MRA Alerts and Updates: 06/14/13

Friday, June 14, 2013

Hagerstown pharmacist pleads guilty in $200K Medicare, Medicaid fraud

THE ASSOCIATED PRESS
First Posted: June 14, 2013 - 8:54 pm

BALTIMORE — A Hagerstown pharmacist has pleaded guilty to improperly billing Medicare and Medicaid more than $200,000 for unlawful prescriptions for oxycodone and methadone.

Sixty-two-year-old David Russo, who owned and operated Russo's Rx, entered the plea Friday in federal court in Baltimore. As part of a plea agreement, prosecutors and the defense with ask for a term of 30 months in prison at sentencing Aug. 22. Russo will also be ordered to pay restitution.

According to his plea deal, Russo filled prescriptions for oxycodone, methadone and benzodiazepines that he knew were issued outside of the legitimate medical course and fraudulently billed Medicare and Medicaid for those prescriptions.

http://www.dailyjournal.net/view/story/5194a150ca9941b596c55a76a9288493/MD--Pharmacist-Fraud/

Competition in Medicare programs: Boon or boondoggle? | TheUnion.com

Does competition to provide insurance for Medicare recipients reduce costs? Or does competition simply increase the tab picked up by taxpayers?

Dr. Ida Hellander, policy director for Physicians for a National Health Program, a nonprofit research and advocacy group, thought taxpayers should know the answers to these questions.

In her research study published in the International Journal of Health Services, Hellander found that competing insurance programs, called Medicare Advantage plans, did not save money. In fact, since their introduction, the private (mostly for-profit) insurance programs have cost taxpayers an extra $282.6 billion.

Hellander adds, “In 2012 alone, private insurers are being overpaid $34.1 billion.” This money, Hellander believes, should have been used to reduce the federal deficit, shore up Medicare’s trust fund or improve patient care — not to enrich private insurance companies.

In 1985, Medicare contracted with private (mostly for-profit) insurance plans such as UnitedHealth and Humana for coverage of Medicare enrollees in a plan called Medicare Advantage. The idea was that Medicare Advantage plans would compete with the traditional fee-for-service Medicare insurance.

(B)ecause of the added benefits, the lower premiums and the need to make a profit, the Advantage programs cost Medicare about 25 percent more than the traditional Medicare program.

Ironically, part of the argument for introducing the Advantage plans was that the competition would lower Medicare costs. Indeed, since their inception, the Advantage plans have become increasingly popular because they offer enrollees additional benefits at reduced premiums. But because of the added benefits, the lower premiums and the need to make a profit, the Advantage programs cost Medicare about 25 percent more than the traditional Medicare program.

Medicare currently pays these privately run plans a set premium per enrollee (about $10,123). This amount is $2,526 more than the premium paid for enrollees covered under the standard Medicare plan.

About 27 percent of Medicare beneficiaries are currently covered under Medicare Advantage plans. Given how profitable the Advantage plans are for private insurers and how attractive the expanded benefits and lower premiums are for enrollees, this number is expected to grow at a fast clip.

Just how profitable are these programs for the private insurers?

UnitedHealth Group could afford to bump the annual compensation of its chief executive officer, Stephen J. Hemsley, to $13.9 million from $13.4 million in the prior year. The increase was based in part on his leadership in solidifying the company’s position as “the biggest provider of the privately run, subsidized versions of the government’s Medicare program for the elderly and disabled people.”

Guess who’s subsidizing Mr. Hemsley’s salary? Look around. It’s you, me and other taxpayers.

Dr. Steffie Woolhandler, coauthor of the study, concludes, “It’s clear that having Medicare Advantage programs compete with Medicare doesn’t save us money. In fact, the opposite is the case. The private plans only add waste, and the aggregate waste is staggering — enough to be a significant drag on the economy.”

Can taxpayers afford the extra cost to help private insurers make a profit from Medicare? Given the intent of Medicare to provide basic healthcare coverage to all enrollees, should all enrollees receive the same benefits? Or are some recipients entitled to expanded benefits at reduced premiums? If so, should taxpayers cover the cost of paying for these extra benefits and lowered premiums?

