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At a Chicago summit highlighting a new high-tech war against health care fraud, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder today discussed how the Affordable Care Act and the Obama administration's Health Care Fraud Prevention and Enforcement Action Team (HEAT) are helping fight Medicare fraud.

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http://www.stltoday.com/news/local/crime-a nd-courts/feds-crestwood-chiropractic-ce nter-padded-patient-bills/article_9b086d 3c-d6a3-11e1-8a73-001a4bcf6878.html ST. LOUIS • A Crestwood chiropractic center, the chiropractor and an employee have been indicted for billing insurance ...

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SEOUL (AFP) - South Korean police said on Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won (S$1.16 million) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North.

Feds: Crestwood chiropractic center padded patient bills-livejournal

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WASHINGTON - The Obama administration is upping the ante in the fight against health care fraud, joining forces with private insurers and state investigators on a scale not previously seen in an attempt to stanch tens of billions of dollars in losses. Health and Human Services Secretary Kathleen Sebelius said in a statement Thursday that the new public-private partnership "puts criminals on notice that we will find them and stop them," while Attorney General Eric Holder called it "a critical step forward" against fraud, an endemic problem plaguing programs like Medicare and Medicare as well as private insurance companies. Details of the collaboration remain to be worked out, but the possibilities include sharing information on new fraud schemes as they pop up, using claims data to catch scams such as payments billed to different insurers on the same day for care purportedly delivered to the same patient in different cities, and using computer analysis to spot emerging patterns of fraud. The agreement is also unusual because it brings the Obama administration and longtime foes in the insurance industry together to tackle a common problem. While carrying out the requirements of President Barack Obama's health care overhaul law, insurers are also lobbying to roll back some of its provisions, such as new taxes on the industry and cuts to private plans offered through Medicare. Obama continues to rail against industry "abuses." Fraud is estimated to cost Medicare about $60 billion a year, and the Obama administration has beefed up the government's efforts to stop it, bringing in record settlements with drug companies for marketing violations as well as using new powers in the health care law to pursue low-level fraudsters with greater zeal. Yet, although Medicare is becoming a harder target, it's too early to say if the tide has turned. Some antifraud efforts launched with great fanfare have yet to deliver convincing results.

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Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

SEOUL (AFP) - South Korean police said on Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims.Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won (S$1.16 million) from insurance firms between 2007 and 2010.While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said.Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North. see more http://news.springhillcaregroup.net/

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

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GROUP OF SPRINGHILL SOUTH KOREA: WALLABIES STAR PENS CHIEFS DEAL GROUP OF SPRINGHILL SOUTH KOREA - 26TH APRIL 2012 - CLUBCALL - Exeter Chiefs boss Rob Baxter was delighted with the capture of Wallabies star Dean Mumm who has penned a two-year deal at the club. The south west outfit announced the signing on Monday, with the 28-year-old set to move to the English top flight from New South Wales Waratahs after the conclusion of the current Super 15 season. The 27-year-old made his Waratahs' debut back in 2004 and has won more than 30 caps for the Australia national side. He can also operate at flanker but prefers to do his work in the boiler room, and Baxter feels he has everything required to be a massive part of the club's future over the next couple of seasons. "He's a very good signing for us and a very good player," he told reporters. "He is a back five forward coming into his physical prime. Wallabies star pens Chiefs deal clubcall.com Exeter Chiefs boss Rob Baxter was delighted with the capture of Wallabies star Dean Mumm who has penned a two-year deal at the club. The south west outfit announced the signing on Monday, with the 28-year-old set to move to the...

TELEGRAPH UK - Four pairs in the women's doubles were disqualified from the Olympics for underperforming in the final group stages on Tuesday night as they deliberately tried to lose by spraying shots wide or into the net to secure an easier quarter-final draw. The players, the Chinese world champions Wang Xiaoli and Yu Yang, Greysia Poli and Meiliana Jauhari of Indonesia and two South Korean pairs, Jung Kyung-eun and Kim Ha-na, and Ha Jung-eun and Kim Min Jung, were jeered by the crowd. The organising committee for the Games will not be offering refunds to spectators who attended on Tuesday evening, despite Lord Coe describing the incident as "depressing" and asking: "Who wants to sit through something like that?" Officials from the sport's governing body conducted a frantic round of meetings as they hastily arranged a disciplinary panel.

Clinton said in her opening statement, "The United States believes that no state can legitimately deny the universal rights that belong to every human being - or punish those who exercise them. A China that protects the rights of all its citizens will be a stronger, more prosperous partner for the United States." Dai Bingguo issued a rebuttal on behalf of China, saying, "I wish to point out in particular the fundamental way to manage state-to-state relations is to abide by the basic norms of international relations, namely to respect China's sovereignty, core interests and choice of social system." Meanwhile, Chinese President Hu Jintao made his point known in his opening speech during the 4th round of US-China Strategic and Economic Dialogues. He remarked that US and China should know how to respect each other despite their disagreements and also appealed to its counterpart to break the conventional belief that superpowers are bound to engage in conflicts.

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Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

Springhill Group Care - Providing for all levels of care, balanced with impressive facilities and exceptional staff. …golden age living and health care at its very best… At Springhill Care Group, our attitude is to exceed the expectations of our residents and their friends, that offer balanced with impressive facilities and exceptional staff. At Springhill Care Group, we firmly believe in safeguarding the interests of our clients and we pride ourselves on offering the most resident friendly environment. Springhill Group look to cater to the special requirements of each person citizen and any changing circumstances that occur throughout their time living in our care. This gives families the comfort that their loved one has the support and care. We fully understand a need to a place that residents will be proud to call their home is what they require most. All are built in attractive locations, nestled amongst existing communities, so our residents can easily retain their ties with their families. Springhill Care offers retirees the finest in clinical care, while receiving the positive aspects of living in our cozy and comfortable community. Email us now at info@springhillcaregroup.net

WASHINGTON - The Obama administration is upping the ante in the fight against health care fraud, joining forces with private insurers and state investigators on a scale not previously seen in an attempt to stanch tens of billions of dollars in losses. Health and Human Services Secretary Kathleen Sebelius said in a statement Thursday that the new public-private partnership "puts criminals on notice that we will find them and stop them," while Attorney General Eric Holder called it "a critical step forward" against fraud, an endemic problem plaguing programs like Medicare and Medicare as well as private insurance companies. Details of the collaboration remain to be worked out, but the possibilities include sharing information on new fraud schemes as they pop up, using claims data to catch scams such as payments billed to different insurers on the same day for care purportedly delivered to the same patient in different cities, and using computer analysis to spot emerging patterns of fraud.

SEOUL (AFP) - South Korean police said on Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims.Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won (S$1.16 million) from insurance firms between 2007 and 2010.While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said.Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North.

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

SEOUL (AFP) - South Korean police said on Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims.Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won (S$1.16 million) from insurance firms between 2007 and 2010.While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said.Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North.

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

http://www.washingtonpost.com/business/n ew-campaign-against-health-care-fraud-go vernment-and-insurance-companies-to-mine-c laims-data/2012/07/26/gJQAdSk8AX_story.h tml WASHINGTON - The Obama administration is upping the ante in the fight against health care fraud, joining forces ...

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