6 Novant Health Practices Joins CMS Patient-Centered Medical Neighborhood Pilot

Six Novant Health physician practices in the Winston-Salem market have been selected to be part of a CMS funded $20.8 million patient-centered medical home neighborhood model pilot project.

The project, funded by a grant from the Centers for Medicare & Medicaid Services will focus on developing a patient-centered medical neighborhood model, where care is coordinated by a primary care physician, to incorporate outside specialists and hospitals.

The collaborative PCMN project plans to achieve the following goals by year three of the demonstration:

• Decrease overall healthcare costs by $49.5 million within the 15 communities;
• Improve the health of the eligible patient population by a 15 percent average in selected quality measures;
• Achieve a 25 percent improvement in the patient experience; and
• Extend PCMH and patient-centered medical neighborhood learning within each of the 15 communities.

The Novant practices will join 84 other practices from 14 other health systems in the pilot group. TransforMED, a nonprofit subsidiary of the Academy of Family Physicians that consults and supports practices as they move toward the patient-centered medical home (PCMH) model will oversee the national project.

Related: Is The Patient Centered Medical Home The Future of Primary Care?

Background

Approximately 157,000 Medicare and Medicaid beneficiaries in up to 15 U.S. health systems and providers will begin participating in a patient-centered medical neighborhood (PCMN) demonstration project as part of a collaboration among TransforMED, Phytel and VHA. Funded by a three-year, $20.75 million cooperative agreement awarded by the Center for Medicare and Medicaid Innovation.

This award is part of the Health Care Innovation Awards program, a Department of Health and Human Services initiative investing up to $1 billion to test new approaches to improving healthcare and lowering program costs for recipients of Medicare, Medicaid and the Children’s Health Insurance Program.

During the three-year program, TransforMED will offer expertise and resources to the participating practices as they develop the neighborhood model during the three years.

References: http://www.bizjournals.com/triad/news/2013/07/18/with-health-care-innovation-project.html?page=all

Power to the Patients: Former NHS chief's five-point plan to put YOU in charge

• By Nigel Nelson
• Comments

21 Jul 2013 00:01

Sir Nigel Crisp's revolution would ­provide for ­patients owning their own medical records, accessible through a ­confidential internet link

Getty

A five-point plan designed to ­revolutionise the NHS with ­patient power is unveiled by the Sunday People today.

Former NHS chief Nigel Crisp ­believes patients should decide how much GPs and hospitals are paid.

Lord Crisp, in charge from 2000-06, says patient representatives should sit at each level of management. They would organise patient satisfaction surveys on the performance of family surgeries and local hospitals.

Those performing well would get more money and those doing badly would be penalised by getting less.

Lord Crisp said: “Patients need to be on the top of the power pyramid, not at the bottom. They need to have teeth. What was shocking when you look at Mid Staffordshire was that they were not listened to.”

There is already a scheme in which hospitals get paid up to 2.5 per cent more for meeting 12 tests including patient satisfaction.

But Lord Crisp said: “This means patient satisfaction alone contributes very little to the overall reward.”

And such schemes are not ­widespread enough to make an overall difference.

Sir Nigel Crisp

PA

 

He added: “If we are really serious about patients’ views there should be larger sums involved. That will really make hospitals and GP practices sit up and take notice. There should also be ­penalties for poor performance.”

Lord Crisp’s revolution would ­provide for ­patients owning their own medical records, accessible through a ­confidential internet link.

Currently they have to go through a cumbersome bureaucratic process.

If patients owned their records they could see whether they received the right treatment, even years later.

And they could use their records to seek a second opinion.

Lord Crisp added: “Patients should be able to see what their doctors have to say about them.”

Hospital doctors must stop thinking of patients as inmates but see ­themselves as guests in patients’ lives.

He added: “Only when professionals are all thinking like this will you know there is real change.”

Staff must listen and learn, by former NHS chief Lord Crisp

In my time as Chief Executive of the NHS we gave priority to reducing waiting times and tackling ­infections such as MRSA.

It needed doing and I am proud of what we achieved. Now, however, as I read about what has happened in some hospitals, I am ­appalled that we weren’t able to prevent these awful things from happening.

It is desperately sad that patients have not been listened to.

As a result I feel very strongly that we now have to change the balance of power in the NHS.

We all know what it is like to feel powerless as patients when we are dealing with busy doctors and nurses who know so much more than we do.

But we still need to be listened to and to be able to ask all the questions we want.

Giving patients more power must become the new top priority for the NHS.

We must use all the methods we used so ­successfully in reducing waiting times and ­infections like so-called superbugs.