Or does a single-payer, not-for-profit model with universal benefits and premiums make more financial sense?

What do you think?

Carole Carson lives in Nevada City.

Park: Better Patient Engagement Will Boost Overall Health System

During an address at the Health Privacy Summit in Washington, D.C., last week, U.S. Chief Technology Officer Todd Park emphasized the importance of patients' engagement in their own health care, FierceHealthIT reports.

Details of Park's Comments

Park said, "Patient engagement -- to quote Leonard Kish -- might be the blockbuster drug of the 21st century," adding, "This will vastly improve our health care system."

He said, "From the very top of government, we're incredibly serious about making sure patients can get a copy of their own records."

Park noted that more than 88 million Americans to date have used the online Blue Button tool, which allows patients to download their own health records. That number is expected to reach 115 million by the end of the year, he said.

He added that sequestration has not impeded Blue Button efforts (Bowman, FierceHealthIT, 6/7).

Health Leaders Push for More Data Use To Boost Patient Care

Also at the summit, several health care leaders discussed how greater use of data can improve patient care.

David Chao -- CTO at the Advisory Board Company -- said that the current status quo in health care delivery is not acceptable. He added that when the right questions are asked, data can "pop" and be "provocative". The Advisory Board Company produces iHealthBeat for the California HealthCare Foundation.

Anil Jain -- chief medical information officer of Explorsys, a health care software platform -- said that the use of data is how physicians and CIOs get transparency on what really is happening. He said, "We have to balance the value the information brings with the privacy and safety of patients."

David Muntz -- principal deputy national coordinator at the Office of the National Coordinator for Health IT -- said that while he and others at the summit support health data privacy, he sees the benefit of increased data sharing and making patients the custodians of their records (Gold [1], FierceHealthIT, 6/7)

Privacy Experts Criticize Health Data Security Efforts

Meanwhile, privacy experts at the summit discussed health data breaches and organizations' security policies.

Omar Khawaja -- a global project manager for Verizon -- said the reactionary approach to health data security breaches is problematic. He said, "It takes months just to contain the breach."

Bill Turner -- chief privacy and security officer of Allium Healthcare, a technology and consulting firm -- said most of the privacy errors he sees are the result of human error.

M. Peter Adler -- health and cybersecurity counsel and chief privacy officer for government affairs for Fairfax, Va.-based technology provider SRA International -- said that data governance is an effective way to prevent and combat breaches, "creating a model where you have stakeholders that are going to help with protection" (Gold [2], FierceHealthIT, 6/7).

UPDATED OIG GUIDELINES FOR EVALUATING STATE FALSE CLAIMS ACTS

Note: These guidelines are effective March 15, 2013, and replace the guidelines effective on August 21, 2006, found at 71 FR 48552.

OIG Guidelines for Evaluating State False Claims Acts

Section 1909 of the Act sets forth four requirements a State law must meet to qualify for the 10-percentage-point decrease in the Federal medical assistance percentage with respect to any amounts recovered under a State action brought under the State law. After consulting with DOJ, OIG has developed guidelines to use in determining whether a State law meets the enumerated requirements. The guidelines are intended to highlight the FCA provisions relevant to OIG’s determination of whether a State law meets the requirements of section 1909 of the Act. OIG will closely review any variation from these provisions of the FCA in the State law.
A. Liability for False or Fraudulent Claims
Under section 1909(b)(1) of the Act, the State law must establish liability to the State for false or fraudulent claims described in 31 U.S.C. 3729, with respect to expenditures related to State Medicaid plans. When evaluating a State law to determine whether it meets the requirements of section 1909(b)(1) of the Act, OIG will consider whether the law provides for the following:

1. Liability to the State for false or fraudulent claims with respect to Medicaid program expenditures, including:

knowingly presenting, or causing to be presented, a false or fraudulent claim for payment or approval;
knowingly making, using, or causing to be made or used, a false record or statement material to a false or fraudulent claim;
knowingly making, using, or causing to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the State or knowingly concealing or knowingly and improperly avoiding or decreasing an obligation to pay or transmit money or property to the State; and conspiring to commit any of the violations described above.

