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GP stalked patient after accessing her medical records to get phone number, tribunal hears

Shidonna Raven Garden and Cook

14 JANUARY 2019 • 12:25PM 

AGP was accused of stalking a patient after accessing her medical records so he could obtain her mobile phone number, a medical tribunal heard.

Dr Chika Mbah, 37, allegedly sent a stream of WhatsApp messages asking the woman out for a date and turned up once outside her home after signing her off work for work-related stress.

The woman repeatedly declined his invitation but father-of-two Mbah, who called himself ‘Dr Sandy’, kept calling her and left messages saying: “How are you stranger? – don’t you remember, it’s me, Dr Sandy?,’ the tribunal heard.

The patient, who was not named and known as Patient A, was grieving at the time Mbah contacted her following the death of her grandparent. 

She was said to be so uncomfortable as a result of his advances that she refused to attend his surgery for an urgent check up over a stomach problem.

Mbah was suspended from medical practice for three months after he was found guilty of misconduct when he admitted pursuing an improper relationship with the patient. 

But he denied allegations of illicitly accessing her medical records and the panel found no evidence of “any predatory behaviour”.

In a statement read out at the Medical Practitioners Tribunal Service in Manchester, the woman said: “During many messages, he asked me out for a drink which I did not go to and I received the odd phone call for a chat.

Health care fraud comes in many forms. Would you recognize it if you saw it? What does it look like? What are the costs?

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Patients voice concerns after Chesapeake doctor arrested for health care fraud

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Source: WAVY News 10 | 11-09

CHESAPEAKE, Va. (WAVY) — A Chesapeake doctor was arrested on Friday for alleged health care fraud and false statements related to health care matters. Court documents say the Federal Bureau of Investigation started investigating 69-year-old Javaid Perwaiz in September 2018, when they received a tip from a hospital employee who suspected he was performing unnecessary surgeries on unsuspecting patients.

Would you recognize health care fraud if you saw it? Would you know if you were taking unnecessary medicine or had an unnecessary procedure? What would it look like?

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Psychiatrist Sentenced to Prison for Healthcare Fraud Scheme – Norfolk, VA

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FOR IMMEDIATE RELEASE Thursday, January 16, 2020

Source: US Department of Justice
NORFOLK, Va. – A Virginia Beach doctor was sentenced today to 27 months in prison for defrauding Medicare, Medicaid, and Tricare, and other health care benefits programs out of hundreds of thousands of dollars.

Additionally, Udaya K. Shetty, 64, agreed to pay over $1 million to settle related civil claims.

According to court documents, was a licensed psychiatrist practicing medicine at his own practice, Behavioral & Neuropsychiatric Group. Beginning in 2013, Shetty created a scheme by which he could overbill healthcare benefit programs by seeing patients for only five to 10 minutes, but then billing for services that were on average 41 to 63 minutes long. Shetty instructed his staff to often double, triple, or even quadruple book appointment times. The fraud became apparent when investigators discovered that on dozens of instances Shetty would need more than 24 hours a day of working to perform the services for which he billed. 

In 2017, Shetty closed his own practice and joined another psychiatric practice, Quietly Radiant Psychiatric Services. While there Shetty, and one of his former employees, Mary Otto, engaged in a similar scheme. Although other Quietly Radiant staff members were responsible for billing, Shetty directed Otto to access the billing system and change all of his billing data to a higher billing rate.  Otto complied and changed the data without the knowledge of Quietly Radiant’s staff. As a result of their actions, Shetty and Otto defrauded various healthcare benefit programs of more than $450,000. Otto pled guilty for her role in the scheme and was sentenced to 15 months in prison on January 10.

In regards to the civil settlement, Shetty agreed to pay $1,078,000 to the United States and the Commonwealth of Virginia to resolve his liability under the False Claims Act and the Virginia Fraud Against Taxpayers Act for submitting or causing the submission of false claims to the Medicare, Medicaid, and TRICARE programs.

G. Zachary Terwilliger, U.S. Attorney for the Eastern District of Virginia; Martin Culbreth, Special Agent in Charge of the FBI’s Norfolk Field Office; Robert E. Craig, Special Agent in Charge for the Defense Criminal Investigative Service’s (DCIS) Mid-Atlantic Field Office; Maureen R. Dixon, Special Agent in Charge of the Office of Inspector General for the U.S. Department of Health and Human Services (HHS); and Mark R. Herring, Attorney General of Virginia, made the announcement after sentencing by U.S. District Judge Rebecca Beach Smith. Assistant U.S. Attorney Joseph L. Kosky prosecuted the criminal case. Assistant U.S. Attorney Clare P. Wuerker handled the civil case.

