Robin Mathias's blog

AG Announces Indictment of Clinical Social Worker for Health Care Fraud

News and Commentary | Fraud Cases
AG Announces Indictment of Clinical Social Worker for Health Care Fraud - Oregon Attorney General Hardy Myers today announced that Robert F. White, a licensed clinical social worker in Manzanita, was indicted by the Tillamook County Grand Jury. [Healthcare Fraud News] The Attorney General’s Office accused Mr. White of billing for services that were not rendered.

Clinics Find Surgery Scam Pays

News and Commentary | Fraud Cases
Clinics Find Surgery Scam Pays - Latimes.com - Sun Jun 20, 12:09 pm GMT [News4Sites Healthcare] Outpatient surgery rent-a-patient scams are in the news again is Southern California. These scams often target low-wage employees at companies that offer health insurance. The clinic pays the insured person to let them do unnecessary surgery. They often employ runners to recruit new patients. Bill Mahon of the National Healthcare Anti-Fraud Association says that insurers have learned from this. In the article, Mahon says, “I think at this stage, most of the industry has learned a great deal from the experience. And they’re making changes to try to stop these things at the front door.”

July-August 2004 News

Newsletters

In this month’s issue:

  • Make Fraud Control Everyone’s Job
  • Wheelchair Fraud Update
  • Let’s talk about Data Mining
  • Upcoming Events

Large OH Health Plan Adds the Latest Prevention and Detection Technology in Its Battle Against Fraud

News and Commentary
Large OH Health Plan Adds the Latest Prevention and Detection Technology in Its Battle Against Fraud - For Medical Mutual, This Emphasis on Anti-Fraud Activities is Critically Important Since Healthcare Fraud is Estimated to Cost American Consumers More Than $100 bln Annually BALTIMORE, 6/7/2004 /PRNewswire/ ViPS a provider of business intelligence… [Healthcare Fraud News] According to the press release, Medical Mutual “often recovers $1 million or more per year in improper payments as a result of its vigilance.” This is a tiny fraction (.05%) of Medical Mutual’s annual revenue of $1.9 billion.

Two Brothers Plead Guilty to Wheelchair Fraud

News and Commentary | Fraud Cases | Medicaid Fraud Cases | Medical Equipment Fraud Cases
Two brothers plead guilty to defrauding Medicare - Anietie H. Edoho-Ukwa, 46, and Ukwa H. Edoho-Ukwa, 48, each pleaded guilty to one count of health care fraud before U.S. District Judge Paul Brown, federal prosecutors said in a news … [Healthcare Fraud News]

Wheelchair fraud is in the news again, as two men in Texas pleaded guilty to submitting fraudulent claims to Medicare for power wheelchairs. In the past year, the Federal government has taken many steps to crack-down on power wheelchair fraud. In February 2004, the Deptartment of Justice announced 11 arrests in Texas as the result of Operation Roll Over. In September 2003, the Centers for Medicare and Medicaid Services (CMS) announced Operation Wheeler Dealer, a ten point plan to curb wheelchair fraud in the Medicare program. At the end of April 2004, CMS announced new payment guidelines to make sure that people who need wheelchairs get them and people who don’t, don’t.

HHS Subpoenas Records at Maryland Hospital

News and Commentary
HHS Subpoenas Records at Maryland Hospital - Sunherald.com - Thu Jun 17, 02:01 pm GMT [News4Sites Healthcare] Maryland General Hospital is under investigation for conducting and billing for inaccurate lab tests.

Big Employers Join Forces in Effort to Negotiate Lower Drug Prices

News and Commentary
Big Employers Join Forces in Effort to Negotiate Lower Drug Prices - To slow the rising cost of health coverage, 50 of the country’s largest employers are creating a buyers’ club to bargain directly with drug makers. [New York Times Healthcare News] I couldn’t help noticing that while many Medicaid programs pay AWP minus 10%, the price at the drugstore (for the example mentioned in the article) was below that price.

Medical Journals May Force Disclosure of Bad Trials

News and Commentary
Medical Journals May Force Disclosure of Bad Trials - WASHINGTON (Reuters) - Editors of the leading medical journals are considering a proposal that would make drug companies disclose trials that shed unfavorable light on their products, The New York Times reported on Tuesday. [Reuters Health News] This development can give Evidence Based Medicine researchers the information they need to evaluate new drugs.

A Study Questions Blood-Test Results on Prostate Cancer

News and Commentary
A Study Questions Blood-Test Results on Prostate Cancer - Significant numbers of older men whose results on a popular screening test for prostate cancer are normal may nonetheless have cancer. [New York Times Healthcare News]

This New York Times article reminds us that we have to be careful how we interpret cancer screening results. Early detection of cancer can lead to unnecessary interventions. The study showed that 15% of men with PSAs below 4 had cancer. The study could lead some doctors and patients to conclude that a biopsy makes sense, even with low PSA. However, the article also says:

May 2004 Newsletter

Newsletters

The Month’s Report:

  • Ten Steps to Stop Healthcare Fraud
  • Fraud Control Toolbox
  • Updated Bidding Opportunities
  • Public Appearances

Ten Steps to Stop Healthcare Fraud

Fraud is a serious problem that affects every healthcare system. Each health plan loses from 3% to 30% to fraud, waste and abuse. Reducing fraud losses is one of the few ways that a health plan can cut costs without hurting their members or providers. Investment in fraud control typically saves $6 to $12 for every dollar spent, yet health systems have not invested in the level of controls that will effectively stop fraud. Check out these ten steps that will help you stop fraud.

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