Friday, June 21, 2013

Houston Man Arrested in Health Care Fraud Scheme

U.S. Attorney’s OfficeJune 20, 2013
  • Southern District of Texas(713) 567-9000
HOUSTON—Mathew U. Okorocha, 63, has been indicted on charges of conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today. Okorocha, of Houston, joins Lawrence T. Tyler, 41, also of Houston, in a 10-count superseding indictment, returned June 12, 2013.
Okorocha is expected to make an initial appearance this afternoon.
The indictment alleges Okorocha sold medical equipment through his company called KC International in Houston. He allegedly created false invoices to assist Tyler in order for his durable medical equipment company to pass its Medicare inspection. In May 2008, Medicare sought invoices from Tyler to verify medical equipment billings to Medicare, according to the indictment. Okorocha allegedly helped create false invoices reflecting more than $300,000 in purchases of orthotic equipment—back, knee, elbow, wrist, and ankle braces. Tyler sent these invoices to Medicare twice—in June 2008 and again in December 2008—in an effort to keep his billing number, according to the indictment. Medicare revoked Tyler at the end of December 2008.
The indictment alleges that from 2007 to 2009, Tyler falsely billed Medicare and Medicaid for so-called “ortho kits” that consisted of assorted braces. Tyler allegedly billed for equipment that was never delivered, billed for equipment using prescriptions from a physician who never treated the patients, and up-coded (billed for a higher reimbursed brace but delivered a cheaper brace that either did not fit the billing code or did not qualify for any Medicare reimbursement). In addition, as part of the conspiracy, the indictment alleges Tyler paid a marketer for patient billing information, a violation of the federal anti-kickback statute.
Tyler, under the company name 1866ICPAYDAY.COM LLC, allegedly billed Medicare and Medicaid approximately $2.3 million and was paid approximately $1.4 million.
If convicted, both face up to five years in prison and a possible $250,000 fine.
The charges are the result of the investigative efforts of the FBI, the Texas Attorney General’s Medicaid Fraud Control Unit, Department of Health and Human Services-Office of Inspector General, Office of Investigations and the United States Attorney’s Office. Special Assistant United States Attorneys Suzanne Bradley and Adrienne Frazior are prosecuting the case.
An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.

CMS Requires More Discharge Planning Under Medicare Conditions of Participation

CMS Requires More Discharge Planning Under Medicare Conditions of Participation (with: Improving the Patient Discharge Planning Process) | AIS Health

CMS Requires More Discharge Planning Under Medicare Conditions of Participation (with: Improving the Patient Discharge Planning Process)

Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers.
CMS raised the bar for discharge planning in its May 17 compliance guidance under the Medicare conditions of participation (CoP). In addition to pinning its hopes on discharge planning to foil readmissions, CMS sees it as part of the “shared responsibility” of health care professionals, patients and facilities throughout the continuum of care, according to revised interpretive guidelines in the state operations manual.
Interpretive guidelines are used by state surveyors to evaluate hospital compliance with Medicare conditions of participation. If hospitals drop the ball in any area, they are cited for deficiencies and could lose their Medicare certification. The Department of Justice has pursued False Claims Act lawsuits based on violations of the conditions of participation, but so far it has been rebuffed by the courts for the most part.
The conditions of participation require hospitals to have written discharge plans for all inpatients, and the interpretive guidelines put meat on the bones of this mandate. Surveyors determine how good hospitals are at assessing and reassessing post-hospital needs, arranging post-acute services, and teaching self-care. New best practices appear in the 39-page document, but hospitals can take them or leave them. For example, CMS suggests that hospitals do “abbreviated post-hospital planning” for outpatients and observation patients in light of the growing complexity of outpatient services.
“There is a lot more detail,” says Steven McGaffigan, director of case management at Tampa General Hospital. “Some people might see this as more intrusive, but hospitals have to stop discharging to the door.” Everyone benefits from effective discharge planning, which improves patient satisfaction, reduces readmissions and unburdens emergency rooms if post-hospital services and patient education keep hospitals out of the revolving-door business, he says.