We need to be absolutely clear about what we are trying to do and change systems and behaviours to achieve it.

I know from the hundreds of visits I made to hospitals when I was the Chief Executive just how good the NHS can be.

I was constantly impressed by the skills, passion and commitment of staff and I know how much patients appreciated them. However, these high standards are not always in place. I believe that only patients, who of course are there all the time, can really keep the service up to the mark all the time.

They can only do so if they are listened to.

I am delighted that the new Inspector of hospitals, Sir Mike Richards, will have patients as part of all his inspection teams.

But I believe we need to do even more.

That is why I suggest how this can be done in my five ways to give patients power.

As Professor Don Berwick, the US health expert who led the review into patient safety after the Mid Staffordshire crisis, has said, professionals “are guests in their patients’ lives.”

It too often feels as if patients are inmates.

Check out all the latest News, Sport & Celeb gossip at Mirror.co.uk http://www.mirror.co.uk/news/uk-news/power-patients-former-nhs-chiefs-2070969#ixzz2ZdaMWgqd
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South Jersey Doctor Sentenced To Two Years In Prison For Fraud Scheme Involving Home Health Care For Elderly Patients

FOR IMMEDIATE RELEASE

July 18, 2013

Doctor Made More Than Half a Million Dollars Illegally

TRENTON, N.J. – A doctor who was the owner and founder of Visiting Physicians of South Jersey (VPA) – a Hammonton, N.J., provider of home-based physician services for seniors – was sentenced today to 24 months in prison for charging lengthy visits to elderly patients that they did not receive, U.S. Attorney Paul J. Fishman announced.  

Lori Reaves, 52, of Waterford Works, N.J., previously pleaded guilty before U.S. District Judge Freda L. Wolfson to an information charging her with one count of health care fraud. Judge Wolfson imposed the sentence today in Trenton federal court.

According to documents filed in this case and statements made in court:

Reaves admitted lying in Medicare billings about the amount of face-to-face time she spent with patients, which led to her receiving at least $511,068 in criminal profits. Reaves was the highest billing home care provider among the more than 24,000 doctors in New Jersey from Jan. 1, 2008, through Oct. 14, 2011.

VPA provided home-based physician health care for elderly and homebound patients in New Jersey, offering services throughout South Jersey. As part of her responsibilities at VPA, Reaves was responsible for Medicare billings as a Medicare-approved provider. The claim submitted by the health care provider requires a physician to state a diagnosis and provide a procedure code – called a Current Procedural Technology (CPT) code – identifying services rendered. Medicare regulations require that each provider certify that the services rendered were medically necessary and were furnished by that provider. A warning at the bottom of the form specifically states that any false claims or statements in relation to the submission of a claim for reimbursement are prosecutable under federal or state law.

In most instances during the relevant time period, Reaves submitted forms that falsely claimed she had provided prolonged service visits to her patients in order to induce Medicare to make payments to her that were significantly higher than the payments she should have received. She routinely billed Medicare using codes that would have required her – under Medicare regulations and depending on the corresponding service – to spend between 60 and 150 minutes with a patient. Many of the claims Reaves submitted would have required her to spend a minimum of 2.5 hours of face-to-face time with her elderly clients, when she actually spent far less. As a result, Medicare reimbursed Reaves more than $511,068 for the fraudulent prolonged service visits Reaves claimed to have made.          

In addition to the prison term, Judge Wolfson sentenced Reaves to three years of supervised release. In addition to Reaves forfeiture of $511,068, Judge Wolfson ordered Reaves to pay restitution of $511,068 and pay a fine of $5,000.

U.S. Attorney Fishman credited special agents of the FBI in Newark, under the direction of Special Agent in Charge Aaron T. Ford, and special agents of the Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Tom F. O’Donnell of the New York Regional Office, with the investigation leading to today’s sentence.

The government is represented by Assistant U.S. Attorneys Deborah J. Gannett and R. David Walk Jr. of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark. 

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Defense counsel: Rocco Cipparone Jr. Esq., Haddon Heights, N.J. 

http://www.justice.gov/usao/nj/Press/files/Reaves,%20Lori%20Sentencing%20News%20Release.html

Manhattan U.S. Attorney Announces Charges Against Eight Individuals In Connection With $2.3 Million Bribery And Kickback Scheme To Secure Business From A Medical Cost-Management Company

Source- http://www.justice.gov/usao/nys/pressreleases/July13/DharayanetalArrestPR.php

