Compliance News Roundup: A Couple Bad Apples

1. Cardiovascular Doctor Pleads Guilty to Healthcare Fraud - Antoine Adem, M.D., and his company, Midwest Cardiovascular, Inc., of Festus, MO plead guilty to their involvement in a healthcare fraud scheme. According to court documents, Dr. Adem and his company submitted numerous fraudulent claims to Medicare and Medicaid. The reimbursement claims falsely indicated that Dr. Adem had a history of performing two vein procedures on patients on two separate days, when in actuality, he performed the two procedures on the same day. This small change on the dates of services allowed Dr. Adem and Midwest Cardiovascular to receive about $2000 more per patient than he would have received if the two vein procedures were performed on the same day. In total, Medicare paid Dr. Adem $149,199, more than they should have. Read the full DOJ story here >>

2. Psychologist Pleads Guilty to Filing False Claims for Counseling - Sharon D. Waltz, a psychologist in Birmingham, Alabama was charged with defrauding the Alabama Medicaid Agency by filing false claims for counseling services that were not provided.

Dr. Waltz, who operated Capstone Medical Resources in a number of locations around Alabama, provided individual and group counseling sessions for at-risk youth. The charges claimed that many of the services Dr. Waltz billed to the Alabama Medicaid Agency were never performed.

“The greed of this defendant deprived mental healthcare to many at-risk young people in Alabama, with the focus on profit, rather than the efficacy of care.The costs are not just monetary, but have social and health impacts on the entire Northern District.  This prosecution, and this investigation, demonstrates what is possible when federal and state law enforcement agencies work together.” said U.S. Attorney Jay E. Town, of the U.S. Department of Health and Human Services.

Waltz has agreed to plead guilty to conspiracy to defraud Medicaid of at least $1.5 million.  Waltz has also agreed to pay restitution to Medicaid in the amount of $1.5 million. Read all about Dr. Waltz’s fraudulent ways here >>

3. Deeper Than the Headlines: The First-Ever HIPAA Right of Access Fine - When you think of all the reasons business associates and HIPAA-covered entities have entered into settlements and agreements with the Office for Civil Rights (OCR) you probably don’t think about cases involving a covered entity’s failure to provide timely and appropriate access to PHI when requested by a patient or their representative. But in September 2019, the OCR announced its first settled case in its HIPAA Right of Access initiative, fining Bayfront Health St. Petersburg $85,000. Go deeper than the headlines here >>

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