National Poll: Zip Code Matters in Overall Health

   (BUSINESS WIRE) – April 4, 2019 – Nearly 90 percent of Americans believe that diet and exercise play the greatest role in influencing their health, and only 44 percent say that where one lives is an important factor, according to a national survey released today by the de Beaumont Foundation. Data from the National Academy of Medicine and other sources indicate that at least 80 percent of a person’s overall health is shaped by social and environmental factors like housing stability and quality, food, and access to parks and public transportation.
   The survey reveals that awareness of health departments is low, and people believe that doctors, schools, police, and firefighters have a greater impact on their communities’ health.
   “The health of our communities largely determines the health of our citizens,” said Brian Castrucci, president and CEO of the de Beaumont Foundation. “Because of that, public health departments are vital to community health and individual health. To improve their visibility and impact, health departments will need adequate funding, partnerships with other sectors, and the ability to demonstrate and communicate their value.”

•    Also uncovered through the national survey of voters: Americans believe the factors that most influence health are personal choices like diet and exercise (87 percent), the environment (79 percent), and access to healthcare (78 percent). Only 44 percent said that where a person lives plays a major role.
• Americans believe hospitals, schools, fire departments, and police departments play a more important role in making their community healthier than public health departments. 56 percent said their local public health department plays an important role, compared with 79 percent for hospitals, 75 percent for schools, 72 percent for fire departments, and 68 percent for police departments.
• Among national voters, 66 percent of women said public health departments are important to community health (scoring them 8-10 on a 10-point scale), compared with only 46 percent of men.
• In both rural areas and nationally, Democrats were much more likely than Republicans to value the role of public health departments. Among Democrats, 71 percent said public health departments play an important role, compared with 54 percent of Independents and 42 percent of Republicans. Only 17 percent of Republicans gave public health departments a score of 10 (“very important”), compared with 36 percent of Democrats.The perceptions of these organizations were similar among national voters and rural voters, each of whom rated public health departments above parks, libraries, and businesses in their impact on the community’s health.

   The poll findings suggest another reason why people may undervalue the work of local health departments: They’re not familiar with them. Nationally, only 15 percent said they are “very familiar” with their local health department and 34 percent are “somewhat familiar.” More than half, 51 percent, said they are “not too familiar” or “not at all familiar” with the department.
   Public Opinion Strategies conducted a national telephone survey among 1,000 registered voters from Aug. 31 to Sept. 8, 2018 (55 percent landline and 45 percent cell). The margin of error for a 1,000-person sample size is +3.1 percent.

Medicare fraud action involves 412 defendants

FLORIDA -- July 13, 2017 -- What is being called the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, was announced on July 13 for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings.

In the Southern District of Florida a total of 77 defendants were charged with offenses relating to their participation in various fraud schemes involving over $141 million in false billings for services including home health care, mental health services and pharmacy fraud.

“Health care fraud schemes have real, long-term consequences for our South Florida community. Patients are being denied the quality of care that they deserve, doctors are turning a blind eye to their oaths, and taxpayer money is being diverted into the pockets of the greedy. Today’s announcement highlights South Florida’s united and ongoing law enforcement effort, culminating in charges against more than twenty percent of the national defendants, to thwart evolving schemes and combat the unlawful distribution of opioids and prescriptions drugs,” Acting U.S. Attorney Benjamin G. Greenberg said

The following are some of the cases included in the take down:

Sober Homes Fraud

1. United States v. Eric Snyder and Christopher Fuller, Case No 17-MJ-8268-Brannon

Eric Snyder, 30, of Delray Beach, Florida, an owner of sober homes and addiction treatment facilities, and patient broker Christopher Fuller, 32, of West Palm Beach, Florida, are charged in a criminal complaint with conspiracy to commit health care fraud for their involvement in a scheme to illegally recruit patients, pay kickbacks and defraud health care benefit programs.