2. Definitions for the terms “knowing” and “knowingly” meaning that a person, with respect to information: (a) has actual knowledge of the information,
(b) acts in deliberate ignorance of the truth or falsity of the information, or
(c) acts in reckless disregard of the truth or falsity of the information. In addition, no specific intent to defraud should be required.

3.A definition for the term “claim” meaning, with respect to any Medicaid program expenditure, any request or demand, whether under contract or otherwise, for money or property and whether or not the State has title to the money or property, that
(a) is presented to an officer, employee, or agent of the State, or
(b) is made to a contractor, grantee, or other recipient if the money or property is to be spent or used on the State’s behalf or to advance a State program or interest and if the State (i) provides or has provided any portion of the money or property requested or demanded or (ii) will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded.

4. A definition of the term “obligation” meaning an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship; from a fee-based or similar relationship; from statute or regulation; or from the retention of any overpayment.

5. A definition of the term “material” meaning to have a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.

If a State law includes provisions that limit the application of the above-described liability provisions and definitions, OIG will consider whether, because of those limitations, the State law fails to fully establish liability to the State for the false or fraudulent claims described in 31 U.S.C. 3729.
least $5,500 to $11,000. If the civil penalties under the FCA are further adjusted by the Federal Civil Penalties Inflation Adjustment Act at a future date, then a State law must provide for civil penalties of at least those adjusted amounts to satisfy the requirements of section 1909(b)(4) of the Act.

Civil Penalty Provisions
Under section 1909(b)(4) of the Act, the State law must contain a civil penalty that is not less than the amount of the civil penalty authorized under 31 U.S.C. 3729. When determining whether a State law meets the requirements of section 1909(b)(4) of the Act, OIG will consider whether the law establishes liability for (1) at least treble damages and (2) civil penalties of at least $5,000 to $10,000 as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note; Pub. L. 104-410). As of the date of this Notice, the civil penalties under the FCA, as adjusted by the Federal Civil Penalties Inflation Adjustment Act, are $5,500 to $11,000. Therefore, a State law must provide for civil penalties of at least $5,500 to $11,000. If the civil penalties under the FCA are further adjusted by the Federal Civil Penalties Inflation Adjustment Act at a future date, then a State law must provide for civil penalties of at least those adjusted amounts to satisfy the requirements of section 1909(b)(4) of the Act.

RAPID PRACTICE INNOVATION

“Rapid Practice Innovation” is a scientific process of implementing positive, whole system change within a medical practice. Our rigorous approach begins at the initial point of contact and provides practical, proven strategies for rapid innovation. ERM’s proprietary model enables clients to shift directions rapidly. Inspired by lessons from lean manufacturing, our unique process integrates education and process improvements to improve the overall experience for all stake holders.

Rapid Practice Innovation in 180 Days

1) Initial on-site “audit” of practice processes.

a. Comprehensive practice evaluation and needs assessment including baseline knowledge of all staff.

b. Detailed findings that outline a specific plan of action to meet compliance and revenue goals.

c. Education and training that includes general compliance and regulatory issues, as well as specific areas for clinical documentation and practice improvement

d. Development of a meaningful compliance plan that is effective for your individual needs.

e. Create Quality improvement initiatives that will enhance staff buy-in and improve the patient experience.

2) On-going education, training and monitoring to asses effectiveness of current initiatives and to prepare for upcoming changes (6 months)

a. Annual Compliance training for all staff

b. Online training to reinforce initiatives

c. ICD-10 Mapping of Top 50 HCC Codes

d. Clinical documentation improvement

e. Risk adjustment methodology / provider responsibilities

f. Contract level requirements

g. HEDIS, PQRS and “Pay for Performance” education and training

h. Patient Centered Medical Home education and training

Visit us online for more information: www.ermconsultinginc.com

Florida's False Claim Act Expanded

Author page »

On June 3, 2013, Florida Governor Rick Scott approved two bills expanding the scope and investigative powers of the State Attorney General under Florida’s False Claim Act. Florida’s False Claim Act currently allows a civil action on behalf of the state against any person who presents or submits false claims for payment or approval to a state agency, uses false records to get a claim paid, or who conspires to do so. Florida’s Attorney General may investigate claims but does not have subpoena powers unless there is a pending action in court.