CMS Raises Discharge Planning Bar

Although CMS emphasizes the goal of reducing readmissions, there is more to the interpretive guidelines. “Some of what is in here is speaking to ‘post-hospital syndrome,’” McGaffigan says. The term, coined by Harlan Krumholz, M.D., in the Jan. 10, 2013, New England Journal of Medicine, refers to “an acquired, transient period of vulnerability.” Patients may not anticipate how much they will be affected by the hospitalization, McGaffigan says. “You are not yourself and you have to remember the new medications and the changes to your diet and wound care and whether you can shower.” CMS also tries to capture progressive ideas about discharge planning by recognizing newer terms, such as “community care transitions.” The language “pushes us to think more broadly about discharging a patient. The hospital is not the only point in the patient’s interaction with the health care delivery system,” McGaffigan says.
Hospitals should use the interpretive guidelines to audit their own discharge planning process, says Steven Meyerson, M.D., vice president of the regulations and education group at Accretive Physician Advisory Services, who spoke on the topic at a mini-webinar on June 3. “They are very specific,” he says. “There are a lot of documentation requirements,” such as updating the discharge plan if the patient’s condition changes and reviewing it periodically. He notes the interpretive guidelines take effect immediately.
The reduction of readmissions is a centerpiece of the interpretive guidelines. Readmissions are unhealthy for patients and pricey for hospitals, with the Medicare readmission reduction program now cutting base DRG payments for “excess” readmissions within 30 days for pneumonia, congestive heart failure and acute myocardial infarction (RMC 10/22/12, p. 1). In the fiscal year 2014 inpatient prospective payment system regulation, CMS proposes to expand the program to readmissions for acute exacerbation of chronic obstructive pulmonary disease and elective total hip arthroplasty and total knee arthroplasty. Certain readmission measures are also linked to Medicare payment through value-based purchasing and the inpatient quality reporting program.
“While hospitals are not solely responsible for the success of their patients’ post-hospital care transitions, under the discharge planning CoP hospitals are expected to employ a discharge planning process that improves the quality of care for patients and reduces the chances of readmission,” CMS says.
The interpretive guidelines describe the elements of the discharge planning CoP and spell out the new requirements. Here are excerpts:
(1) Screening patients for the risk of bad outcomes in the event there is no discharge planning.Hospitals must “voluntarily” develop discharge plans for all patients or have clear policies on who gets one and why. They must decide early after admission whether patients need discharge planning and get to work on it promptly. There won’t be sanctions as long as discharge planning is underway up to 48 hours before the patient’s departure and there aren’t delays due to the hospital’s failure to finish the evaluation. Even patients who stay fewer than 48 hours are entitled to an evaluation. In a blue box, CMS advises hospitals to assume all patients need some kind of discharge planning given the risk of “adverse health consequences” after discharge.
(2) Evaluating post-discharge needs for inpatients who are at risk or if this is requested by the patient, patient’s representative or physician. CMS added two major items to the overall requirement: The discharge planning must include an evaluation of (a) the patient’s potential need for post-hospital services and their availability, and (b) the “patient’s capacity for self-care” or for care in the location they came from. If family members or caregivers can’t handle all of the patients’ needs, the hospital should determine whether services exist to help them stay home (e.g., home health, respiratory therapy).
(3) Designing a discharge plan if necessary. Only a registered nurse, social worker or other appropriate staff can do it. The plan should match the needs identified in the evaluation and patients may participate.
(4) Initiating the discharge plan before patients leave. Discharge planning should be collaborative, CMS says, involving patients and their caregivers. Outcomes are improved when patients who are discharged home are taught about their disease processes, medications, treatments, expected symptoms and when and how to get help, and when they are given supplies, such as bandages, and user-friendly discharge instructions, preferably in checklist form. In a blue box, CMS suggests that hospitals consider filling patients’ prescriptions before discharge, scheduling follow-up appointments, and using remote monitoring technology, such as pulse oximetry and daily weigh-ins for congestive heart failure.
The interpretive guidelines won’t require many changes at Tampa General Hospital, McGaffigan says. “We attach to patients at admission and follow them through the inpatient stay,” he says. Case managers determine the appropriate setting — inpatient vs. outpatient/observation — and evaluate their post-discharge needs, McGaffigan says. Inappropriate admissions obviously are risky in terms of Medicare claim denials but overuse of observation can stick beneficiaries with higher out-of-pocket expenses.
Tampa General assigns patients to one of three categories — A, B or C — according to their discharge complexity (see box, p. 6). “A” is for simpler discharge planning needs, “B” is moderately complex and “C” is complex. Case managers, nurses and/or social workers also quickly determine whether the patient is a readmission from the previous 30 days. If that’s the case, they investigate the reason the patient is back and discuss what could be done differently to encourage a better outcome (e.g., caregiver support, transportation to doctor’s appointments, home health care). “Then we have huddles on the nursing unit on a daily basis where we re-address whether the patients’ discharge needs have changed,” he says.
McGaffigan has also learned that patients don’t want discharge sprung on them. “There is too much information they have to absorb,” he says. And they may need help when they get home to prevent readmissions and promote patient satisfaction. For example, hospitals are moving in the direction of ensuring patients have follow-up visits with their physicians, discussing how they will get medical equipment and sending someone over to ensure they understand their new medication regimen and toss out old drugs. “Patients want us to do that,” McGaffigan says. “They don’t want to get home and have a lot of questions and not feel ready and feel panicked.” Patient satisfaction is a big part of CMS’s value-based purchasing program through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
Although CMS does not mandate the steps in the blue boxes, he sees it as a segue to a future where health systems are paid a lump sum to manage covered lives. “It’s about thinking more of what will transpire in the days after patients leave the hospital,” he says.
Access the compliance guidance at

