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The Daily Scan

​Last Updated: 10:20 AM EST


  • Yesterday, the Maine Supreme Court denied Governor Paul LePage's request to delay the implementation of Medicaid expansion. The ruling dealt a blow to LePage, who has been blocking Medicaid expansion ever since voters approved it in November. The court did not rule on the merits of the case; it dismissed LePage’s appeal of a lower court decision, sending the case back to Superior Court. The initial lawsuit was filed after LePage failed to meet an April deadline to submit a two-page State Plan Amendment to the federal government that establishes a process for ensuring eligibility for people under 65 years of age who qualify for medical assistance. A Superior Court judge on June 4 ruled against the LePage administration and set a June 11 deadline for the governor to submit the plan to the federal government. The state appealed that order to the Maine Supreme Judicial Court, and a temporary stay was issued so arguments could be heard. Thursday’s Supreme Court ruling lifted the temporary stay and ordered the the lower court to resolve outstanding questions in the original lawsuit. (TheHill.com, Courts.Maine.gov)

  • The Justice Department announced yesterday that Reliant Rehabilitation Holdings Inc., a national provider of rehabilitation therapy and related services, has agreed to pay the United States $6.1 million to resolve allegations that it violated the False Claims Act by paying kickbacks to skilled nursing facilities and physicians in connection with care provided to Medicare beneficiaries as a way of improperly promoting Reliant’s rehabilitation therapy business. The U.S. alleged that between April 2013, and May 2017, Reliant knowingly offered improper inducements, in the form of Reliant-employed nurse practitioners who worked at client nursing homes without charge or for a nominal, below fair market fee in order to induce or reward nursing homes for contracting with Reliant to provide rehabilitation therapy for their residents. The settlement resolves this claim and a separate allegation that Reliant violated the FCA by causing the submission of claims to Medicare that were tainted by improper contracts between Reliant and physicians working at skilled nursing facilities that offered the physicians above fair market compensation for supervising and collaborating with Reliant nurse practitioners in exchange for the facilities’ therapy business. (Justice.gov)

  • A federal jury in Los Angeles, California found a doctor guilty yesterday of conspiracy for his role in a Medicare kickback conspiracy involving a Los Angeles-area home health agency. Kanagasabai Kanakeswaran, M.D. was convicted of one count of conspiracy to pay and/or receive kickbacks for Medicare referrals and four counts of receiving kickbacks for Medicare referrals after a six-day trial. According to evidence presented at trial, from 2008 to 2016, Kanakeswaran and others engaged in a conspiracy to refer Medicare patients to Star Home Health Resources (Star), in exchange for illegal kickback payments. Kanakeswaran received cash kickback payments, as well as kickback payments by check through a company Kanakeswaran owned called Digital Perfection Corporation, the evidence showed. As a result of the conspiracy, the owners and operators of Star submitted claims to Medicare based on the Medicare beneficiaries that Kanakeswaran referred to Star, and Medicare paid approximately $4.1 million based on those claims. (Justice.gov)

  • Yesterday a jury convicted Matilda Lynn Prince of Georgia of 29 counts of healthcare fraud for filing fraudulent claims with Medicare and the Georgia Medicaid program for optometry and ophthalmology services that were never provided to patients. Despite being previously excluded from the Medicare and Medicaid programs in September 2011 and informed of her ineligibility to be employed or involved with any entity that received Medicare or Medicaid funds, Prince operated under a company named Eye Gallery 20/20 to bill Medicare and Medicaid for services that were not rendered. As part of the scheme, Prince targeted her advertising towards senior citizens and disabled populations in housing complexes and community centers, offering on-site eye exams and prescription glasses at no charge to patients on Medicare and Medicaid. Prince contracted with two licensed optometrists to provide basic eye exams. Although the patients received only basic eye exams and measurements for prescription glasses, Prince often billed for complex ophthalmological procedures involving the surgical insertion of medical devices called “punctal plugs” into patients' tear ducts to treat dry eye conditions. Prince then used the identities of the two licensed optometrists to bill Medicare and Medicaid repeatedly for this procedure. On some occasions, she billed for the same patient as many as seven times on the same claimed date of service, even though the procedures were never performed. In total, Prince fraudulently submitted over $1.2 million in insurance claims to Medicare and Medicaid for services never rendered. (Justice.gov)