FOR IMMEDIATE RELEASE

Wednesday, July 17, 2013

One Executive Has Pled Guilty to Accepting Bribes and Kickbacks

Preet Bharara, the United States Attorney for the Southern District of New York, Thomas O’Donnell, the Special Agent-in-Charge of the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), and Steven G. Hughes, the Special Agent-in-Charge of the New York Office of the U.S. Secret Service today announced charges against eight individuals for their alleged involvement in a lucrative scheme in which information technology vendors paid over $2.3 million in bribes and kickbacks to secure business from executives of a Manhattan-based medical cost management company (the “New York Company”). The defendants charged with paying the bribes and kickbacks are SARVESH DHARAYAN, SANJAY GUPTA, VENKATA ATLURI, RANGARAJAN KUMAR, VADAN KUMAR KOPALLE, and DARREN SIRIANI. The defendants charged with receiving the bribes and kickbacks are ANIL SINGH and KEITH BUSH. DHARAYAN, GUPTA, KOPPALLE, and SIRIANI were arrested this morning at their homes in New Jersey, and were presented in Manhattan federal court this afternoon before U.S. Magistrate Judge James L. Cott. SINGH, who was previously arrested in April 2013, pled guilty to honest services fraud and other charges before U.S. District Judge Denise L. Cote on July 11, 2013. BUSH, who was also arrested previously on July 12, 2013, is next scheduled to appear in court for a pretrial conference on August 15, 2013. ATLURI and KUMAR are not yet in custody.

Manhattan U.S. Attorney Preet Bharara said: “For the eight defendants charged in this multi-million dollar scheme, bribes and kickbacks were allegedly the cost they imposed for doing business with this medical-cost management company. As today’s charges detail, the defendants achieved their years-long fraud through fake companies, sham invoices and made-up consulting services. Today’s actions underscore our commitment to work with our law enforcement partners to bring to justice individuals who break the law out of greed.”

HHS-OIG Special Agent-in-Charge Thomas O’Donnell said: “This scheme was motivated by greed and it deprived its victim, a company in the health care field, of the honest labor of its employees. We will continue to aggressively investigate those who pay kickbacks and bribes to gain an advantage in the public and private health care sectors.”

USSS Special Agent-in-Charge Steven G. Hughes said: “The Secret Service continues to enjoy its partnership with the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General. We find partnerships such as this to be an effective way to share resources and stop criminals from continuing to engage in fraudulent schemes.”

According to the allegations contained in the Complaint, the Informations filed against BUSH and SINGH, and other statements made in Manhattan federal court:

SINGH was employed as a Senior Vice President and the Chief Information Officer at the New York Company, which provided nation-wide medical cost management solutions including, among other things, medical reimbursement services, and BUSH was employed as the company’s Director of Database Administration. SINGH and BUSH had considerable influence over the selection of vendors, specifically vendors of database administrators (“DBAs”), hired by the New York Company.

From 2008 to September 2012, various individuals collectively paid over $2.3 million in money and other benefits to SINGH and BUSH in exchange for SINGH’s and BUSH’s agreement to steer millions of dollars of the New York Company’s DBA business to them. Specifically, as alleged:

• DHARAYAN, the owner of a New Jersey information technology company (“Vendor 1”) and GUPTA, an employee of Vendor 1, paid approximately $1,722,620 in kickbacks and bribes to BUSH and SINGH in exchange for receiving DBA business from the New York Company. From 2010 to 2012, the New York Company paid Vendor 1 approximately $6,625,479.20 for placing DBAs with the New York Company.
• ATLURI, the owner of another New Jersey information technology company (“Vendor 2”), paid approximately $190,436.75 in kickbacks and bribes to BUSH and SINGH in exchange for receiving DBA business from the New York Company. From 2008 to 2012, the New York Company paid Vendor 2 approximately $11,495,804.88 for placing DBAs with the New York Company.
• KUMAR paid approximately $247,634 in kickbacks and bribes to BUSH and SINGH in exchange for their agreement to steer DBA business to another New Jersey information technology company (“Vendor 3”). From 2009 to 2012, the New York Company paid Vendor 3 approximately $2,593,210.38 for placing DBAs with the New York Company.
• KOPALLE, who was in charge of delivery and operations at a Texas information technology company (“Vendor 4”), paid approximately $142,967.50 in kickbacks and bribes to BUSH and SINGH in exchange for receiving DBA business from the New York Company. From 2009 to 2010, the New York Company paid Vendor 4 approximately $1,035,660 for placing DBAs with the New York Company.
• SIRIANI, the owner and operator of another New Jersey information technology company (“Vendor 5”) paid approximately $23,000 to $29,000 in cash kickbacks and bribes to BUSH and SINGH in exchange for receiving business from the New York Company. SIRIANI also paid for hotel rooms in Las Vegas and Costa Rica, deep sea fishing, massages, sports tickets, and other things, all in exchange for receiving business from the New York Company. From 2008 to 2012, the New York Company paid Vendor 5 approximately $1,177,600.91 for various services and products.

