessible over Internet

The managed care company WellPoint Inc. has agreed to pay the U.S. Department of Health and Human Services (HHS) $1.7 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules.

This case sends an important message to HIPAA-covered entities to take caution when implementing changes to their information systems, especially when those changes involve updates to Web-based applications or portals that are used to provide access to consumers’ health data using the Internet.

The HHS Office for Civil Rights (OCR) began its investigation following a breach report submitted by WellPoint as required by the Health Information Technology for Economic and Clinical Health. The report indicated that security weaknesses in an online application database left the electronic protected health information (ePHI) of 612,402 individuals accessible to unauthorized individuals over the Internet.

Beginning Sept. 23, 2013, liability for many of HIPAA’s requirements will extend directly to business associates that receive or store protected health information, such as contractors and subcontractors.

Read the entire article here.

July 12th, 2013

Aetna’s Cuts to Pathology Services Averted in North Carolina

The leadership of the NC Society of Pathologists (NCSP) recently learned of a proposal by Aetna to unilaterally modify its national laboratory fee schedule beginning July 1. Under this shift, large pathology practices would see payment rates for basic services drop to 45-50 percent of current Medicare rates.

After NCMS and NCSP raised a direct interest in the revised fee schedule for national labs, Aetna decided not to implement these drastic cuts in North Carolina as planned.

The NCMS and NCSP consider this a major victory in our continuing effort to defend physicians from unfair health insurer practices.

Read the entire article here.

June 27th, 2013

CMS Stresses Doctors’ Rights to Challenge Data Collected Under Sunshine Act

CHICAGO–Centers for Medicare & Medicaid Services policymakers rolling out the Physician Payments Sunshine Act June 17 attempted to soothe physicians’ fears over potentially false or misleading reports pointing to dubious financial relationships with medical device and pharmaceutical manufacturers.

“Data accuracy is the number one goal of our program,’’ Griner said. “We want the data put on the public website to be complete and accurate.”

Beginning Aug. 1, manufacturers of pharmaceuticals, medical devices, and biologicals will commence complying with the sunshine law’s National Physician Payment Transparency Program, which CMS is calling OPEN PAYMENTS. The program requires companies to track items of value provided to physicians and teaching hospitals and submit annual reports on such activities. The data will be published annually as a strategy for preventing inappropriate influences on research, education, and clinical decisionmaking.

Griner said physicians do not have specific reporting requirements under the program. At the same time, she said physicians will have the right to check the information being supplied by manufacturers and GPOs and challenge inaccuracies prior to publication. Specifically, physicians will have 45 days to access the consolidated reports through an online portal. Disputed information then will undergo a resolution process.

Read the entire article here.

June 24th, 2013

Scope of Practice for Physician Assistants Expanded Under New South Carolina Law

RALEIGH, N.C.—Physician assistants in South Carolina now may prescribe controlled substances, with certain limitations, under a bill (S. 448) signed into law May 21 by Gov. Nikki Haley (R).
The new law, which took effect immediately, also aims to expand other tasks and functions such providers may engage in and streamline their regulation by the state Board of Medical Examiners.

Read the entire article here.

View the new law here.

May 30th, 2013

Charlotte Man Arrested And Charged With Stealing Identities Of Children And Clinicians To Commit Medicaid Fraud

A Charlotte man charged with defrauding Medicaid of at least $450,000 and stealing the identities of children and clinicians to commit the fraud was arrested in Charlotte today, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina.

A federal grand jury returned the criminal indictment against Calvin Cantrell Estrich, 31, of Charlotte on May 23, 2013. The indictment charges Estrich with one count of health care fraud conspiracy, four counts of health care fraud, four counts of false statements in connection with health care matters, eight counts of aggravated identity theft, one count of money laundering and one count of making false statements to investigators. The indictment also includes a forfeiture allegation seeking a money judgment in the amount of at least $462,178.

“Rooting out health care fraud and bringing to justice those looking to scam taxpayer-funded health care programs is a priority for this office,” said U.S. Attorney Tompkins. “We will continue to fight health care fraud through concentrated and sustained efforts and to aggressively safeguard precious taxpayer dollars.”

“Cases like this one send a strong signal that we won’t tolerate health care fraud in North Carolina,” said Attorney General Roy Cooper. “Our investigators and attorneys will continue to work closely with their federal counterparts to stamp out health care fraud and abuse, save taxpayers’ money, and protect patients.”

Read the entire article here.

May 29th, 2013

Orthofix Territory Manager Convicted for Committing Health Care Fraud and Paying Kickbacks

A former Orthofix territory manager, Hunter A. Rigsby, 33, of Knoxville, Tenn, was convicted today for health care fraud and paying kickbacks.
Rigsby was a territory manager for Orthofix, Inc., a company that sold bone growth stimulator medical devices. Medicare only pays for “long bone” stimulators when at least 90 days have elapsed without clinically significant healing, and it only covers certain types of injuries. Rigsby was well-aware of these guidelines, but Rigsby’s territory ordered bone growth stimulators that did not satisfy Medicare’s guidelines.

Read the entire article here.

May 20th, 2013

United States Sues Novartis Pharmaceuticals Corp. For Allegedly Paying Multi-Million Dollar Kickbacks To Doctors In Exchange For Prescribing Its Drugs

United States Attorney for the Southern District of New York announced today that the United States has filed a civil false claims lawsuit against NOVARTIS PHARMACEUTICALS CORP. (“NOVARTIS”). The Government’s Complaint seeks damages and civil penalties under the False Claims Act and under the common law for paying kickbacks to doctors to induce them to prescribe NOVARTIS pharmaceutical products that were reimbursed by federal health care programs. This is the second lawsuit to be filed in the Southern District this month against NOVARTIS alleging illegal kickbacks.

Read the entire article here.

April 29th, 2013

OMB Reviewing Advance HHS Rulemaking To Ease Sharing of Mental Health Records

The federal government is a step closer to amending the Health Insurance Portability and Accountability Act Privacy Rule to make it easier for states to share certain mental health records for the purposes of background checks for gun ownership.

In January, OCR Director Leon Rodriguez issued a memo to health care providers telling them they were allowed under the HIPAA Privacy Rule to share mental health records in cases where individuals were considered dangerous to themselves or others.

Read the entire article here.

April 11th, 2013

Physician-Owned Distributorships Present High Risk of Fraud, OIG Alert Says

Physician-owned distributorships (PODs) pose a high risk of fraud and abuse and may lead to delivery of inappropriate and potentially harmful services, according to a Special Fraud Alert from the Department of Health and Human Services Office of Inspector General released March 26.

Read the entire article here.

April 9th, 2013

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