Improving the Patient Discharge Planning Process

The revised interpretive guidelines for Medicare conditions of participation on discharge planning may not be as challenging for Tampa General Hospital because it has a tiered system to evaluate discharge-planning needs within 24 hours of the patient’s admission, says Steven McGaffigan, director of case management. The hospital assigns patients to one of three categories — A, B or C — depending on the anticipated complexity of their post-discharge experience, and then reassesses during the stay. Contact McGaffigan at
Improving the Patient Discharge Planning Process

UMass Medical School Health Policy Experts to Present at AcademyHealth Conference

Sharing Knowledge on Patient-Centered Medical Homes, Behavioral Health and Dental Policy.
June 21, 2013 09:09 AM Eastern Daylight Time 
WORCESTER, Mass.--(BUSINESS WIRE)--Several health policy experts from UMass Medical School will present at AcademyHealth’s annual research meeting, taking place in Baltimore, June 23 - 25.
Bruce Barton, PhD, research professor in the Medical School’s Quantitative Health Sciences department, and team leader for research methods at the School’s Commonwealth Medicine division, Center for Health Policy and Research, will deliver a podium presentation on interim results from the Massachusetts Patient-Centered Medical Home Initiative.
Dr. Barton’s podium presentation will take place on Tuesday, June 25, 11:30 a.m., at the Baltimore Convention Center, room 317.
A multi-disciplinary team from UMass Medical School was instrumental in helping implement and evaluate the Massachusetts patient-centered medical home demonstration project, an initiative that involves 45 primary care practices and multiple payers. Dr. Barton will present findings from a study that analyzed the extent to which practices adopted characteristics central to medical homes, including increased access to care and information, improved care coordination among practice team members and delivery of care that is considered “patient-centered” – a model that supports the involvement of patients and families in all care decisions. Robin Clark, PhD, Judith Steinberg, MD, and Ann Lawthers, ScD, co-authored the study with Dr. Barton.
UMass Medical School, Commonwealth Medicine staff will also be making several pre-conference presentations on behavioral health and state health policy topics to colleagues from around the country, as well as presenting posters during the conference. Below is a complete schedule of presentation and poster sessions.