According to the Complaint, DHARAYAN, GUPTA, ATLURI, KUMAR, and KOPALLE paid the kickbacks and bribes through conduit companies established by BUSH and SINGH for the very purpose of disguising the true nature and origin of the illegal payments. To further conceal the bribery and kickback scheme, BUSH and SINGH sent false invoices to the conduit companies for consulting services that never occurred. Many of the kickbacks and bribes were paid pursuant to these false invoices.

*                      *                      *

DHARAYAN, 42, of Edison, New Jersey, GUPTA, 38 of East Windsor, New Jersey, ATLURI, 41, of Monmouth Junction, New Jersey, KUMAR, 47, of Monroe, New Jersey, KOPALLE, 43, of Edison, New Jersey, and SIRIANI, 45, of Matawan, New Jersey, were each charged with one count of conspiracy to commit honest services fraud, which carries a maximum term of 20 years in prison, one count of conspiracy to violate the Travel Act, which carries a maximum term of five years in prison, one count of honest services fraud, which carries a maximum term of 20 years in prison, and one count of violating the Travel Act, which carries a maximum term of five years in prison. DHARAYAN, GUPTA, ATLURI, KUMAR, and KOPALLE were also charged with one count of conspiracy to commit money laundering, which carries a maximum term of 20 years in prison.

SINGH, 40, a resident of East Brunswick, New Jersey pled guilty to one count each of conspiracy to commit honest services fraud, conspiracy to violate the Travel Act, honest services fraud, violating the Travel Act, and conspiracy to commit money laundering. He faces a maximum penalty of 70 years in prison on all counts. BUSH, 41, a resident of Rahway, New Jersey, is charged with one count each of conspiracy to commit honest services fraud, conspiracy to violate the Travel Act, honest services fraud, violating the Travel Act, and conspiracy to commit money laundering. He also faces a maximum penalty of 70 years in prison if convicted on all counts.

Mr. Bharara praised the outstanding efforts of HHS-OIG and the U.S. Secret Service in the investigation. He also thanked the New York Company for its assistance and cooperation in the investigation.

This case is being handled by the Office’s Complex Frauds Unit. Assistant U.S. Attorney Jason P. Hernandez is in charge of the prosecution. Assistant U.S. Attorney Christine Magdo of the Office’s Asset Forfeiture Unit is responsible for the forfeiture aspects of the case.

The charges and allegations contained in the Complaint and the Information filed against BUSH are merely accusations, and the defendants are presumed innocent unless and until proven guilty.

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Aetna Launches Patient-Centered Medical Home Program in Massachusetts

PRESS RELEASE

July 15, 2013, 12:29 p.m. EDT

-- Rewards Primary Care Physicians for Improved Patient Care Coordination --

HARTFORD, Conn., Jul 15, 2013 (BUSINESS WIRE) -- Aetna AET +0.40% announced today the launch of its Patient-Centered Medical Home (PCMH) program in Massachusetts. The program recognizes primary care physicians (PCPs) who more actively coordinate and manage their patients' care across the health care system. By strengthening the role of PCPs, the PCMH program aims to improve patient health outcomes.

"Patient-centered care is something Aetna has always advocated. Our PCMH program rewards PCPs who focus on the patient's entire health needs, not just a single condition," said Elizabeth Curran, head of National Network Strategy and Program Development for Aetna. "As a result, members may experience better health, fewer hospitalizations, improvements in transitions of care, and greater engagement. The PCMH program is one more way we are moving from a system that rewards the quantity of procedures to a system that rewards quality outcomes."

Primary care providers who participate in Aetna's networks, who have been recognized by the National Committee for Quality Assurance (NCQA) as a PCMH, and who are not participating in other quality incentive programs with Aetna are being considered for the PCMH program in Massachusetts. Recognized providers will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care. The NCQA-recognized PCMH practices are recognized for providing a number of services, including:

-- Improved access to care, such as the ability to reach health professionals outside normal business hours;

-- Proactive and planned preventive care (screenings, physicals, labs);

-- Improved access through e-mail, web or telephone visits; and

-- Access to nurses and other health care professionals, allowing more focused physician visits.

Aetna serves approximately 208,000 commercial members in Massachusetts. More than 300 physicians are currently part of the growing program.

About Aetna

Aetna is one of the nation's leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.

http://cts.businesswire.com/ct/CT?id=bwnews&sty=20130715006022r1&sid=cmtx6&distro=nx

SOURCE: Aetna