According to the criminal complaint, Snyder established a sober home, Halfway There Florida, LLC (HWT), also known as A Safe Place LLC, in Palm Beach County, Florida, which was purportedly in the business of providing a safe and drug-free residence for individuals suffering from drug and alcohol addiction. The defendants referred the sober home’s residents to a treatment center, Real Life Recovery Delray, LLC, (RLR), which was also owned by Eric Snyder. This treatment center purportedly offered clinical treatment services for persons suffering from alcohol and drug addiction.

According to the criminal complaint, to obtain patients for the sober home and treatment center (collectively “HWT/RLR”), Synder and other members of the conspiracy provided kickbacks and bribes, in the form of free or reduced rent, airline tickets, and other benefits, to individuals who agreed to reside at the sober homes, attend drug treatment therapy sessions, and submit to regular drug testing that members of the conspiracy could bill to the residents’ insurance plans. These patient brokers, including Fuller, were also paid kickbacks themselves by Snyder and others for referring patients to HWT/RLR for purported treatment.

According to the criminal complaint, fraudulent billings were submitted by HWT/RLR for services that were not medically necessary and/or were never provided. Licensed health professionals who used to work at HWT/RLR describe treatment conducted by unqualified and non-licensed employees, and billings for treatment that never occurred. The licensed professionals were asked to sign for and/or backdate this treatment as though they had conducted it. In addition, licensed professionals at HWT/RLR were asked to complete intake forms and other documents for patients that they had not seen. In some instances, services were billed for residents who left the sober homes and were no longer receiving treatment at the treatment centers. In other instances, patients were billed for therapy sessions they never attended, and therapy sign-in sheets and other documents fraudulently reflected that these patients attended these sessions, when they did not. The defendants provided services meant solely to maximize insurance reimbursements, such as expensive urine drug screens. HWT/RLR fraudulently used urine drug screens as a profit-machine, including splitting samples to send them to different laboratories, improper duplicate testing, and fraudulently double billing for tests for the same patients at both HWT and RLR. In addition, samples were fraudulently comingled prior to testing to prevent identical test results from exposing the scheme. After a search warrant was executed at a different treatment facility in Palm Beach County, in September 2014, Snyder and others attempted to stop or modify these illegal practices, and evidence of this wrongful conduct was removed and destroyed.

Drug and Pharmacy Fraud Schemes – Medicare Part D

2. United States v. Orlando Bustabad, et al., Case No. 17-20441-CR-Moore

Orlando Bustabad, 61, Orlando Olver Bustabad, 31, Idilsis Manresa, 30, Sara Fernandez Escobar, 61, Mirtha Carrion Jimenez, 58, Alejandro Mena, 21, and Alejandro Sierra, 47, all of Miami, Florida, are charged by indictment with conspiracy to commit health care fraud and health care fraud. Orlando Bustabad and Orlando Olver Bustabad are also charged with aggravated identity theft.

According to the indictment, Orlando Bustabad and his son Orlando Olver Bustabad were the true owners of eight pharmacies located in Miami Dade County, namely, Med Solution Pharmacy, 17th Street Pharmacy, Rapid Pharmacy, Euro Pharmacy, A&B Pharmacy, Maxi Pharmacy, Mariposa Pharmacy, and 49th Street Pharmacy. Orlando Bustabad and Orlando Olver Bustabad operated these pharmacies under their own names or enlisted co-conspirators Manresa, Escobar, Jimenez, Mena, and Sierra to appear as owners. These pharmacies purportedly provided prescription drugs to Medicare beneficiaries. From February 2013 until June 2017, the defendants submitted and caused the submission of approximately $10,183,031 in claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by the pharmacies. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to the corporate bank accounts of the eight pharmacies in the approximate amount of $4,649,743.