Florida Governor Rick Scott approved CS/CS/HB 935 on June 3, 2013, which expands the investigative powers of the Florida Department of Legal Affairs. The DLA may now subpoena records, require answering of written questions under oath, and compel the giving of sworn testimony, all prior to a False Claim Act action being filed. Penalties of up to $1,000,000 are provided for the destruction or use of potential evidence subject to a subpoena if a person knows or “has reason to believe” a subpoena has been issued. The FCA now includes state subdivisions and instrumentalities, vests exclusive state prosecution authority to the DLA and the Department of Financial Services, and changes the statute of limitations to three years from the date these agencies became aware of the material facts giving rise to such claims. Either department may intervene in a private action brought under the FCA. Private FCA actions will be precluded when the facts underlying such claims have become publicly known. An accompanying bill, HB 1297 was also approved by Governor Scott and provides that information obtained pursuant to an FCA investigation is confidential and exempt from the public records laws.

Both bills become law effective on July 1, 2013.

The majority of business dealings with the state are conducted honestly and above board, but all companies doing business with the state must assure complete compliance with the requirements of truthful presentation of applications for payment and associated documents. All companies doing business with the state in any capacity must also be aware of the potential ramifications of a subpoena or even knowledge of a subpoena. If your firm does business with the state, consultation with legal counsel regarding appropriate records retention policies and protective measures to assure accuracy in applications for payment is advised.

http://www.lexology.com/library/detail.aspx?g=afc761bf-f4bb-4d7d-902c-64268d7bb391

Doctors should be able to veto treament data until 'happy' with it, say surgeons

Doctors should be able to veto the publication of data showing how their patients fare after treatment until they are "happy" with the figures, the Royal College of Surgeons has said.

Hunt: doctors who refuse to publish patient data will be named and shamed

Mr Hunt's intervention provoked fury from the Royal College of Surgeons Photo: PA

By Robert Winnett, and Rowena Mason

9:39AM BST 14 Jun 2013

30 Comments

Professor Norman Williams, president of the surgeons' group, said some doctors are concerned the data is not "reliable and robust" enough, given the complexities of their work.

His comments come after Jeremy Hunt, the Health Secretary, said there was “no valid reason” why doctors should be able to stop the release of the information, which would help patients identify the best place for treatment.

The Government is preparing to "name and shame" surgeons who refuse to make their data public.

It comes after the Daily Telegraph disclosed that doctors were secretly being given the opportunity to opt out of new Government league tables next month.

However, the Royal College of Surgeons has said the plan to name and shame doctors risks undermining public confidence and "stigmatising" them.

Professor Williams said the medical profession is committed to publishing surgical data, but there is a risk some doctors could shy away from doing difficult operations to keep up their good records.

He said the "way forward" is for all surgeons to publish their data when they are "happy with it". Only a small minority are vetoing publication, he added.

The first data – covering ten different surgical specialisms – will be released imminently before the transparency drive is extended throughout the NHS.

However, 92 surgeons have so far vetoed the publication of “their” data. Many are thought to have death rates which are worse than the average.

NHS England refused to name the surgeons and Mr Hunt has now ordered his officials to draw up plans to “name and shame”.

He said: “Subject to proper risk adjustment of the data there can be no valid reason why it should not be published – and the majority of consultants strongly support the case for doing so.

“In an era of public concern over patient safety issues at Mid Staffordshire Hospital, this will be a major step forward in restoring public confidence.”

Senior health officials said that the public can “draw their own conclusions” about whether they wish to be treated by those withholding data about performance. Whitehall sources have described the situation as “farcical”.

This newspaper disclosed that the surgeons were being privately contacted and asked if they wish to opt out of the publication of so-called “outcomes data”.

The Royal College of Surgeons said that its members were being asked to give their consent to comply with data protection laws.

However, it has now emerged that the Government has not even sought legal advice to establish whether this is the case – but relied on the advice given to it by the professional bodies.

