Midwest Edition
Calendar
October 3-5
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November 15-16
December 4-5
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NEWS
Fraud (Continued from Page One)
charged more than 1,330 defendants who have been accused of falsely billing Medicare of more than $4 billion. Money cannot be permitted to be the basis of a medical referral over medical necessity or quality of service, said Lamont Pugh, a HHS special agent who is in charge of the Chicago region for the agency. The strike force is located in nine cities and expanded to Chicago in February 2011 part of a crackdown on healthcare fraud that has been pursued by the Obama Administration since early 2010. In the Midwest in the past year, 60 defendants have been charged with Medicare fraud. The strike force has not only ratcheted up prosecutions, but has courted the media, conducting fraud summits in Medicare fraud hotspots such as Miami and Los Angeles. Felicia Manno Alesia, an Assistant U.S. Attorney based in Chicago, said her ofce is still prosecuting the same kind of cases as before the task forces creation but its support has made its efforts more robust and focused. The task force provides both money and resources for the organization. Manno Alesia said the additional funds help pay for prosecutors and investigators. We are constantly in need of more agents and we have to wait to get to cases because we just dont have prosecuting attorneys (available), she said. Her ofce is also able to use national resources such as data analytics, which is a major driver of investigations. Justice Department analysts are able to compile data to see which claimants are billing highest in proportion to others, who has the highest number of Medicare patient enrollees; how many patients are being treated by the same doctor, and many other variables that can catch the eye of law enforcement.
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In Brief
Minnesota Receives $42.5 Million Grant For Health Insurance Exchange
The state of Minnesota has received a third grant from the federal government toward the construction and launch of its health insurance exchange. The $42.5 million grant is the largest received by the state to date for exchange construction and operation. Minnesota has received a total of $70.3 million. Open enrollment for exchanges in most states will begin in less than a year, with coverage going into effect on Jan. 1, 2014. This grant is urgently needed to perform the critical development work to keep the project on track, said exchange director April Todd-Malmlov in a statement. In addition to Minnesota, exchange grants were also announced last week that were awarded to Arkansas, Kentucky, Colorado, Massachusetts and the District of Columbia. Several states, including Texas, Florida and South Dakota, had said they would not participate in building their own exchanges. The federal government will construct and operate exchanges when state governments opt out.
Manno Alesia said the feds have always prosecuted more traditional fraud cases involving durable medical equipment, and physicians who are billing and diagnosing inappropriately. But one of the newer areas that has become especially problematic in the Midwest is home healthcare. The state of Illinois, and Cook County in particular, has an inordinate amount of home health providers in relation to its population, ofcials said. Cook County also has a very high rate of billing for this kind of service. Since June, federal prosecutors in Chicago have had three cases in a row that focused on home health providers with doctors referring patients or kickback allegations. Home health is meant for patients who have been in the hospital and need services after their treatment. But recruiters for crooked providers are using people who go door-to-door to bring patients into home health programs. You shouldnt be receiving home health services because someone knocks on your door and asks you if you need it, Manno Alesia said. It should be something a doctor should refer you to. Psychiatric services are another area with problems particularly providers billing for services that arent provided or when an unlicensed professional bills for treatment. Medicare is an attractive target for fraud because it has huge enrollee numbers and pays relatively well. The program also has traditionally engaged in perspective auditing asking questions after payment has been made. That has changed with the creation of the task force, meaning claims are scrutinized as they are submitted, Manno Alesia said. The program has been successful enough that the special task force in Chicago recently received funding for two more years, according to Manno Alesia. _TAMMY WORTH
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NEWS
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In Brief
20 elementary schools across the Wolverine State in order to combat childhood obesity. About 10,000 students in the schools will receive equipment, professional training and materials to better educate children about the perils of obesity. The programs at the schools will be implemented by the Wayne State University Center for School Health and the Michigan Fitness Foundation. We are very excited to join this partnership and the take the lead in promoting the health and well-being of so many of our children, many of whom reside in Michigan's most underserved communities," said WSU Center for School Health Director Nate McCaughtry, M.D. A new report by the Trust for Americas Health estimated that nearly six in 10 Michiganders could be obese by 2030, driving up the rate of chronic conditions such as diabetes and heart disease, and causing healthcare costs to soar.
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OPINION
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MARKETPLACE/EMPLOYMENT
Page 5
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