PHARMACY SETTLES ALLEGATIONS IT USED GIFT CARDS AS INDUCEMENTS FOR MEDICARE, MEDICAID PATIENTS

FROM:  U.S. JUSTICE DEPARTMENT
Wednesday, December 3, 2014
Rite Aid Corporation Pays $2.99 Million for Alleged Use of Gift Cards to Induce Medicare and Medicaid Business

Rite Aid Corporation, a Delaware corporation and national retail drugstore chain with its principal place of business in Camp Hill, Pennsylvania, has paid the United States $2.99 million to resolve allegations that it violated the False Claims Act by inappropriately using gift cards as inducements, the Department of Justice announced today.

The settlement resolves allegations that Rite Aid offered illegal inducements to Medicare and Medicaid beneficiaries to transfer their prescriptions to Rite Aid pharmacies.  The government alleged that from 2008 to 2010, Rite Aid had knowingly and improperly influenced the decisions of Medicare and Medicaid beneficiaries to transfer their prescriptions to Rite Aid pharmacies by offering them gift cards in exchange for their business.

“This case demonstrates the government's ongoing commitment to enforcing accountability, transparency and fairness in the retail pharmacy industry,” said Acting Assistant Attorney General Joyce R. Branda for the Civil Division.  “The government will continue to advocate for the best interests of Medicare and Medicaid patients, and prevent pharmacies from improperly manipulating their healthcare choices.”

“This settlement holds Rite Aid accountable for exerting undue influence on individuals when they make important healthcare decisions about where and when to fill prescriptions,” said Acting U.S. Attorney Stephanie Yonekura for the Central District of California.  “Corporate profit should never steer an individual away from making the right healthcare decision.”

“Pharmacies are not allowed to improperly influence the decision-making of Medicare and Medicaid patients about where to fill prescriptions,” said Special Agent in Charge Glenn R. Ferry for the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).  “Pharmacy chains that manipulate patient choices in this way will be held accountable.”

The settlement resolves allegations filed by Jack Chin under the qui tam, or whistleblower provisions of the False Claims Act, which authorizes private parties to sue for fraud on behalf of the United States and share in the recovery.  Chin will receive approximately $508,300 of the settlement.      

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $23.2 billion through False Claims Act cases, with more than $14.9 billion of that amount recovered in cases involving fraud against federal health care programs.

This case was investigated jointly by the Commercial Litigation Branch of the Civil Division, the U.S. Attorney’s Office for the Central District of California, the National Association of Medicaid Fraud Control Units and HHS-OIG.

The claims settled by today’s agreement are allegations only and there has been no determination of liability.

HHS SAYS MORE PHYSICIANS, HOSPITALS USING ELECTRONIC HEALTH RECORDS (EHRs)

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

More physicians and hospitals are using EHRs than before

CDC data provides baseline for EHR adoption among health care providers

Significant increases in the use of electronic health records (EHRs) among the nation’s physicians and hospitals are detailed in two new studies published today by the HHS Office of the National Coordinator for Health Information Technology (ONC).

The studies, published in the journal Health Affairs, found that in 2013, almost eight in ten (78 percent) office-based physicians reported they adopted some type of EHR system. About half of all physicians (48 percent) had an EHR system with advanced functionalities in 2013, a doubling of the adoption rate in 2009.

About 6 in 10 (59 percent) hospitals had adopted an EHR system with certain advanced functionalities in 2013, quadruple the percentage for 2010. Unlike the physician study, the hospital study does not have an equivalent, established measure of adoption of some type of EHR system; it only reports on adoption of EHRs with advanced functionalities.

“Patients are seeing the benefits of health IT as a result of the significant strides that have been made in the adoption and meaningful use of electronic health records,” said Karen DeSalvo, M.D., M.P.H., national coordinator for health information technology. “We look forward to working with our partners to ensure that people’s digital health information follows them across the care continuum so it will be there when it matters most.”

The information in the studies was collected by the Centers for Disease Control and Prevention’s National Center for Health Statistics and the American Hospital Association in 2013.

These data provide an early baseline understanding of provider readiness to achieve Stage 2 Meaningful Use of the Medicare and Medicaid EHR Incentive programs.  Stage 2 will begin later this year for providers who first attested to Stage 1 Meaningful Use in 2011 or 2012. About 75 percent of eligible professionals and more than 91 percent of hospitals have adopted or demonstrated Stage 1 Meaningful Use of certified EHRs.