A copy of this press release is located on the website of the U.S. Attorney’s Office for the Eastern District of Virginia. Related court documents and information are located on the website of the District Court for the Eastern District of Virginia or on PACER by searching for Case No. 2:19-cr-089.

Some patients often start off with private health care and end up with Medicaid, Medicare or Tricare because these government health insurance or more advantageous for those medical ‘professionals’ seeking to defraud patients and insurance providers. Would you recognize health care fraud if you see it? What does it look like? Have you been a victim of health care fraud?

Share your comments with the community by posting them below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

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HHS Turning up the HEAT on Healthcare Fraud Charges

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Source: Policy Med

HEALTHCARE REFORMHHS-OIG By Thomas Sullivan Last Updated May 5, 2018

Since the health care reform debate began almost two years ago, the Obama Administration has identified fighting fraud committed against public health care programs as a top priority. Both the Recovery Act and Affordable Care Act include significant provisions to fight health care fraud. Among many other changes, the ACA amended the False Claims Act’s public disclosure provision and strengthened the provisions of the federal health care Anti-Kickback Statute.

One of the main reasons for this is because the Obama Administration largely asserted during the debate that significant reductions in health care fraud and abuse could help pay for part of the health care reform legislation.

These goals were further expressed in President Obama’s FY 2011 budget, which included $561 million in discretionary resources to the Department of Health and Human Services (HHS), an increase of $250 million. HHS Secretary Kathleen Sebelius acknowledged that this increase would strengthen the Medicare and Medicaid program integrity activities, with a particular emphasis on fighting health care fraud in the field, increasing Medicaid audits, and strengthening program oversight while reducing costs. 

Such an investment against fraud and abuse claims to help save $9.9 billion over ten years. According to HHS, the additional funding will better equip the Federal government to minimize inappropriate payments, pinpoint potential weaknesses in program integrity oversight, target emerging fraud schemes by provider and type of service, and establish safeguards to correct programmatic vulnerabilities.

Additionally, the HHS budget will install a set of new program integrity proposals that will give HHS the necessary tools to fight fraud by enhancing provider enrollment scrutiny, increasing claims oversight, improving Medicare’s data analysis capabilities, and reducing over-utilization of Medicaid prescription drugs. These proposals will claim to save approximately $14.7 billion over 10 years.

Consequently, the Department of Justice (DOJ) has been busy trying to reach that goal, securing more than $3 billion in civil settlements and judgments in cases involving fraud against the government in the fiscal year ending Sept. 30, 2010. Announcing this accomplishment, Tony West, Assistant Attorney General for the Civil Division, announced in a press release that this total includes $2.5 billion in health care fraud recoveries—the largest in history—and represents the second largest annual recovery of civil fraud claims.

West also mentioned that the amounts recovered under the False Claims Act since January 2009 have eclipsed any previous two-year period with $5.4 billion in taxpayer dollars returned to federal programs and the Treasury. Of that total, $4.6 billion were under the False Claims Act from health care providers and others in the industry, a two-year health care fraud record. DOJ also secured 25 criminal convictions. Since 1986, when Congress substantially strengthened the civil False Claims Act, recoveries now total more than $27 billion.RELATED POSTS

The largest fiscal year 2010 False Claims Act recoveries came from the pharmaceutical and medical device industries, which accounted for $1.6 billion in settlements, including the $669 million from Pfizer Inc., $302 million from AstraZeneca, and $192.7 from Novartis Pharmaceutical Corporation. These numbers may appear to be deceptive however, as some have predicted that the era of big pharma settlements may be ending. For example, many companies such as Pfizer have entered into lengthy corporate integrity agreements that span over the next several years.

While it is certainly important for revenue purposes that DOJ continues to successfully prosecute wrongful acts of companies, the agreements these companies have entered into require more of an oversight role than investigative, to ensure compliance with the agreement. Without large settlements, the DOJ might not be able to sustain its ‘profitability’ of fraud collections. For example, without a large settlement like Pfizer’s, DOJ’s claims may not cover the $500 million plus the government put in. In other words, if the administration is to continue such efforts, they will first have to recover $500 million to break even.