Date and Location

Presenter Name

June 22, 2013
9:45 a.m.
Convention Center
Room #317

Judith Steinberg, MD, MPH

State Policy Interest Group Meeting - Massachusetts Patient-Centered Medical Home Initiative: Impact on Clinical Quality at Midpoint
June 22, 2013
3:20 p.m.
Convention Center
Room 319/322

Judith Steinberg, MD, MPH

Behavioral Health Interest Group Meeting - Integrating Behavioral Health Care into the Patient-Centered Medical Home: The Massachusetts Experience
June 22, 2013
4:45 p.m.
Convention Center
Room 319/322

Robin Clark, PhD

Behavioral Health Interest Group Meeting - The Impact of Prior Authorization on Buprenorphine Dose, Cost and Relapse Rates for Massachusetts Medicaid Beneficiaries with Opioid Dependence
June 25, 2013
11:30 a.m.
Convention Center
Room #317

Bruce Barton, PhD

Podium Presentation: Adoption of Medical Home Characteristics: Interim Results from the Massachusetts Patient-Centered Medical Home Initiative

Date and Location

Presenter Name

June 23, 2013
2:30 p.m.-4:00 p.m.
Poster Session and Number:
Exhibit Hall A, #423

Paul Kirby, MA

Dental Service Quality Measurement in a Medicaid Population: Testing Measure Sensitivity to Continuous Enrollment Requirements
(Authored by Paul Kirby, MA, Bruce Barton, PhD, David Tringali, MA, Brent Martin, DDS, MBA)
June 23, 2013
2:30 p.m.-4:00 p.m.
Poster Session and Number:
Exhibit Hall A, #431

Paul Kirby, MA

Early Experiences from the Massachusetts Multi-Payer Patient-Centered Medical Home Initiative
(Authored by Teresa Anderson, PhD, Linda Cabral, MM, Laura Sefton, BA, Ann Lawthers, ScD)
June 23, 2013
2:30 p.m.-4:00 p.m.
Poster Session and Number:
Exhibit Hall A, #477

Sai Cherala, MD

Massachusetts Patient-Centered Medical Home Initiative: Impact on Clinical Quality at Midpoint
(Authored by Judith Steinberg, MD, Sai Cherala, MD, Christine Johnson, PhD, Ann Lawthers, ScD)
June 24, 2013
9:45 a.m.-11:15 a.m.
Poster Session and Number:
Exhibit Hall B, #616

Judith Steinberg, MD, MPH

Integrating Behavioral Health Care into the Patient-Centered Medical Home: The Massachusetts Experience
(Authored by Judith Steinberg, MD, Megan Burns, MPP, (Bailit Health Purchasing), Michael Bailit, MBA, (Bailit Health Purchasing), and Alexander Blount, EdD, (UMass Medical School)

About the University of Massachusetts Medical School
The University of Massachusetts Medical School, one of the fastest-growing academic health sciences centers in the country, has built a reputation as a world-class research institution, consistently producing noteworthy advances in clinical and basic research. The Medical School attracts more than $255 million in research funding annually, 80 percent of which comes from federal funding sources. The mission of the Medical School is to advance the health and well-being of the people of Massachusetts and the world, through pioneering education, research, public service and health care delivery. Commonwealth Medicine, the Medical School’s health care consulting and operations division, provides a wide range of care management and consulting services to government agencies and health care organizations. For more information, visit
University of Massachusetts Medical School
Tom Lyons, 508-856-2115

Alternative Models - Therapeutic Communities

Alternative Models - Empirical Risk Management

Consider these facts from the Texas Department of Justice:

  • The individuals who entered TDCJ in 2011 for a drug possession offense are costing Texas taxpayers nearly $700,000 EVERY DAY.
  • 90% of drug-related arrests in Texas are for possession – not for delivery or distribution.
  • 30% of incoming inmates were sentenced for drug offenses in 2011, 75% of which were for possession.
  • Over 27,000 individuals in prison in 2011 were there because of a drug off ense,16,000 of which were for possession.

Therapeutic Communities

Download the TDCJ Addiction Primer
TCJC Addiction Primer (Jan 2013).pdf
Adobe Acrobat document [1.9 MB]

ERM believes that whole system change includes a holistic approach. Therapeutic communities can be implemented quickly and have shown great success as an alternative to incarceration. I have include a sample TC below. If you need help designing a cost effective, value added solution, please contact us today. 