The studies also show that more work is needed to support widespread health information exchange and providers’ ability to achieve Stage 2 Meaningful Use requirements under the Medicare and Medicaid EHR Incentive Programs. Among the details include the following:

In 2013, health information exchange among physicians was relatively low: 4 in 10 (39 percent) reported they electronically share data with other providers, but only 14 percent electronically share data with ambulatory care providers or hospitals outside their organization.
In 2013, the vast majority of hospitals had capabilities that could be used to support many Meaningful Use Stage 2 objectives but were not being used. However, 10 percent of hospitals were providing patients with online access to view, download, and transmit information about their hospital admission.
Throughout 2014, HHS has prioritized its efforts to support providers in achieving Meaningful Use Stage 2 and work toward an interoperable health system that enables nationwide health information exchange. These include:

On-the-ground support from many of the 62 ONC-funded regional extension centers to more than 150,000 providers that serve all types of patients, including Medicare, Medicaid, private pay, and uninsured, helping them use their EHRs to meet the Stage 2 measures such as those for clinical quality improvement, transitions of care, care coordination, and the privacy and security requirements;
Sharing tools and resources to support providers in engaging their patients in their health and health care using health IT tools, and to help meet the “view, download, and transmit measure” needed to achieve Meaningful Use Stage 2; and
Webinars, user guides, tip sheets, listserv subscriptions and other educational resources provided by the CMS eHealth University and available on the CMS website.

SUPERVISOR SENTNECED IN $63 MILLION HEALTH CARE FRAUD SCHEME

FROM: U.S. DEPARTMENT OF JUSTICE

Monday, July 8, 2013

Supervisor of $63 Million Health Care Fraud Scheme Sentenced in Florida to 10 Years in Prison

A former supervisor at defunct health provider Health Care Solutions Network Inc. (HCSN) was sentenced today in Miami to serve 10 years in prison for her central role in a fraud scheme that resulted in more than $63 million in fraudulent claims to Medicare and Florida Medicaid.


The sentence was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department's Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

Wondera Eason, 51, of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to her prison term, Eason was sentenced to serve three years of supervised release and ordered to pay $14,985,876 in restitution.

On April 25, 2013, a federal jury found Eason guilty of conspiracy to commit health care fraud.

Eason was employed as the director of medical records at HCSN’s partial hospitalization program (PHP). A PHP is a form of intensive treatment for severe mental illness. In Florida, HCSN operated community mental health centers at two locations. After stealing millions from Medicare and Medicaid in Florida, HCSN’s owner, Armando Gonzalez, expanded the scheme to North Carolina, opening a third HCSN location in Hendersonville, N.C.

Evidence at trial showed that at all three locations, Eason, a certified medical records technician, oversaw the alteration, fabrication and forgery of thousands of documents that purported to support the fraudulent claims HCSN submitted to Medicare and Medicaid. Many of these medical records were created weeks or months after the patients were admitted to HCSN facilities in Florida for purported PHP treatment and were utilized to support false and fraudulent billing to government-sponsored health care benefit programs, including Medicare and Medicaid. Eason directed therapists to fabricate documents, and she also forged the signatures of therapists and others on documents that she was in charge of maintaining. Eason interacted with Medicare and Medicaid auditors, providing them with false and fraudulent documents, while certifying the documents were accurate.

The "therapy" at HCSN oftentimes consisted of nothing more than patients watching Disney movies, playing bingo and having barbeques. Eason directed therapists to remove any references to these recreational activities in the medical records.

According to evidence at trial, Eason was aware that HCSN in Florida paid illegal kickbacks to owners and operators of Miami-Dade County assisted living facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid. Eason also knew that many of the ALF referral patients were ineligible for PHP services because many patients suffered from mental retardation, dementia and Alzheimer's disease.

From 2004 through 2011, HCSN billed Medicare and the Medicaid program more than $63 million for purported mental health services.

Fifteen defendants have been charged and have pleaded guilty or been convicted by a jury for their roles in the HCSN health care fraud scheme.

This case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case was prosecuted by Trial Attorney Allan J. Medina, former Special Trial Attorney William Parente and Deputy Chief Benjamin D. Singer of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.