KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Hospice Fraud Is Costing Medicare Millions Of Dollars

Federal officials prosecuted more than 60 cases just last year. Also, news outlets report on fraud cases in Illinois, Texas, Florida and Indiana.

Pittsburgh Post-Gazette: Hospice Fraud Becoming A Costly Problem For Medicare
Theft has been called a crime of opportunity, which would make cheating Medicare’s hospice benefit a bag of Skittles left open on the coffee table. No one knows how big the problem of hospice fraud is — all types of improper Medicare payments are estimated at $65 billion for 2010 — but federal investigators prosecuted more than 60 cases in the last year alone, involving hundred of millions of dollars nationwide. The system that was built to help dying patients live out their remaining days with dignity and comfort has few quality metrics to meet, no minimum requirements for how often care is provided, and low barriers to getting into the business. Critics say that can make end-of-life care seem ripe for abuse. (Mamula, 3/6)

The Chicago Tribune: Doctor Known As 'King Of Nursing Homes' Convicted In Kickback Scheme
A federal jury on Friday convicted a doctor known as the "king of nursing homes" for routinely referring elderly patients to a financially struggling hospital on Chicago's West Side as part of a kickback scheme. Dr. Venkateswara Kuchipudi became the fifth physician and 10th defendant overall to be convicted for taking part in the massive Medicare and Medicaid fraud scheme at the now-shuttered Sacred Heart Hospital for 12 years. Doctors referred patients to the hospital in exchange for hundreds of thousands of dollars in kickbacks disguised as office rent, teaching fees and other bogus payments, prosecutors charged. (Eltagouri, 3/4)

Reuters: Texas Doctor Found Guilty Of Bilking Insurers, Government Of $10 Million
A Texas doctor has been found guilty of bilking $10 million from health insurance companies and the U.S. government through fraud, including being paid for attending surgeries while he was actually on his private jet, U.S. prosecutors said on Friday. Anesthesiologist Richard Toussaint Jr., 58, was convicted by a federal jury in Dallas on seven counts of fraud for submitting false claims for payments in 2009 and 2010 from Blue Cross Blue Shield of Texas, United Healthcare, Aetna, Cigna the Federal Employees Health Benefits Program and others, they said. (Richter and Herskovitz, 3/4)

NPR: Florida Doctor Says False Diagnoses Inflate Bills, Could Harm Patients
Insurance giant Humana Inc., which operates some of the nation's largest private Medicare health plans, knew for years of billing fraud at some South Florida clinics but did little to curb the practice even though it could harm patients, a doctor alleges in a newly unsealed whistleblower lawsuit. The suit was filed by South Florida physician Mario M. Baez. It accuses Humana and Baez's former business partner, Dr. Isaac K. Thompson, of engaging in a lucrative billing fraud scheme that lasted for years. The suit also names three other Palm Beach County doctors, two medical clinics and a doctors' practice group as defendants. The suit was filed in October 2012 but remained under a federal court seal until Feb. 26. (Shulte, 3/4)

The Associated Press: Indiana Man Gets 2 Years For Bilking $1M From Medicare
A northern Indiana man has been sentenced to two years in prison for conspiracy to commit health care fraud. Forty-two-year-old Anthony Bitterling of Winamac also was sentenced Thursday to 400 hours of community service and two years of supervised release. He was ordered to pay more than $1 million in restitution. (3/4)

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