The Daily Scan

November 6, 2018

Last Updated: 1:00 PM EST

Litigation

  • At the request of the FTC, a federal judge has temporarily shut down a Florida-based operation that allegedly collected more than $100 million by preying on Americans in search of health insurance, selling these consumers worthless plans that left tens of thousands of people uninsured. Many of these consumers have incurred substantial medical expenses and have been stuck with thousands of dollars in unpaid medical bills. A federal court temporarily halted the operation pending resolution of the case. The FTC seeks to permanently stop the defendants’ practices and return money to consumers. In a complaint filed in federal court against Simple Health Plans LLC, the company’s owner, Steven J. Dorfman, and five other entities, the FTC alleged that the defendants misled people to think they were buying comprehensive health insurance that would cover preexisting medical conditions, prescription drugs, primary and specialty care treatment, inpatient and emergency hospital care, surgical procedures, and medical and laboratory testing. Consumers who enrolled reported paying as much as $500 per month for what was actually a medical discount program or extremely limited benefit program that did not deliver the promised benefits and effectively left consumers uninsured, the FTC alleged. (FTC.gov: Press Release, Temporary Restraining Order)

 

  • ImmediaDent of Indiana, LLC (ImmediaDent), which operates nine dental care practices in Indiana, and Kansas based Samson Dental Partners, LLC (SDP), which provides administrative support services to ImmediaDent, have agreed to pay the United States and the State of Indiana $5.139 million to resolve allegations that they improperly billed Indiana’s Medicaid program for dental services; the companies have been determined to continue to be a high risk to the United States health care programs and their beneficiaries. The companies are accused of submitting false claims for payment to Indiana’s Medicaid program between January 2009 and September 2013. Both companies are alleged to have submitted false claims to Indiana’s Medicaid program by (1) improperly billing simple tooth extractions as though they were surgical extractions and (2) improperly billing Scale and Root Planings (otherwise known as “deep cleanings”) that were either not performed or not medically necessary. Additionally, SDP is accused of violating Indiana’s law prohibiting the corporate practice of dentistry by improperly influencing ImmediaDent’s medical professionals and staff by rewarding production, disciplining employees for not meeting production objectives, and directing personnel in a manner which compromised clinical judgment. SDP and ImmediaDent agreed to pay the United States $3.4 milllion under the settlement. The companies also agreed to pay $1.7 million to the state of Indiana. In connection with this settlement, OIG determined that the companies needed additional oversight, which will come in the form of a Corporate Integrity Agreement. (Justice.gov)

 

  • Sophia Eggleston, of Detroit, Michigan, was convicted of one count of conspiracy to receive health care kickbacks and two counts of receipt of health care kickbacks on Friday following a three-day trial. Sentencing has been scheduled for Feb. 6, 2019 before U.S. District Judge Bernard Friedman of the Eastern District of Michigan, who presided over the trial. According to evidence presented at trial, from 2009 to 2012, Eggleston and her co-conspirators engaged in an illegal kickback scheme to defraud Medicare of approximately $1.1 million through fraudulent home health claims. The evidence showed that Eggleston solicited and received kickbacks in exchange for referring Medicare beneficiaries to serve as patients at a home health agency owned by her co-conspirators. Eggleston’s co-conspirators then submitted claims to Medicare for home health services that were purportedly provided to those beneficiaries. (Justice.gov)

Legislation

  • Voters in four red states will decide today whether to expand Medicaid to thousands of low-income adults. Ballot initiatives in Idaho, Montana, Nebraska and Utah aim to bring those states in line with the 32 that have already embraced Medicaid expansion. Winning margins on Election Day would also increase the odds for similar ballot campaigns in the other 14 states where policymakers — often Republicans — have rejected expansion. Jonathan Schleifer, executive director of The Fairness Project, a Washington-based advocacy group backed by SEIU United Healthcare Workers West that has spent millions of dollars supporting expansion, told TheHill.com: “If Medicaid expansion wins in these states, it can win anywhere." (TheHill.com)

 

 

 

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