OIG Issues 2013 Guidance On Provider Self-Disclosure Protocol | The Metropolitan Corporate Counsel

Charged with protecting the integrity of federal healthcare funds, the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) has allowed parties in violation of the law to self-report their actions under its self-disclosure protocol (SDP) as a method of policing federal health program fraud. Issued on April 17, the updated Provider Self-Disclosure Protocol replaces OIG’s previous guidance on the SDP and follows on the heels of OIG’s request for public comment on revising the SDP to be more user-friendly for healthcare providers.
OIG’s Previous Guidance And The SDP To Date
Initially designed to provide healthcare providers working with federal healthcare programs the opportunity to self-report potential fraud, disclosure under the SDP sought to expedite resolution of such matters by permitting the providers themselves to undertake the bulk of the investigative burden. The SDP delineates the specific elements that disclosing parties must include in their report and gives disclosing parties the opportunity to avoid the costs associated with government-directed investigations or civil or administrative actions. Benefits of the SDP from the provider standpoint may include a speedy resolution of the matter, imposition of a lower multiplier for calculating damages or an exclusion release without the obligation of a corporate integrity agreement. OIG determines whether to grant these leniencies, if any, on a case-by-case basis. The SDP has proven successful, depending on one’s point of view, over the course of its roughly 15-year existence, as the program has aided in the resolution of more than 800 disclosures and resulted in recoveries of more than $280 million to federal healthcare programs. OIG’s 2013 guidance supersedes and replaces its previous guidance on the topic, including its 1998 Federal Register Notice and the three Open Letters to Health Care Providers in 2006, 2008 and 2009.
OIG’s Updated Guidance
While the updated SDP guidance preserves many aspects of the previous SDP system, the guidance makes several interesting clarifications. Notably, the updated guidance provides that self-reporting parties will likely not need to enter into corporate integrity agreements with OIG. Further, OIG’s new guidance seeks to expedite the SDP process by requiring disclosing parties to complete internal investigations surrounding the matter within 90 days of submitting the matter to OIG, as opposed to within 90 days of OIG’s acceptance of the matter for review. Additionally, OIG notes that it will coordinate with the Department of Justice and the Centers for Medicare & Medicaid Services to resolve criminal and civil liability under those agencies’ statutory mandates. Other major elements of OIG’s updated SDP guidance are discussed below.
Parties And Conduct Eligible For Reporting Under SDP
Generally, the SDP is available to facilitate the resolution of matters that potentially violate federal criminal, civil or administrative laws for which civil monetary penalties are authorized. As a self-reporting system, the SDP allows disclosing parties to report only their own conduct; however, successor liability may be implicated when mergers or acquisitions are involved. A key element of the SDP is that the disclosing party must acknowledge that the conduct is a potential violation of the law and must explicitly identify the specific laws that were potentially violated. Further, the disclosing party must agree to waive any statutes of limitation, laches or other similar defenses to any resulting administrative action filed by OIG relating to the disclosed conduct. In addition, prior to disclosure, the party should generally make sure that the conduct reported within the SDP has ceased and take steps to ensure that corrective action is taken.
Types Of Information To Be Included In All Disclosures
Disclosures made pursuant to the SDP must include information responsive to 11 discrete categories, including, but not limited to:
  • a concise statement of all details relevant to the conduct disclosed;
  • a statement of the federal criminal, civil or administrative laws that are potentially violated by the disclosed conduct;
  • the federal healthcare programs affected by the disclosed conduct;
  • an estimate of the damages; and
  • a description of the party’s corrective action taken on discovery of the conduct.
Conduct Involving False Billing
When reported conduct involves the submission of improper claims to federal healthcare programs, the disclosing party is required to estimate the improper amount paid by the federal healthcare program. This estimate may be based on either a tally of all the claims affected by the matter at issue or a statistically valid random sample of claims, which will then be used as a basis for estimating overall damages of the entire claims population impacted by the reported conduct. Additional requirements are applicable for SDP reports based on sampling.
