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Bringing about a higher level of transparency and accountability in provincial and federal governments to help protect taxpayers from abuse

Bringing about a higher level of transparency and accountability in provincial and federal governments to help protect taxpayers from abuse.

Inpatient psychiatric facilities get $45 million raise from Medicare

The CMS will give inpatient psychiatric facilities a modest 1% Medicaid reimbursement increase next year of $45 million.

That’s less than half of the 2.2%, $100 million increase in Medicare reimbursement they received this fiscal year.

The agency made the change via a notice rather than a rulemaking on Wednesday, and will not accept comments on the decision. The CMS said rulemaking was unnecessary because the updates don’t reflect any “substantive” changes in policy.

Read more at Modern Health Care

Agency Owner Sentenced in $400 Million Home Health Fraud

The owner of a home health agency in Dallas has been sentenced to 17 years in prison for his role in the nation’s largest home health care fraud scheme in history—a nearly $400 million scam, the Justice Department announced Tuesday.

Wilbert James Veasey, Jr., 65, was sentenced to 210 months in federal prison and ordered to pay more than $23 million in restitution to Medicare and more than $500,000 to Medicaid. Veasey, along with several others involved in the scheme, was found guilty last year. He has been in custody since early 2016.

read more at homehealthcarenews.com

The FBI And Defense Department Are Investigating America’s Biggest Psychiatric Hospital Chain

America’s largest chain of psychiatric hospitals is the target of a multi-agency federal investigation into whether it systematically holds patients longer than necessary to maximize revenues — an allegation two nurses at one of its facilities raised following a protest at its headquarters in Pennsylvania last week.

According to three sources with direct knowledge of the investigation, officials are examining whether Universal Health Services directs its hospitals to hold patients for as many days as their insurer agrees to pay for, regardless of actual medical need. The probe has been ongoing since at least 2013, when the Department of Health and Human Services issued subpoenas to 10 UHS psychiatric hospitals.

But BuzzFeed News has exclusively learned that the investigation has since broadened to include the FBI and the Department of Defense, which is scrutinizing UHS’s billings to Tricare, the insurance plan for active military and their families. UHS, a $12 billion company, made nearly one-third of its revenues last year from government insurance providers such as Medicare and Medicaid.

Read more at buzzfeed.com

Canada should take health-care lessons from Australia

Australia and Canada share many characteristics, but Canadians may not know one of them is that Australia’s universal health insurance scheme, Medicare, was modelled on Canada’s, albeit adapted to account for constitutional differences between the two countries.

There are indeed a number of areas where Australia’s experience might prove helpful to Canada. The first is the public funding of pharmaceuticals. Australia has had a national Pharmaceutical Benefits Scheme since the late 1940s. It now provides comprehensive coverage against the cost of pharmaceuticals for the whole population. The scheme, though, requires patients to make a modest co-payment for each prescription. For people on income support (retirees, unemployed) the co-payment is $6.30 ($6.34); for the rest of the population it is $38.80. There is a safety net, which drops the price to zero or $6.30 after about 50-60 prescriptions a year.

read more at theglobeandmail.com

Detroit Home Health Owner To Serve 30 Years for $33 Million Scam

The owner of four Detroit area-based home health companies was sentenced to 30 years behind bars for a $33 million Medicare fraud scheme he played a role in.

Zafar Mehmood, owner of Access Care Home Care Inc., Patient Care Home Care Inc., Hands on Healing Home Care Inc. and All State Home Care Inc., was involved in a Medicare scam that took place from 2006 through 2011, according to the Department of Justice.

Mehmood was convicted of one count of conspiracy to commit health care fraud, four counts of health care fraud, one count of conspiracy to pay and receive health care kickbacks, one count of conspiracy to commit money laundering, two counts of money laundering and two counts of obstruction of justice, court documents show.

Through this scheme, Mehmood obtained patients by paying cash kickbacks to recruiters, who then paid cash to patients to convince them to sign up for home health care with Mehmood’s companies. Mehmood also paid kickbacks to physicians to refer patients to his companies for unnecessary home health care services, the evidence in court showed.

Along with co-conspirators, Mehmood falsified records to make it appear that patients were qualified to receive certain services that Medicare paid over $33 million for during the six years the conspiracy took place.

Source: http://homehealthcarenews.com/2016/10/detroit-home-health-owner-to-serve-30-years-for-33-million-scam/