  • United States Attorney Mike Stuart announced that Karl O’Dell, 61, a pharmacist and owner of a pharmacy in Ashland, Kentucky, pled guilty yesterday to a conspiracy to misbrand oxycodone and hydrocodone. Stuart praised the investigation conducted by the Food and Drug Administration, the U.S. Department of Health and Human Services - Office of Inspector General, Internal Revenue Service – Criminal Investigations, the Kentucky State Police, the Kentucky Board of Pharmacy, the West Virginia State Police, and the Drug Enforcement Administration. O’Dell admitted that he conspired to misbrand oxycodone and hydrocodone and introduced them into interstate commerce when he manufactured compounded oxycodone and hydrocodone not for medically legitimate purposes in anticipation of prescriptions written by HOPE Clinic practitioners for their customers. O’Dell admitted that in furtherance of the conspiracy, on two separate occasions, once in July 2014 and once in August 2014, he received and filled two prescriptions for 120 oxycodone 32mg compounded capsules written by two different HOPE Clinic practitioners for two different customers. O’Dell faces up to 1 year in prison and a $100,000 fine when he is sentenced in November. (Justice.gov)

  • Dr. Philip Dean of Missouri, pled guilty on Wednesday to two felony charges, illegally distributing opiate medications and making a false statement to the Medicare program. According to his plea agreement, Dr. Dean operated a medical office in Warren County, Missouri. Dr. Dean had personal relationships with three women, living with these women for some time periods. While engaging in personal relationships with these women, Dr. Dean also prescribed them with prescription opioid pain relief medications, including Oxycodone, Hydrocodone, and several forms of Fentanyl. The two felony charges from Dr. Dean’s plea agreement involve two of these women. “This is an outrageous violation of the trust our society commits to physicians. Dr. Dean violated that trust and exploited his drug dependent patients. On top of it all, the taxpayers were forced to foot the bill for his crimes,” said U.S. Attorney Jeff Jensen. (Justice.gov)


  • U.S. Senator Richard Shelby (R-Ala.), chairman of the Senate Committee on Appropriations, today applauded the Senate’s passage of H.R. 6157, the third Fiscal Year 2019 minibus appropriations bill. The funding legislation packages the eighth and ninth FY2019 funding measures to be processed by the full Senate this year – Department of Defense; and Labor, Health and Human Services, Education, and Related Agencies. The funding measure was approved by a vote of 85 – 7. The package provides appropriations to support various national priorities within the Departments of Defense, Labor, Health and Human Services, and Education, and other related agencies. The legislation includes an increase in funding for the Pentagon, the largest pay raise for our troops in a decade, as well as increased NIH funding and boosted resources for opioid treatment, prevention, and recovery programs. Both of the bills included in the package were passed by the full Senate Appropriations Committee with near-unanimous support. (Appropriations.Senate.gov)

Medicare & Medicaid

  • Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced a new Innovation Center payment and service delivery model as part of a multi-pronged strategy to combat the nation’s opioid crisis. The Integrated Care for Kids (InCK) Model aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs. The model will empower states and local providers to better address these needs through care integration across all types of healthcare providers. (CMS.gov)


  • Yesterday, the Government Accountability Office (GAO) released the results of a new investigation titled "Health Insurance Exchanges: HHS Should Enhance Its Management of Open Enrollment Performance." GAO examined 2018 enrollment in Affordable Care Act health insurance exchanges and federal efforts to encourage enrollment. GAO found that about 8.7 million people bought insurance in 2018 through the federal website (healthcare.gov), 5% less than in 2017. Additionally, Health and Human Services reduced its advertising and other consumer outreach. The 23 stakeholders we interviewed had mixed views about the effects of these reductions on enrollment. Finally, HHS did not set enrollment targets for 2018, but reported meeting its goal of enhancing specific aspects of consumer experience. GAO recommended that HHS take steps to better manage its performance. (GAO.gov)

#Regulation #Medicaid #Medicare #Legislation #Litigation


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