3.United States v. Victor Rocha, Case No. 17-20409-CR-Altonaga

Victor Rocha, 49, of Miami Lakes, Florida, was charged by indictment with six counts of health care fraud. The indictment charges Rocha with falsely and fraudulently submitting medical claims for prescription medications for reimbursement to Medicare Part D from September 2012 through May 2013, through his pharmacy, Med Express Pharmacy Discount, Inc. The Indictment charges that the claims were for prescription medications that were not provided and/or not medically necessary.

4. United States v. Alejandro Hernandez Rios, Case No. 17-20442-CR-Ungaro

Alejandro Hernandez Rios, 35, of Miami, Florida, was charged by indictment with five counts of health care fraud. The indictment charges Rios with falsely and fraudulently submitting medical claims for prescription medications for reimbursement to Medicare Part D from June through September 2014, through his pharmacy Independence Pharmacy and Discount, Inc. The indictment charges that the claims were for various prescription medications that were not provided and/or not medically necessary.

5.United States v. Pedro Mangano, Case No. 17-20408-CR-Martinez

Pedro Mangano, 52, of Miami, Florida, was charged by indictment with ten counts of Medicare fraud. The indictment alleges Mangano was the owner and operator of PVRX Pharmacy, located in Miami, Florida. Between March 2014 and June 2017, Mangano’s pharmacy submitted fraudulent claims for allegedly dispensing drugs to Medicare beneficiaries that the pharmacy never had in inventory to begin with. As part of the scheme, Mangano paid patient recruiters for fraudulent scripts used to defraud the Medicare Part D program. The fraudulent claims resulted in overpayments exceeding $1.1 million.

6.United States v. William Salazar Ortega, et al., Case No. 17-20454-CR-Gayles

On June 28, 2017, William Salazar Ortega and Oscar Alonso Gonzalez were indicted in connection with their roles at Latin Pharmacy, a pharmacy that defrauded Part D of the Medicare program of $2.38 million by billing for expensive prescription medications that were not prescribed to patients; were not necessary; and were not purchased. Salazar was the nominee owner of the pharmacy, and Gonzalez was its true owner. Each defendant was charged with one count of conspiracy to commit health care fraud and wire fraud and four counts of health care fraud. Gonzalez is also charged with one count of money laundering.

7.United States v. Yara Suarez, et al., Case No. 17-20453-CR-Moreno

On June 29, 2017,Yara Suarez, Jesus Sanchez, Anthony Moya and Yoel Concepcion were indicted in connection with their roles at Albe Pharmacy, a pharmacy that defrauded Part D of the Medicare program of $3.4 million by billing for expensive prescription medications that were not prescribed to patients; were not necessary; and were not purchased. Sanchez and Suarez were the owners of the pharmacy, and are each charged with one count of conspiracy to commit health care fraud and wire fraud, three counts of health care fraud and one count of conspiracy to commit money laundering. Moya and Concepcion owned and controlled shell corporations through which over $380,000 of the fraud proceeds were laundered. Moya and Concepcion are each charged with one count of conspiracy to commit money laundering and three counts of substantive money laundering.

8. United States v. Lisbet Cordova, Case No. 17-20450-CR-Cooke

On June 29, 2017, Lisbet Cordova, the owner of Jalvarez Pharmacy, Inc. (“Jalvarez”) was indicted on four counts of health care fraud. Through Jalvarez, Cordova billed Medicare, pursuant to Part D of the Medicare program, for prescriptions that were not medically necessary, prescribed or dispensed to Medicare beneficiaries. As part of the scheme, Jalvarez submitted approximately $730,000 in fraudulent claims to Medicare.

Prescription Drug Diversion

9. United States v. Jose De Jesus Rodriguez, Case No. 17-20486-CR-Scola

Jose De Jesus Rodriguez, 47, of Miami, Florida, was charged by indictment with one count of conspiracy to unlawfully distribute prescription drugs and three substantive counts of improperly distributing prescription drugs, also referred to as prescription drug diversion. The indictment charges Rodriguez with illegally distributing millions of dollars’ worth of prescription medications from August 2011 through March 2015.

