University City doctor gets year in prison for health care fraud : News

July 11, 2013 4:43 pm  •  By Robert Patrick rpatrick@post-dispatch.com 314-621-5154

ST. LOUIS • A doctor from University City was sentenced to 366 days in federal prison Thursday for overbilling Medicare and Medicaid, prosecutors said.
Dr. Wit A. Jamry, 62, pleaded guilty in U.S. District Court here in February to a health care fraud charge and admitted that from 2007-11, he and his practice billed $26,227 for his time while he was actually out of town or out of the country. Some of the work was performed by a nurse practitioner while Jamry was in Atlanta, Poland and Mexico.
Jamry also billed over $92,773 for patient visits lasting more than an hour when there was no evidence to show that he or his nurse practitioner had spent that amount of time, prosecutors say.
Jamry faced 12 to 18 months in prison under federal guidelines.
He and his company, Dr. Wit-Internal Medicine Professional Geriatric, P.C., were ordered to repay $119,000 and Jamry was fined $30,000.
At the time of his plea, Jamry was an adjunct associate professor at St. Louis University Medical School’s Division of Geriatrics and practiced at St. Luke’s Hospital and Des Peres Hospital.


University City doctor gets year in prison for health care fraud : News

UnitedHealthcare expecting big savings from accountable care | EHRintelligence.com

Author Name Kyle Murphy, PhD   |   Date July 12, 2013

 

While many in the healthcare industry are awaiting evidence that accountable care organizations (ACOs) will actually lead to more manageable costs, one health insurer is exceedingly confident that the adoption of accountable models is paying off and will continue to do so in the coming years. In a midweek announcement, UnitedHealthcare indicated its expectation of a sizeable increase in ACO contracts in the next four years.

The news comes just a couple weeks after both Aetna and Cigna signaled their efforts to increase their skin in the ACO game by striking agreements with healthcare organizations serving Arizona, Kentucky, New York, Pennsylvania, South Carolina, and Virginia.

Already working with more than 575 hospitals, 1,100 medical groups and 75,000 physicians nationally, UnitedHealthcare intends to take an even more aggressive approach within the five years to grow its ACO contract base. After revealing that it had already paid out $20 billion in reimbursements to healthcare organizations and providers, the company anticipates these figures reaching $50 billion by 2017.

According to Wednesday’s announcement UnitedHealthcare’s ACO strategy consists of three categories which vary according to the amount of financial risk the provider is willing to assume:

Performance-based programs: bonus-based incentives for primary care practices, or performance-based contracts with hospitals, physicians and ancillary care providers for successfully improving patient health outcomes and lowering costs.

Centers of Excellence programs: bundled reimbursements for specific treatments and/or procedures rather than charging for each visit or drug administered.

Accountable care programs: Conventional ACOs and patient-centered medical homes in which both the health plan and provider share risk and savings.

And if its figures are correct, each of these programs is currently proving capable of positively impacting healthcare costs. For instance, the organization’s performance-based programs have shown the ability to reduce the use of non-Tier 1 (i.e., those with higher copays) and out-of-network laboratory services by 14 percent and 25 percent, respectively. Similarly positive results have emerged from the other two categories as well with reductions in medical cost trend (4–4.5%), emergency room visits (16%), and inpatient days (17%).

UnitedHealthcare expecting big savings from accountable care | EHRintelligence.com