Stephen Dorrell, a former Conservative Cabinet minister who chairs the health select committee, said the law should be rewritten if it was preventing full disclosure. “If it’s true that the Data Protection Act cuts across the principle of professional accountability as it needs to be applied in the modern world, then in my mind it’s very clear that the Data Protection Act needs amendment.”

On Thursday NHS England released further details of the approval process which will lead to the data being published, or withheld. For reasons which are unclear, surgeons with average survival or recovery rates will automatically have their data published unless they raise objections – but those with poor mortality rates will be asked to give explicit approval to publication.

Mr Hunt had hoped that the new system would drive up standards across the NHS and save hundreds of lives by embarrassing those with poor records.

Prof Norman Williams, the President of the Royal College of Surgeons, said the College was “not there to defend 'bad’ doctors, or those who are not performing as well as they should. Patients have a right to know of doctors who are not meeting the standards expected of them.

“We always expected this information would be mandated but it was the Government’s own legal advice, taken earlier this year, that made it clear that in preparation for the publication of data from nine national surgical clinical audits, they would have to ask for doctors to consent to the use of their data, under the Data Protection Act of 1998.

“We would urge the Government to work with us on this, for the sake of better patient care and more transparency.”

http://www.telegraph.co.uk/health/healthnews/10120098/Doctors-should-be-able-to-veto-treament-data-until-happy-with-it-say-surgeons.html

HHS-Operated Risk Adjustment Data Validation Stakeholder Meeting (June 25)

HHS is holding a meeting on June 25, 2013 to discuss the HHS risk adjustment data validation process that will be conducted when HHS operates the ACA insurance market risk adjustment program on behalf of a state. The stakeholder meeting is being offered as both an in-person meeting (registration deadline is June 7) and web conference (registration deadline is June 19).

http://www.mondaq.com/unitedstates/x/245010/Healthcare/HHSOperated+Risk+Adjustment+Data+Validation+Stakeholder+Meeting+June+25

GIGTANK Presents Healthcare Entrepreneur Ross Mason - 06/13/2013 - Chattanoogan.com

Thursday, June 13, 2013

The Company Lab, in partnership with First Tennessee Bank, will present the first public GIGTANK event of the summer. “GIGTANK Presents: Ross Mason on Innovation, Healthcare and Chattanooga” on the evening of June 25 at the First Tennessee Bank building.

Mr. Mason, venture philanthropist and founder of the Healthcare Institute for Neuro-Recovery and Innovation, will speak to Chattanoogans about his work in healthcare and the ongoing need for entrepreneurial thinking across the industry.

“Chattanooga is uniquely positioned to be a national and global leader in digital healthcare solutions because of the amazing investment in infrastructure and tremendous commitment to innovation the community has made,” Mr. Mason said. “The 'Gig City' can also take advantage of the market leadership of Nashville in healthcare services and Atlanta in healthcare IT to develop the digital platform that will provide the next generation of healthcare technologies, treatments and cures.”

Originally from Madison, Ga., Mr. Mason became passionate about healthcare after volunteering at an AIDS hospital in Zambia. In 2004, he founded HINRI, a venture philanthropy that provides free venture capital services to early stage nonprofits.

Mr. Mason’s commitment to healthcare innovation has been further inspired by a more personal, life-changing event: due to a biking accident in 2007, he was paralyzed from the collarbone down. Prior to his accident, Mr. Mason pursued a broad range of outdoor sports and active hobbies; that energy is now applied to identifying breakthrough healthcare solutions and improving the lives of others.

He is particularly interested in supporting organizations that aid war veterans, including Warrior 2 Citizen, which helps assimilate veterans to civilian life. The June 25 event will focus in part on recognizing and raising funds for UTC’s Veterans Entrepreneurship Program.

"Healthcare has an immense and growing presence in Chattanooga, and it’s highly relevant to GIGTANK 2013,” said Mike Bradshaw, CO.LAB entrepreneur-in-residence. “Two of our eight teams are developing businesses in the healthcare space, and BlueCross BlueShield of Tennessee, a program sponsor, has demonstrated a longstanding commitment to healthcare innovation. We’re excited to learn how the ideas and technologies Ross has introduced to the Georgia market could be supported by Chattanooga’s unique infrastructure.”