Much of the success for recovering this money stems from the Department of Health and Human Services (HHS) creation of a new interagency task force, the Health Care Fraud Prevention and Enforcement Action Team (HEAT). On May 20, 2009, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius created HEAT to increase coordination and optimize criminal and civil enforcement, which they argue results in higher quality health care at a more reasonable price. DOJ and HHS also assert that HEAT is used as a tool to protect the Medicare Trust Fund for seniors and the Medicaid program for the country’s neediest citizens.

West further acknowledged the role of HEAT by recognizing that Since January 2009, the Civil Division, together with the U.S. Attorneys’ offices, commenced more health care fraud investigations, secured larger fines and judgments, and recovered more taxpayer dollars lost to health care fraud than in any other two-year period.” Most of the cases resulting in recoveries were brought to the government by whistleblowers under the False Claims Act, the federal government’s primary weapon in the battle against fraud.

In 1986, Senator Charles Grassley and Representative Howard Berman led successful efforts in Congress to amend the False Claims Act to revise the statute’s qui tam (or whistleblower) provisions, which encourage whistleblowers to come forward with allegations of fraud. Since 1986, recoveries in qui tam cases have exceeded $18 billion, and relators (whistleblowers) have obtained more than $2.8 billion in awards. They were awarded $385 million in 2010.

Impact of Settlements

Ultimately, while the success of the DOJ is clear, how much this will continue down the road depends on a number of factors. Nevertheless, it is important that the DOJ and HHS continue to work with companies on solutions to prevent fraud, waste and abuse to reduce costs and improve efficiency in the health care system. While the recoveries may help to pay for some of the provisions in health care reform, it is more important that the companies maintain their trust and integrity with the public by adhering to their agreements and making a concerted effort to prevent fraud and abuse.

How much of your tax dollars do you think go towards health care fraud (unnecessary procedures, over billing etc.? How much of your health insurance premium dollars do you think goes towards paying for fraudulent procedures and over billing? Do you look at your insurance bill? Does your insurance company send you a copy of your medical charges?

Share your comments with the community by posting them below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

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US coronavirus stimulus went to some healthcare providers facing criminal inquiries

Source: CNBC
PUBLISHED SAT, MAY 2 2020 6:07 AM EDT

The exterior of the U.S. Department of Health and Human Services in Washington, DC.

Eager to bolster the healthcare system during the coronavirus pandemic, the U.S. government last month sped $30 billion in stimulus payments to most healthcare providers that billed Medicare last year.

That speed resulted in taxpayers’ money flowing to some companies and people facing civil or criminal fraud investigations, according to defense lawyers and others representing more than a dozen firms and people facing such inquiries.

The disclosures about such payments have prompted outrage among some congressional Democrats, who say they highlight the problems with how stimulus funds have been distributed.

“I have an enormous amount of frustration with the way the Trump administration is distributing these dollars, and examples like these magnify the consequences of the White House’s efforts to limit transparency and stonewall oversight,” Senator Ron Wyden, ranking member of the Senate Finance Committee, told Reuters.

Henry Connelly, a spokesman for House of Representatives Speaker Nancy Pelosi, added: “It is alarming to see the Trump administration giving precious taxpayer dollars to unscrupulous entities while so many hospitals and health care workers on the frontlines of the battle against coronavirus are desperate for resources.”

The Department of Health and Human Services, which sent the payments, told Reuters it transmitted funds to all medical providers who submitted billings in 2019 to Medicare, the federal health insurance program for elderly and disabled Americans, unless they had already been excluded from participating.

It declined to respond to the criticism from Wyden and Pelosi’s office and did not respond to specific questions from Reuters about the payments.

Katherine Harris, a spokeswoman for the HHS Office of the Inspector General, said her office oversees the program but declined to comment on the specific distribution of funding.

“While we cannot comment specifically on any work other than what has been publicly announced, I can tell you that we regularly perform reviews of the department’s administration of programs, including the distribution of funding,” Harris said.

Reuters was unable to independently determine what portion of the stimulus payments went to entities and individuals involved in civil and criminal actions with Medicare.

In an email to funding recipients seen by Reuters, HHS asked providers to sign a lengthy attestation that stipulates they have been or will be treating patients suffering from COVID-19, the disease caused by the new coronavirus.

If providers do not respond within 30 days, HHS said it will assume they have accepted the government’s terms and conditions. It said in a statement it “has mechanisms in place to recoup funds and address fraudulent activity.”WATCH NOWVIDEO05:53CARES Act, Fed response insufficient given headwinds: Chief economist

The funds came from the $2.3 trillion CARES Act passed by Congress to blunt the economic toll of the pandemic, which has killed more than 64,000 Americans and thrown at least 30 million people out of work.

