The Daily Scan

September 5, 2018

Last Updated: 8:55 AM EST

Litigation

  • A Houston, TX psychiatrist was sentenced to 150 months in prison yesterday for his role in a $155 million Medicare fraud scheme involving false and fraudulent claims for psychiatric services. Riyaz Mazcuri, a former attending psychiatrist at Riverside General Hospital of Houston, was also ordered to pay $20,607,410.22 in restitution to Medicare and $2,250,789.69 in restitution to Medicaid. According to the evidence at trial, from 2006 until February 2012, Mazcuri and others engaged in a scheme to defraud Medicare by submitting to Medicare, through Riverside, approximately $155 million in false and fraudulent claims for partial hospitalization program (PHP) services. A PHP is a form of intensive outpatient treatment for patients with severe mental illness. In addition, evidence presented at trial showed that Mazcuri indiscriminately admitted and readmitted patients into these intensive psychiatric programs – often for years on end – many of whom suffered from severe Alzheimer’s or dementia and were unable to participate in the treatment purportedly provided at the PHPs, and who therefore did not qualify for the services. Evidence also showed that Mazcuri falsified medical records and signed false documents to make it appear as if patients admitted to the PHPs qualified for, required, and actually received the intensive psychiatric services. (Justice.gov)

Medicare 

  • The CMS Innovation Center released a new report last week titled "Evaluation of the Accountable Care Organization Investment Model: AIM Impacts in the First Performance Year." This report focuses on introducing AIM and evaluating the participating ACOs’ first performance year in AIM. Of note, AIM ACOs earned shared savings according to the financial reconciliation in the 2016 performance year, totaling $22.6 million. After subtracting the $22.6 million in earned shared savings from aggregate reductions in spending, net savings to the Medicare program was approximately- $82.8 million in the first AIM performance year. These savings represented 1.7% in base Medicare spending. (Innovation.CMS.gov)

Affordable Care Act

  • A new poll from the Kaiser Family Foundation continues to find pre-existing conditions as a widespread concern for Americans. With the impending lawsuit Texas v. United States, a majority of the public say it is “very important” that the Affordable Care Act’s (ACA) protections for people with pre-existing conditions ensuring guaranteed coverage (75%) and community rating (72%) remain law. About half (52%) of the public are “very worried” that they or someone in their family will have to pay more for health insurance and four in ten (41%) are “very worried” they will lose their coverage if the Supreme Court overturns these protections. (KFF.org)

Private Sector

  • Stryker announced today a definitive merger agreement to acquire all of the issued and outstanding shares of common stock of K2M Group Holdings, Inc. for $27.50 per share, or a total equity value of approximately $1.4 billion. K2M, which was founded in 2004, has emerged as a key player in the roughly $10 billion spinal market. According to an official press release: "With annual sales approaching $300 million, K2M brings to Stryker's Spine division a highly complementary and innovative portfolio, which includes a strong position in the complex spine market. Additionally, K2M's broad portfolio will strengthen Stryker's Spine offering in the core spinal segment, including an attractive minimally invasive spine portfolio, further Stryker's capabilities in additive manufacturing, and expand the Company's global footprint. K2M's compelling product portfolio and sales force focus have driven a double-digit compounded annual growth rate over the past five years." (Stryker.com)

 

 

 

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