To register for the event, visit http://gigtankrossmason.eventbrite.com/.

Coburn joins effort to fight Medicaid fraud

Updated: 6/11 9:29 am

Published: 6/11 9:11 am

OKLAHOMA CITY (AP) — U.S. Sen. Tom Coburn is part of a bipartisan group of federal legislators who have introduced a bill designed to prevent billions of dollars in waste, fraud and abuse in the Medicare and Medicaid programs.
The Republican from Muskogee announced Monday that he is a co-sponsor of the Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2013, or the PRIME Act. The bill is co-sponsored in the Senate by U.S. Sen. Tom Carper, a Democrat from Delaware.
Among other things, Coburn says the bill would enact stricter penalties for fraud, curb improper payments, expand the sharing of fraud data, and help states identify and prevent Medicaid overpayments.
Coburn says the bill would help prevent billions of dollars in lost health care dollars each year.

Innovation key to improving patient care, access

June 12, 2013 by Greg St. Martin

Larry J. Merlo, president and CEO of CVS Caremark, said on Tuesday morning at Northeastern’s CEOBreakfast Forum that the challenges presented by America’s rapidly evolving healthcare landscape will require innovative solutions that lower costs and improve patient access to quality care.

Merlo said today’s healthcare industry is grappling with challenges ranging from meeting the needs of Baby Boomers to what he called the “epidemic” of patients’ non-adherence to prescription medication schedules. The Affordable Care Act, he added, is constantly introducing new elements into the fold.

“All of the stakeholders in the system including consumers, employers, and hospitals, are experiencing levels of unprecedented change,” said Merlo, the latest keynote speaker at Northeastern’s CEO Breakfast Forum series. President Joseph E. Aoun hosts the events, where leading CEOs share their expertise with audiences of other CEOs and senior executives from the Greater Boston area.

President Joseph E. Aoun, right, greets Larry Merlo, president and CEO of CVS Caremark, on Tuesday morning at Northeastern’s CEO Breakfast Forum.Photo by Brooks Canaday.

CVS Caremark, Merlo explained, is driving many innovative approaches to meet these healthcare challenges, particularly by reinventing pharmacy’s role in the equation. He detailed CVSCaremark’s Pharmacy Advisor Program, which helps patients manage the treatment of chronic diseases through a variety of resources such as counseling services and email notifications. He also pointed to MinuteClinic, CVS Caremark’s retail medical clinics located in select CVS/pharmacy stores nationwide that Merlo said offer convenient, affordable, high-quality care and ease the burden on hospitals treating non-emergency conditions. Launched in 2000, there are now 650 MinuteClinic locations that have collectively treated 15 million patients.

“CVS Caremark is uniquely positioned to help stakeholders navigate the complexities of a changing healthcare system,” said Merlo. He noted that the company’s resources and services are extending the frontlines of care for consumers, helping to alleviate the primary-care physician shortage, closing gaps in care, and improving medication adherence.

In his introductory remarks, Aoun highlighted the longstanding relationship between Northeastern and CVS Caremark, particularly through partnerships in the School of Pharmacy and School of Nursing in the Bouvé College of Health Sciences. CVS Caremark currently employs 278 alumni and nearly 700 students have completed co-ops at CVS Caremark since 2002. In addition, 45 pharmacy students from the 2013 graduating class were placed at CVS Caremark for their Advanced Pharmacy Practice Experiences—intensive experiential courses—during their final year in the Doctor of Pharmacy program.

“Northeastern graduates have certainly demonstrated their leadership abilities among our workforce,” Merlo said.

Aoun noted how Northeastern’s innovative approach to higher education through experiential education parallels CVS Caremark’s novel approach to healthcare solutions. “I was struck by the similarities between the two,” he said.

During a question-and-answer session, Jack Reynolds, dean of the School of Pharmacy, asked Merlo to discuss ways in which the school’s curricula could integrate new elements that align with the evolving healthcare field. Merlo pointed to two areas of opportunity: customer interaction and the evolving nature of the pharmacy industry.