10. United States v. Reynaldo Ocana, Case No. 17-MJ-02939-Otazo-Reyes

Reynaldo Ocana, 46, of Miami, Florida, was charged by criminal complaint with improperly distributing prescription drugs, also referred to as prescription drug diversion. The criminal complaint charges Ocana with illegally diverting prescription drugs in August 2016.

Home Health Care Fraud – Medicare Part A

11. United States v. Hector Fajardo Ramirez, Case No. 17-20301-CR-Moreno

Hector Fajardo Ramirez, 48, of Miami, Florida, was charged by indictment with six counts of health care fraud. The indictment charges that Ramirez falsely and fraudulently submitted medical claims for home health therapy for reimbursement to Medicare from February through July 2015, through his clinic Longevity Home Health Services, Inc. The indictment charges Ramirez with submitting claims for home health services that were not medically necessary and not provided.

12. United States v. Duniesky Cruz and Carlos Gomez Bravo, Case No. 17-20401-CR-Scola

Duniesky Cruz, 50, of Miami, Florida, the owner of home health agency Life & Hope Healthcare, Inc., and an employee Carlos Gomez Bravo, 33, of Miami, Florida, were charged by indictment with conspiracy to defraud the United States and pay health care kickbacks and payment of kickbacks in connection with a federal health care program. The charges stem from their involvement in a home health fraud scheme involving kickback payments to patient recruiters, patients, and clinic owners in exchange for patient referrals and prescriptions.

13. United States v. Vilma Alonso, Case No. 17-20468-CR-Ungaro

Vilma Alonso, 57, of Hialeah, Florida, an employee of South Florida Physician Care Network was charged by indictment with participating in a conspiracy to defraud the United States. Alonso was charged with conspiring with others to unlawfully enrich themselves by, among other things, submitting and causing the submission of false and fraudulent claims to Medicare and concealing the submission of false and fraudulent claims to Medicare. Alonso allegedly did this by causing the issuance of home health prescriptions that were not medical necessary and by paying recruiters for the referral of Medicare beneficiaries for home health services.

14. United States v. Maria Blanco, Case No. 17-20474-CR-Williams

Maria Blanco, 50 of Cape Coral, Florida, was charged by information with five counts of receiving kickbacks in connection with a federal health care program. The information charges Blanco with receiving approximately $8,500 in kickbacks on at least five occasions in 2014.

15. United States v. Enrique Vilarello, et al., Case No. 17-20482-CR-Williams

On July 7, 2017, Enrique Vilarello and Alberto Ordaz were each indicted on one count of conspiracy to pay and receive illegal kickbacks. Ordaz was also indicted on two counts of receipt of kickbacks in connection with a federal health care program. The charges stem from their roles as patient recruiters, paying illegal kickbacks to obtain medical prescriptions from clinics and receiving illegal bribes for referring patients to pharmacies, and home health agencies in and around Miami, Florida. Several of these entities, such as Merfi and City Center, are now defunct as a result of their owners being charged and pleading guilty to multi-million dollar fraud schemes.

16. United States v. Juan Rodriguez, Case No. 17-20347-CR-Scola

On May 25, 2017, Juan Rodriguez, President and Director of Good Home Care, Inc., a now-defunct home health agency located in Miami, Florida, was indicted on five counts of health care fraud for his role in a $4 million scheme. Good Home allegedly billed Medicare for home health services that were never prescribed by a licensed physician or provided to Medicare beneficiaries.

17. United States v. Jesus Escobar Montero, Case No. 17-20439-CR-Williams

On June 22, 2017,Jesus Escobar Montero, President and Director of Better Care Home Health Services, Inc., a now-defunct home health agency located in Sunrise, Florida, was indicted on four counts of health care fraud for his role in a nearly $1 million scheme. The charges arise from Montero’s ownership of Better Care, which billed Medicare for home health services that were never prescribed by a licensed physician or provided to Medicare beneficiaries.

