Weekly Watchdog: Convictions in $20M healthcare fraud scheme

Catch up on all things fraud and ethics in the healthcare industry with HealthExec’s weekly watchdog report.

Doctor and hospital owner convicted in $20M healthcare fraud scheme

An internal medicine doctor and a hospital owner have been convicted of conspiracy to commit healthcare fraud, 17 counts of healthcare fraud and three counts of money laundering in a $20 million scheme, the Department of Justice announced.

Narang, the owner and doctor at North Cypress Clinical Associates in Texas, and Dayakar Moparty, manager and operator of Red Oak Hospital, together conspired to commit healthcare fraud. They allegedly submitted false and fraudulent claims for medical tests that were not medically necessary or not provided, and then billed Red Oak Hospital at a higher reimbursement rate. Each faces up to 10 years in federal prison for each count of healthcare fraud and up to 20 years for money laundering.

Narang and co-conspirators also falsified home health patient assessment form documents to make patients seem sicker than they were to receive higher payments from Blue Cross Blue Shield, Aetna and Cigna, according to the DOJ. Healthcare benefit programs paid the hospital roughly $3.2 million, and Moparty paid Narang about $3 million. Another co-conspirator has already pleaded guilty and is awaiting sentencing.

Mississippi woman pleads guilty for role in $200M pharmacy scheme

Hope E. Thomley, of Hattiesburg, Mississippi, pleaded guilty for her role in a $200 million healthcare scheme that defrauded benefit programs including TRICARE, which covers U.S. military service members and their families.

Specifically, she pleaded guilty to one count of conspiracy to commit healthcare fraud and once count of conspiracy to commit money laundering and tax evasion. The scheme defrauded healthcare benefit programs by marketing compounded medications, which are typically combined or formulated to meet the individual needs of patients. Thomley owned the marketing agency for a pharmacy where her agency retained nearly half of the reimbursements from compounded medications.

The compounded medications were formulated without regard to patient needs, according to the DOJ. Thomley also admitted to obtaining signatures on blank prescription forms and filling them out with names of her children and TRICARE beneficiaries recruited to receive the medications. Through the scheme, she evaded paying roughly $6.6 million in income taxes. From April 2012 through January 2016, TRICARE and other healthcare benefit programs reimbursed the pharmacy and others involved at least $200 million.

Lawmakers look for solution in measles outbreak

A measles outbreak in the U.S. is leaving lawmakers scrambling about the potential ethics of vaccines. The public health debate over vaccines is riddled with several challenges, including conspiracy theories about the dangers of vaccines and misinformation. These issues came to a head during a hearing held by the House Committee on Energy and Commerce, NBC reported.

Measles was declared eradicated in the U.S. in 2000, but a recent outbreak in Washington has been a result of lower vaccination rates. In the state, which has 65 cases of the measles, about 76 percent of kindergartners are unvaccinated, compared to a vaccination rate of 91 percent of children younger than 3 nationally.