Describing the challenges related to customer interaction, Merlo told the story of a MinuteClinic nurse practitioner who noticed a high-school athlete’s heart murmur during a routine physical and directed the family to a specialist. The boy’s mother initially questioned the finding, but the specialist’s later confirmation compelled her to write a warm letter to CVS Caremark lauding the nurse practitioner’s careful attention.

“This is just one story about what is happening out there every day, whether it’s a nurse practitioner or a pharmacist doing wonderful things that ultimately end up saving people’s lives,” Merlo said.

http://www.northeastern.edu/news/2013/06/ceo-breakfast-larry-merlo/#sthash.TEGFj8WR.dpuf

Bail denied to Miami TV star caught up in Medicare fraud case

BY ENRIQUE FLOR

EFLOR@ELNUEVOHERALD.COM

A Miami federal judge denied bail Tuesday to TV entrepreneur Roberto Marrero, indicted on charges of stealing millions in a massive Medicare fraud scheme.

Justice John O. Sullivan denied the petition because of Marrero’s potential flight risk. Marrero has traveled to Cuba on four occasions, according to government arguments presented at the 40-minute hearing.

Defense attorney Frederick S. Robbins was upset by Sullivan’s decision.

“I disagree [with the decision], but I hope Mr. Marrero will eventually be freed on bail,” Robbins said after the hearing. “I honestly believe he is not a flight risk.”

Justice Department attorney Brendan Stewart said Marrero and his wife Sandra Fernández Viera, presented false invoices for more than $20 million to the Medicare program covering alleged house health-care services provided to diabetic patients.

Stewart said that Marrero received more than $15 million of that amount.

The indictment says the couple was part of a network of 89 people who conspired to commit Medicare fraud in an operation that extended from Miami to Detroit to Los Angeles. The group, which includes doctors, nurses and clinic operators, was charged collectively of conspiring to scam $223 million from Medicare.

Marrero, who appeared at the hearing handcuffed and shackled and dressed in khaki prison garb, is the owner of Cubana de Televisión’s local cable station. He and his wife were co-owners of Trust Care Health Services in Miami from 2007 to 2010.

Robbins said Marrero was not involved in the day-to-day operations, though he was the company’s titleholder.

“There is no question that he was the president of the company,” Robbins said. “But he did not manage the day-to-day operations. He made no payments to Medicare beneficiaries.”

Stewart said Marrero had recruiters of phony Medicare beneficiaries.

The indictment says that the couple paid thousands of dollars a month to Enrique Rodríguez, who provided patients with Medicare cards. Rodríguez was included in the indictment, charged with bribing Medicare patients.

At the hearing, Stewart said Marrero received $4 million deposited in corporations he had set up, in addition to more than $5 million from invoices issued by Trust Care Health Services.

Also, according to the indictment, his wife received $400,000 for Trust Care invoices.

Marrero said briefly that he no longer had money and that he had used it to pay the nearly 250 employees of the local TV station.

Relatives and friends who attended the hearing refused to comment.

Marrero comes from a family of Cuban actors and has played supporting roles in television series like Miami Vice, America’s Most Wanted and Unsolved Mysteries. In 2008, he opened a cable television studio in Allapattah and later transferred the business to Miami Beach. The channel has remained off the air since Marrero and his wife were arrested in mid-May.

According to the indictment, the Marreros sent illegal invoices to Medicare for services rendered to 700 diabetic patients who allegedly could not inject themselves with the insulin they needed and required the help of expensive trained nurses.

Additionally, the couple billed Medicare for physical therapy the patients did not need, according to the indictment.

The government program approved most of the invoices the couple sent.

http://www.miamiherald.com/2013/06/12/3447874/bail-denied-to-miami-tv-star-caught.html

Read more here: http://www.miamiherald.com/2013/06/12/3447874/bail-denied-to-miami-tv-star-caught.html#storylink=cpy

Friday, June 14, 2013

Doctors should be able to veto the publication of data showing how their patients fare after treatment until they are "happy" with the figures, the Royal College of Surgeons has said.

Related Articles

BY ENRIQUE FLOR