18.United States v. Carlos Barroso, et al., Case No. 17-20432-CR-Martinez

On June 22, 2017, Carlos Barroso, Andres Perez, Rolando Perez and Reiniel Garcia were indicted in connection with their roles at Sweet Home Health, Inc., a home health agency that defrauded Part A of the Medicare program of $8.4 million by billing for home health services that were not prescribed to patients; were not necessary; and were not rendered. Barroso was the owner of Sweet Home Health and was charged with seven counts of health care fraud, as well as one count of conspiracy to commit money laundering. A. Perez, R. Perez and Garcia owned and controlled shell corporations through which the fraud proceeds were laundered. They are each charged with one count of conspiracy to commit money laundering, three counts of money laundering and three counts of structuring to avoid reporting requirements.

19. United States v. Jhony A. Alfau, et al, Case No. 17-20452-CR-Ungaro

On June 29, 2017, Jhony A. Alfau, Hector J. Garcia, and Sergio E. Santana were indicted on one count of conspiracy to commit health care and wire fraud, one count of conspiracy to make false statements relating to health care matters, and one count of making false statements relating to health care matters.The charges stem from the defendants’ role in a $50 million scheme to defraud Medicare where they falsely and fraudulently certified they provided home health care physical and occupational therapy services to Medicare beneficiaries, when in fact, they had not done so.

20. United States v. Ernesto Velasquez, Case No. 17-20462-CR-Martinez

On July 5, 2017, Ernesto Velasquez, was charged by information with one count of conspiracy to commit health care fraud. The charge stems from the defendant’s role as an employee of staffing agencies that sought to defraud the United States by billing Medicare for providing licensed physical and occupational therapy to home bound patients when, in fact, they had not rendered the services. As part of the scheme, these alleged services were billed to Medicare with a loss of over $3 million.

21. United States v. Suley Cao, Case No. 17-20451-CR-Martinez

On June 29, 2017, Suley Cao, the owner and operator of Good Friends Services, Inc. (“Good Friends”), a home health agency, was indicted on five counts of health care fraud; one count of conspiracy to defraud the United States and pay Health Care Kickbacks; and two counts of payment of kickbacks in connection with a federal health care benefit program. The charges stem from Cao’s role as owner and operator of Good Friends, which fraudulently billed Medicare for approximately $3,017,276.89 for home health services that involved a scheme whereby Good Friends made kickback payments to induce the referral of Medicare beneficiaries.

22. United States v. Rafael Arias et al., Case No. 17-MJ-02962-Garber

On July 13, 2017, Rafael Arias, Aylen Gonzalez, Ana Gabriela Mursuli Caballero, and Rafael Cabrera were charged by criminal complaint with conspiracy to commit health care fraud for their roles in an approximately $6 million Medicare fraud scheme involving various home health agencies in and around Miami, Florida. Arias was alleged to be the true owner of multiple home health agencies, such as Nestor’s Health Services, Inc. Arias hid the fact of his true ownership and instead directed others, like Cabrera, to fraudulently represent themselves as owners to Medicare, which allowed them to obtain Medicare provider numbers and submit claims for services purportedly provided to Medicare beneficiaries even though many of the services were medically unnecessary or were obtained as a result of illegal bribes and kickbacks. Gonzalez and Caballero were patient recruiters who facilitated kickback schemes with Arias by referring patients to home health agencies operated by Arias in exchange for bribes and kickbacks. Gonzalez and Caballero also purchased medically unnecessary prescriptions from fraudulent medical clinics. Caballero also owned and operated City of Angels Home Health Care LLC, a home health agency that she used to bill Medicare for home health services that were medically unnecessary or were obtained as a result of illegal bribes and kickbacks.