Unlike the portions of that package intended to help small businesses, which required companies to apply for it, some of the healthcare funding was initiated by the U.S. Department of Health and Human Services and showed up as a surprise in the bank accounts of many healthcare providers.

Reuters interviewed six defense lawyers and others representing more than a dozen healthcare providers facing civil or criminal inquiries who received the money, including a pain medicine doctor who recently settled a civil false claims case, and an operator of an assisted living facility who is planning to plead guilty to healthcare fraud.

“The left hand does not know what the right hand is doing,” said Joel Hirschhorn, an attorney who represents the pain medicine doctor and the operator of the assisted living facility.

The lawyers who spoke to Reuters declined to identify their specific clients, citing confidentiality rules.

The surprise deposit of funds has led attorneys to scramble to warn clients to be ready to return the money.

“There is no such thing as a windfall from the government,” said Sam J. Louis, a former prosecutor who is now a partner with the law firm Holland & Knight, whose law firm issued an alert to clients warning them of the potential of legal liability in taking the funds.

Some former federal prosecutors say it would not have been difficult for HHS to weed out these providers first.

“If fraudulent providers, either convicted or under investigation, are receiving CARES Act bail-outs automatically, without any vetting, then shame on the government,” said Paul Pelletier, one former prosecutor.

However, defense lawyers stressed that people charged with crimes are innocent until proven guilty, and they are not usually barred from billing Medicare until well after they are convicted of a crime. People facing criminal healthcare charges usually agree to stop billing Medicare as a condition of their bond, they added.

Another pool of practitioners eligible for the cash infusions include doctors who have lost their medical licenses or licenses to prescribe highly addictive drugs, said Ron Chapman, a lawyer in Miami.

HHS declined to say what portion of the $30 billion went to providers facing criminal or civil inquiries.

It said it distributed funds to more than 315,000 provider billing organizations reaching over 1.5 million healthcare providers.

In fiscal year 2019, investigations by the HHS inspector general’s office led to 747 criminal actions and 684 civil actions.

In the midst of the pandemic health care fraud is alive and prevalent while many suffer economically across the globe. How has the pandemic effected you financially? Do you think pandemic aid could have been better spent? How many people do you think lost or missed work? How many industries and small business have been impacted or closed due to COVID 19?

Share your comments with the community by posting them below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

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10. The Stanford Prison Experiment

Source: Mental Floss
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The Stanford Prison Experiment
Source Mental Floss
Shidonna Raven Garden and Cook

In 1971, Philip Zimbardo of Stanford University conducted his famous prison experiment, which aimed to examine group behavior and the importance of roles. Zimbardo and his team picked a group of 24 male college students who were considered “healthy,” both physically and psychologically. The men had signed up to participate in a “psychological study of prison life,” which would pay them $15 per day. Half were randomly assigned to be prisoners and the other half were assigned to be prison guards. The experiment played out in the basement of the Stanford psychology department where Zimbardo’s team had created a makeshift prison. The experimenters went to great lengths to create a realistic experience for the prisoners, including fake arrests at the participants’ homes.

The prisoners were given a fairly standard introduction to prison life, which included being deloused and assigned an embarrassing uniform. The guards were given vague instructions that they should never be violent with the prisoners, but needed to stay in control. The first day passed without incident, but the prisoners rebelled on the second day by barricading themselves in their cells and ignoring the guards. This behavior shocked the guards and presumably led to the psychological abuse that followed. The guards started separating “good” and “bad” prisoners, and doled out punishments including push ups, solitary confinement, and public humiliation to rebellious prisoners.

Zimbardo explained, “In only a few days, our guards became sadistic and our prisoners became depressed and showed signs of extreme stress.” Two prisoners dropped out of the experiment; one eventually became a psychologist and a consultant for prisons. The experiment was originally supposed to last for two weeks, but it ended early when Zimbardo’s future wife, psychologist Christina Maslach, visited the experiment on the fifth day and told him, “I think it’s terrible what you’re doing to those boys.”

Despite the unethical experiment, Zimbardo is still a working psychologist today. He was even honored by the American Psychological Association with a Gold Medal Award for Life Achievement in the Science of Psychology in 2012.

Does this occur in prisons? Did it begin to occur before or after such experiments? Is any of this behavior acceptable and to be considered real health care?