In addition to providing an estimate of damages, a disclosing party that is self-reporting false billing must include all of the following information in its report:
  • detail regarding review objectives;
  • descriptions of the population/group of claims affected by the false billing;
  • the sources of data;
  • the qualifications of the personnel conducting the review; and
  • the characteristics being measured.
Conduct Involving Excluded Persons
When reporting violations of the law involving the employment of or contracting with individuals who appear on OIG’s List of Excluded Individuals and Entities, disclosing parties must ensure that all self-reports contain the following information:
  • the identity of the excluded individuals;
  • the duties performed by those individuals;
  • the dates of the employment or relationship;
  • a description of the disclosing party’s screening process for employees or contractors; and
  • a description of the steps taken for corrective action to prevent future hiring of excluded individuals.
Further, the disclosing party must screen all other current employees to ensure that the organization does not employ or contract with other excluded individuals. With regard to calculating the damage to federal healthcare programs due to a disclosing party’s involvement with an excluded party, OIG provides guidance that distinguishes between procedures to be used when billing associated with the excluded individual may be itemized versus global billing situations in which it is difficult or impossible to analyze individual items.
Conduct Involving The Anti-Kickback Statute (AKS) And The Stark Law
Self-disclosures involving potential violations of the AKS and the Stark Law must contain certain data elements. First, the disclosure must clearly acknowledge that the party believes the matter constitutes a potential violation of the AKS and/or the Stark Law. The statement must be clear and straightforward and contain no conditional or mitigating language. The description must also include a concise statement of the relevant details and a specific analysis of the reason each disclosed arrangement potentially violates the AKS and the Stark Law. Further, the disclosure should include a description of the parties’ relationships with each other, payment arrangements, and the context and features of the arrangement that raise potential liability. When calculating damages, the parties should include the total amount of remuneration involved in each arrangement, but they may explain why they believe that certain portions of the remuneration should not be excluded from OIG’s calculation of a settlement amount.
Minimum Settlement Amounts
Although OIG does not demand admission of liability in settlement agreements, disclosing parties should nevertheless expect to pay above single damages. OIG’s general practice is to require a minimum multiplier of 1.5 times the actual damages. Further, OIG imposes minimum settlement amounts under the SDP ranging from a minimum of $50,000 for an AKS-related submission to a minimum of $10,000 for all other submissions.
SDP’s Interaction With The “60-Day Rule”
Under the 60-Day Rule, all providers are obligated to report and return to Medicare and Medicaid any overpayments within 60 days following the date the overpayment was identified or the date any applicable corresponding cost report is due, whichever is later. OIG states that a return of an overpayment pursuant to the 60-Day Rule that is subsequently linked to the same or similar conduct disclosed under the SDP will result in OIG crediting the amount paid under the 60-Day Rule toward the ultimate settlement amount under the SDP.
Providers must take note of OIG’s new guidance when deciding whether to disclose under SDP. OIG’s full Provider Self-Disclosure Protocol is available at To discuss the guidance’s impact on your organization, please contact Douglas A. Grimm, FACHE, at 215.564.8539.
Douglas A. Grimm serves as the Chair of Stradley Ronon’s Health Care practice group and represents healthcare systems, with an emphasis on regulatory counseling in the areas of compliance planning, government investigations, health information privacy and security, health information technology, peer review/medical staff and certificates of need, development of new service lines, licensure and provider enrollment, and insurance issues. His clients also include physician group practices, ambulatory surgical centers, skilled nursing facilities, diagnostic imaging centers, health maintenance organizations and home health agencies.
Laura E. Souchik is an Associate in firm’s Philadelphia office. She advises a broad range of public and private companies on mergers and acquisitions, securities, finance, and corporate organization and compliance matters.