Assisted Living Facility Fraud

23. United States v. Bertha Blanco, Case No. 17-MJ-02949-Garber

On July 11, 2017, Bertha Blanco, who was employed for approximately 30 years by the State of Florida’s Agency for Health Care Administration (AHCA), was charged by complaint with bribery of a program receiving federal funds. AHCA is responsible for administering the Medicaid program in Florida, and is tasked with regulating and licensing health care facilities in Florida, including skilled nursing facilities (SNFs) and assisted living facilities (ALFs). The charge alleges that Blanco solicited and received cash bribes from Medicare and Medicaid providers in exchange for providing them with confidential, nonpublic AHCA reports and information, including patient complaints and the unannounced inspection schedules of AHCA surveyors. This information was ultimately used by the purchasers, some of whom were owners of skilled nursing facilities (SNFs) and assisted living facilities (ALFs), to fabricate and falsify medical paperwork and to temporarily remedy deficiencies so that AHCA would not discover lapses in patient care and revoke the licenses of these facilities. The owners of these SNFs and ALFs then submitted false and fraudulent claims to Medicare and Medicaid for patients named in the complaints and inspection reports sold to them by Blanco.

Clinics, Managed Care, Medicare Advantage Fraud – Medicare Part C

24. United States v. Beatriz Carrasco, Case No. 17-20464-CR-Ungaro

On July 6, 2017, Beatriz Carrasco, 49, of Hialeah, Florida was charged by information with one count of conspiracy to commit health care fraud and wire fraud. The information charges Carrasco, a Florida licensed insurance agent, with conspiring to enroll others into Medicare Advantage plans and Florida Medicaid. These individuals resided in Nicaragua, outside of the Medicare Advantage plans coverage area. As a result of Carrasco’s and her co-conspirator’s actions, Medicare and the Florida Medicaid program paid over $1,013,244 in monthly capitation payments and premiums on behalf of individuals residing in Nicaragua, who were otherwise ineligible to receive these benefits.

25. United States v. Greesy Misuraca, Case No. 17-20461-CR-Scola

On July 5, 2017, Greesy Misuraca, a licensed therapist, was charged by information with one count of conspiracy to commit health care fraud. The charge stems from the defendant’s alleged role in billing Medicare for licensed physical and occupational therapy that was given to home bound patients when, in fact, she did not provide the therapeutic services. As part of the scheme, these alleged services were billed to Medicare with a loss of over $650,000.

Private Insurance Fraud (Non-Medicare)

26. United States v. Leopoldo Becerra, Case No. 17-20470-CR-Moreno

Leopoldo Becerra, 50, of Miami, Florida was charged by indictment one count of health care fraud. The indictment charges Becerra with using Doctor Jalal Taslimi Medical Center, Inc., to falsely and fraudulently submit medical claims for reimbursement to Blue Cross Blue Shield of Florida from November 25, 2014 through May 25, 2015. The indictment charges Becerra with submitting fraudulent claims for beneficiaries purportedly receiving various injections.

27. United States v. Jorge A. Gonzalez and Lazaro La Paz Paz,

Case No. 17-20440-CR-Martinez

Jorge A. Gonzalez, 50, of Miami, Florida and Lazaro La Paz Paz, 50, of Hialeah, Florida are charged by indictment with one count of conspiracy to commit health care fraud and wire fraud. The indictment charges Gonzalez and La Paz Paz with using two companies, Xtra Health Center, Inc & Gold Medical Center, Inc, and fraudulently representing that medical services were prescribed by doctors and provided to private insurance beneficiaries by these businesses. Gonzalez and La Paz Paz then falsely and fraudulently submitted these medical claims for reimbursement to Blue Cross Blue Shield of Florida from April 2014 through February 2015.

Tricare Fraud – Military Insurance

28. United States v. Michael Shane Matthews, Case No. 17-20463-CR-Gayles

On July 6, 2017, Michael Shane Matthews, 47, of Newberry, Florida, was charged by information with causing the misbranding of drugs while held for sale.