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5 Unethical Unauthorized Medical Experiments

5 Worst Medical Experiments
Source: This is genius
Shidonna Raven Garden and Cook

What are the worst medical experiments you know of? Why do you think these medical experiments occur? What should be the consequences for such experiments?

Share your comments with the community by posting them below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

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Feds accuse Chesterfield psychiatrist of $15M in health care fraud

ST. LOUIS — A psychiatrist from Chesterfield and his business partner have been indicted on federal charges for their involvement in what prosecutors said Thursday was $15 million in health care fraud.

Prosecutors said Dr. Franco Sicuro and Carlos Himpler, of Baton Rouge, Louisiana, owned Genotec DX and Midwest Toxicology Group, which received over $15 million for performing drug tests. But prosecutors said the companies didn’t have the equipment required to perform the urine tests. Instead, they paid other labs $125 per sample, then billed Medicare and private insurance companies thousands of dollars per sample as if they had done the work themselves, authorities said.

To pull off the scheme, the two companies billed as if they had performed multiple tests on the same sample, and submitted them on different days with different billing codes.

One of the victims was a local union, United Food and Commercial Workers local 655, which paid Genotec DX $1 million for urine drug tests for seven union members from January to October 2015, and paid $150,000 to Midwest Toxicology Group, prosecutors said.

Prosecutors are seeking the forfeiture of cash, investments accounts, real estate and luxury vehicles owned by both men. 

Sicuro is facing 19 charges in U.S. District Court in St. Louis and Himpler was named in 21 counts, including charges of conspiracy, health care fraud and money laundering. No lawyers are listed for either man in online court records, and a call to Sicuro’s Chesterfield office was not immediately returned.

Himpler is a former St. Louis-area resident who started several businesses here, the indictment says. 

Source: St. Louis Post Dispatch

Has your insurance ever been over billed? Do you look at your insurance bill? Would you recognize health care if you see it? Share your comments with the community by posting them below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

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Radiology center pays more than $500K to resolve health care fraud allegations

Advanced Imaging of Port Charlotte, LLC, a radiology center headquartered in Port Charlotte, has agreed to pay $501,000 to resolve allegations that it violated the False Claims Act by submitting fraudulent claims to Medicare and Tricare, a health care program for uniformed service members, retirees, and their families.

As part of the settlement, the United States contends that Advanced Imaging knowingly submitted claims to Medicare and Tricare by (1) administering dye-contrast scans without direct physician supervision as required by Federal regulations and (2) improperly billing for services performed by doctors who were not properly credentialed by Medicare.

“This settlement reflects our continuing efforts to protect our military and their families, our community, and the taxpayers by ensuring that the care provided to beneficiaries of government-funded health care programs is consistent with federal regulations,” said United States Attorney Chapa Lopez. “We will continue to hold health care providers accountable when they provide services by individuals who are not credentialed, licensed, or appropriately supervised.”

“Working alongside our investigative partners, The Defense Criminal Investigative Service (DCIS) is committed to protecting the integrity of the U.S. Military Healthcare program,” said Cynthia A. Bruce, Special Agent in Charge, DCIS Southeast Field Office. “DCIS appreciates the continual support of the U.S. Attorney’s Office throughout Florida for their efforts to recoup financial losses which will be used for the care of our military beneficiaries.”

This settlement resulted from a coordinated effort by the U.S. Attorney’s Office for the Middle District of Florida, DCIS, and the U.S. Department of Health and Human Services Office of Inspector General. The investigation was led by Assistant U.S. Attorney David P. Sullivan.

The claims resolved by the settlement are allegations only and there has been no determination of liability. The civil settlement resolves the following captioned cases: United States, et al. v. KMH Cardiology Centres, Inc., et al., 2:16-cv-618-TPB-MRM, and United States of America, et al. v. SAVN Administrative Services, Inc., et al., 2:16-cv-622-SPC-MRM.

Source: Wink News

Would you recognize health care fraud when you see it? Would you health have suffered before you recognize health care fraud? Do you think you ever had a unnecessary procedure before? Share your comments with the community by posting them below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

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Health Care Fraud during COVID

COVID 19 Fraud
Source: Senior Medical Patrol
Shidonna Raven Garden and Cook

How has this article helped you and yours? Do you think you can identify COVID 19 health care or health care fraud in general when you see it? What do you do when you see health care fraud? Share your comments with the community by posting them below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

If these articles have been helpful to you and yours, give a donation to Shidonna Raven Garden and Cook Ezine today.