The Daily Scan

June 25, 2018

Last Updated: 9:05 AM EST

Litigation

  • The Texas Supreme Court ruled Friday that Xerox is responsible for the $1 billion in fraudulent Medicaid payments the company made while overseeing pre-authorizations for Texas Medicaid patients’ dental work. In a 25-page decision, the state’s high court upheld a Texas Court of Appeals ruling that Xerox — and not the dentists — was responsible for mismanaging and mis-authorizing payments for Medicaid dental services. The decision comes years after the state found that Texas Medicaid and Healthcare Partnership, a subsidiary of Xerox, allowed workers with limited expertise to approve dental claims for the state's Medicaid program, the joint federal-state health insurance program for the poor and disabled. The state, dental providers and Xerox have been battling over who is responsible for paying back the funds. (Decision: TXCourts.gov, Article: TexasTribune.org)

 

  • On Friday a federal jury found one physician and two nurses guilty of health care fraud, and one physician and one nurse guilty of conspiracy to commit health care fraud, all for their roles in a home health fraud scheme. “Medical professionals Kelly Robinett, Kingsley Nwanguma, and Joy Ogwuegbu engaged in a multimillion-dollar scheme to defraud the taxpayer-funded Medicare program by certifying patients for medically unnecessary home health services and falsifying medical records to hide their crimes,” said Acting Assistant Attorney General Cronan. “The Criminal Division and our law enforcement partners are committed to protecting taxpayer dollars by vigorously pursuing medical professionals and anyone else who seeks to profit off our federal health programs through fraud and deceit.” (Justice.gov)

 

  • Livingston Regional Hospital, LLC, a LifePoint Health Inc. company, agreed on Thursday to pay $784,000 to settle allegations that Livingston Regional Hospital violated the False Claims Act, announced United States Attorney Don Cochran for the Middle District of Tennessee. The settlement resolves allegations that between July 9, 2015 and October 31, 2015, Livingston Regional Hospital violated the False Claims Act by knowingly billing Medicare Part A for inpatient psychiatric care that was not medically necessary. (Justice.gov)

Legislation

  • On Friday, the House of Representatives passed H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, authored by Representative Greg Walden (R-OR). H.R. 6 passed the House by a bipartisan vote of 396-14. The bipartisan bill will help efforts to advance treatment and recovery initiatives, improve prevention, protect our communities, and bolster our efforts to fight deadly illicit synthetic drugs like fentanyl. (Press Release: Walden.House.gov, Bill: Congress.gov)

 

  • Michigan Governor Rick Snyder signed Senate Bill 897 on Friday. The new law implements work requirements for health care coverage under the state’s Healthy Michigan program, which has enrolled more than 670,000 people since 2014. Under the adjusted requirements, beneficiaries will be required to have at least 80 hours per month at a part-time job, a post-secondary educational institution or high school equivalency test training, a job training program, volunteer work or community service, an internship, or substance abuse treatment. Those exempted from the requirements include anyone age 63 or older, disabled persons, pregnant women, full-time students, children, a parent of a dependent child younger than age 6, a recipient of unemployment benefits and anyone under age 21 who had previously been in foster care. (Michigan.gov)

Regulation

  • The Department of Homeland Security (DHS) and Health and Human Services (HHS) have a process established to ensure that family members know the location of their children and have regular communication after separation to ensure that those adults who are subject to removal are reunited with their children for the purposes of removal. The United States government knows the location of all children in its custody and is working to reunite them with their families. As part of the apprehension, detention and prosecution process, illegal aliens, adults and children, are initially detained by U.S. Customs and Border Protection (CBP) before the children are sent to HHS’ Office of Refugee Resettlement (ORR) and parents to Immigration and Customs Enforcement (ICE) custody. Each entity plays a role in reunification. (HHS.gov)

 

  • On Friday, Planned Parenthood affiliates filed suit against the Department of Health and Human Services (HHS), HHS Secretary Alex Azar, and Valerie Huber, Senior Policy Advisor in the Office of the Assistant Secretary of Health, challenging the administration’s efforts to impose their abstinence-only-until-marriage (AOUM) agenda on the 1.2 million young people who are set to benefit from the Teen Pregnancy Prevention Program (TPP program). The lawsuit seeks to protect the future of the TPP program. If successful, the lawsuit will ensure that the TPP program maintains its evidence-based principles and that new grantees are not forced to push dangerous AOUM curriculums. (PlannedParenthood.org)

Private Sector

  • A new report from Sherlock Company revealed that in 2017, excluding the effect of Miscellaneous Business Taxes, Blue Cross Blue Shield Plans reported administrative cost increases of 5.9%, far higher than the previous three years, and the highest since 2013. (SherlockCo.com)

 

 

 

 

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