OIG Issues 2013 Guidance On Provider Self-Disclosure Protocol | The Metropolitan Corporate Counsel

Telemedicine patients more likely urban, educated

June 18, 2013 | By Susan D. Hall 

Urbanites are twice as likely as those in rural areas to take part in telemedicine, though participation rates for both remain low, according to a report on broadband use released by the National Telecommunications and Information Administration.
Based on data from 53,000 households collected by the Census Bureau in July 2011, the report found 8 percent of urban Internet users took part in telemedicine initiatives, compared with 4 percent in rural areas. That stands in contrast to telemedicine's common selling point that it can more effectively and conveniently provide services to people in remote locations.
The telemedicine participants also were wealthier. In households with incomes of $100,000 or more, 11 percent of Internet users took part in remote care, compared 4 percent from households in the under $25,000 bracket. Those with college degrees (10 percent) also were more likely to use telemedicine than those with no high school diploma (2 percent).
Asian-Americans (11 percent) were more likely to use telemedicine than whites (7 percent), blacks or Hispanics (both 6 percent).
Meanwhile, the uses and acceptance of remote care continue to grow. One of the latest examples is a pilot project by the University of California-San Diego Health System to use telemedicine to reduce emergency room wait times. Cameras in the waiting rooms will help bring in extra doctors as needed.
In the broadband report overall, only 7 percent of Internet users reported going online to access medical records, participate in videoconferencing with a doctor, or take advantage of remote procedures such as heart rate monitoring.
It found users ages 25 and 44 were more likely to go online to look up health plans or practitioners than older age groups, as were urban dwellers and those with more education.
That doesn't mean lower-income or less-educated patients don't want to use the Internet for healthcare. It might involve finding the right mix of traditional and online communication with underserved populations, such as cell phones, which workers with multiple jobs often rely on, according to a coalition of advocacy organizations.
A study published this month by researchers from Cincinnati Children's Hospital Medical Center found that urban pediatric clinics could better communicate with hard-to-reach populations through use of digital technologies, including email and smartphones.
A report published this week by Orem, Utah-based ressearch firm KLAS found that most telehealth efforts by providers are focused in five areas: home monitoring, psychiatry, stroke, neurology and intensive care.

Read more: Telemedicine patients more likely urban, educated - FierceHealthIT 
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Private healthcare fraud - a growing risk

A brand new report from the Centre for Health & the Public Interest highlights how the increased use of private healthcare providers in the NHS opens up considerable opportunities for fraud. The government must act to protect us, the authors suggest.
Last week, new independent think tank the Centre for Health and the Public Interest (CHPI) released a report showing that the reforms to the NHS in England introduced by the current government will lead to significant implications for the level of fraud, which have not been adequately mitigated against by the government. The introduction of markets, with large companies preoccupied with profits, combined with greater complexity will make fraud (and error) a much greater risk.
One can look to the experience of the USA to illustrate this risk. In the USA large for-profit health companies delivering healthcare through contracts with state and private insurers is the mode of delivery. There is much evidence of private companies delivering these contracts of ‘upcoding’ or invoicing for higher levels of treatment and for services not delivered. In 2009 it was estimated there were $98 billion of improper payments (fraud and error) of which $54 came from Medicare and Medicaid.
Closer to home, the recent Public Accounts Committee inquiry into the provision of out of hours care by the private company Serco found that it had wilfully falsified data on 252 occasions to misrepresent its performance under the contract that it had with Cornwall Primary Care Trust. The Committee found that the company had “fiddled the figures”to present a “false, much rosier picture of its performance” particularly in relation to emergency care. Unlike the US, where there is an effective set of sanctions for deceiving or defrauding the state in this way, no action has been taken against Serco for its behaviour. This is perhaps because politicians have yet to wake up to the increased potential for fraudulent behaviour as a result of the new NHS market.
The main body countering NHS fraud is NHS Protect, which has a counter fraud service within it. This capacity has reduced from 200 to 165 staff in recent years and traditionally most of the investigative work has focussed upon fraud by individuals, typically nurses working for agencies while supposed to be off sick, midwives submitting false overtime claims, dentists exaggerating treatments administered and consultants abusing their entitlements for private work.
The NHS Counter Fraud Service (CFS) has had some success in the past taking on major corporate entities engaged in fraud as ‘Operation Holbein’ illustrated. In 2008 the criminal case brought by the SFO against the pharmaceutical companies involved collapsed after an 8 year investigation. The case centred around an alleged £120 million of fraud by pharmaceutical companies fixing prices. The CFS, however, did receive some success through civil actions and out of court settlements with cases brought in parallel between 2002 and 2007 with around £46 million paid by five pharmaceutical companies in compensation. This case was pursued at the height of the CFS’s resources and influence and since 2007 there has been a substantial decline in the capacity of this body.
The lessons from this investigation illustrate a number of issues. First and foremost there needs to be an appropriately dedicated unit within NHS Protect dedicated to this type of fraud. Such a unit should also be equipped to utilise the civil route and other sanctions too. The reality is that criminal prosecutions in complex cases involving large sums of money against opponents with resources for high quality lawyer are very expensive and high risk for failure on legal technicalities or bewildered juries.
It is for this reason that other tools utilised in the USA should also be considered. The passage of the Crime and Courts Act 2013 provides the legislation for the implementation of Deferred Prosecution Agreements in England and Wales. Deferred Prosecution Agreements (DPA) and Non-Prosecution Agreements (NPA) have been commonly used in the USA to deal with major corporate wrongdoing. In return for non-prosecution the corporate body agrees to co-operate with the authorities, undergo additional compliance scrutiny and pay penalties/compensation. These have been frequently used in healthcare in the USA. For example in 2011 the pharmaceutical giant Merck and Co (and related subsidiaries) in relation to the inappropriate marketing of a painkiller called Vioxx in 2004 entered into a corporate integrity agreement with the US Department of Health and Human Services, paid a fine of $321m, settled a civil case for $628 million and pleaded guilty to a misdemeanour criminal charge. This ended an investigation which had been ongoing for many years. These will be initially tools for the SFO and CPS but should also be extended to NHS Protect.
In the USA another tool is the False Claims Act. This essentially gives whistleblowers a financial incentive to report fraud and wrongdoing (15 to 30% of funds recovered). Cases of merit are usually joined by federal and/or state prosecutors who also have a financial incentive to become involved. It therefore puts corporate organisations at greater risk of exposure of wrongdoing.
The new landscape of the NHS with the greater risk of fraud therefore requires the following action to meet this challenge:
(1) An appropriately resourced unit dedicated to corporate fraud should be created within NHS Protect, with appropriate staff capable of pursuing all possible sanctions and with experience of successfully doing so.
(2) Deferred Prosecution Agreements, which are to be introduced in the UK, should also become a major tool for dealing with the likely problems, based on a recognition that criminal prosecution – although desirable – is not always the most viable option.
(3) Consideration should also be given to passing a UK equivalent of the False Claims Act to encourage the exposure of fraud and malpractice by private corporate bodies in receipt of public funds, and to legislation to ban the award of a contract by any NHS body to any company, or subsidiary of a company, which has been convicted of, or settled, a criminal charge.
(4) Consideration should also be given to preventing companies or subsidiaries of companies found guilty of healthcare fraud in the UK from providing NHS services in the future, and to providing for the imposition of punitive fines on the scale necessary to provide a deterrent to multi-billion pound enterprises.
Interestingly the government has just introduced a provision within the Care Bill to make it a criminal offence for providers of NHS funded care – including private providers – to deliberately supply false information to regulators or commissioners of services. Whilst the intention behind this is to prevent providers from concealing ‘poor quality care’ – a key recommendation of the Francis Report Inquiry – the impact assessment makes no mention of the fraud issue at all, but does acknowledge that “there are incentives for providers to supply false or misleading information”. The debate on these provisions, therefore, perhaps provides an opportunity for Parliament to take seriously the risk of healthcare fraud.
Read CHPI’s new report, ‘Healthcare Fraud in the new NHS market – a threat to patient care‘ by Professor Mark Button and Colin Leys.
This article is cross-posted from the British Politics and Policy at the LSEblog

Wichita Business Journal - Wesley Medical Center to launch telemedicine network for stroke care

Wichita Business Journal - Wesley Medical Center to launch telemedicine network for stroke care

Doctor to pay $3M to settle health care claims

Published: June 20, 2013

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 — The U.S. attorney's office in Seattle says a Lakewood, Wash., oncologist has agreed to pay the United States $3.1 million to settle accusations that he and his wife significantly overbilled federal health care programs.
U.S. Attorney Jenny Durkan said Thursday in a statement that the government contends Dr. Alfred Chan and his wife Judy Chan overbilled Medicare and other federal health care programs by more than $1 million for cancer treatment drugs.
Durkan says the settlement recovers nearly three times the estimated loss. A former employee who alerted the government will receive more than $600,000 of the settlement under the False Claims Act.
Federal prosecutors say the Chans fled to Taiwan in February 2011.

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