29. United States v. Asciano Serna, Case No. 17-20484-CR-Altonaga

On July 7, 2017, Asciano Serna, owner and operator of ASC Pharmacy, Inc., was charged by information with one count of conspiracy to commit health care fraud. The charge arises from Serna’s role in a compounding pharmacy scheme at ASC Pharmacy involving the submission of at least $3.4 million of false and fraudulent claims to private insurance companies, Medicare, TRICARE, and other federal programs.

Unlicensed Money Transmitting and Money and Laundering

30. United States v. Yisel Torres, Case No. 17-20477-CR-Moreno

Yisel Torres, 31, of Cape Coral, Florida was charged by information with one count of participating as an unlicensed money transmitter. The information charges Torres with cashing several checks totaling $135,000 from on or about May 22, 2014, through on or about March 11, 2015. The proceeds that Torres cashed were used to pay cash kickbacks to Medicare beneficiaries that were enrolled in R&N Professional Services.

31. United States v. Angel Rivero, Case No. 17-20475-CR-Cooke

Angel Rivero, 43, of Miami, Florida was charged by information with one count of participating as an unlicensed money transmitter. The information charges Rivero with cashing several checks totaling $100,000 from on or about May 22, 2014, through on or about March 11, 2015. The proceeds that Rivero cashed were used to pay cash kickbacks to Medicare beneficiaries that were enrolled in Happy Heart Home Health Care.

32. United States v. Yailyn Marimon, et al., Case No. 17-20492-CR-Martinez

On July 11, 2017, Yailyn Marimon and Yamilka Echeverria were indicted in connection with their roles laundering money four Orlando-area medical clinics stole from Part C of the Medicare program. The Clinics, which were owned by Yosbel Marimon – the defendants’ brother and ex-husband, respectively – billed Medicare for $13.8 million of expensive infusion therapy drugs and physical therapy that were not medically necessary, and were never provided. On June 26, 2017, Yosbel Marimon was sentenced to 90 months’ imprisonment for his role in the scheme. The indictment alleges that Yailyn Marimon and Yamilka Echeverria laundered over $2 million of the fraud proceeds through shell companies they owned and controlled. Each defendant was charged with one count of conspiracy to commit money laundering and one count of substantive money laundering.

If convicted of a charged offense, a defendant faces a possible maximum statutory sentence of: five years in prison for participating in a conspiracy (to defraud the United States by paying and receiving health care kickbacks or by unlawfully distributing prescription drugs), in violation of Title 18, United States Code, Section 371; 20 years in prison for mail fraud, in violation of Title 18, United States Code, Section 1341; 20 years in prison for wire fraud, in violation of Title 18, United States Code, Section 1343; ten years in prison for health care fraud, in violation of Title 18, United States Code, Section 1347; twenty years for conspiracy to commit health care fraud and wire fraud, in violation of Title 18, United States Code, Section 1349; 20 years for money laundering or conspiracy to commit money laundering, in violation of Title 18, United States Code, Section 1956; and ten years in prison for money laundering, in violation of Title 18, United States Code, Section 1957; and five years in prison for conducting an unlicensed money transmitting business, in violation of Title 18, United States Code, Section 1960(b)(2). In addition, a defendant may be subject to one year in prison for misbranding a drug held for sale, in violation of Title 21, United States Code, Sections 331(t) (prescription drug marketing violations are subject to a maximum penalty of 10 years in prison, in accordance with Title 21, United States Code, Sections 333(b)(1)(D), and 353(e)(1)(A)) and five years in prison for payment and receipt of kickbacks in connection with a federal health care program, in violation of Title 42, United States Code, Section 1320a. Furthermore, if convicted of aggravated identity theft, in violation of Title 18, United States Code, Section 1028A, a defendant faces a mandatory consecutive term of two years in prison.

A criminal complaint, information or federal indictment is a charging instrument containing allegations. All defendants are presumed innocent, unless and until proven guilty in a court of law.

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

The case was announced on July 13 by Benjamin G. Greenberg, Acting United States Attorney for the Southern District of Florida; George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health & Human Services, Miami Regional Office, Office of Inspector General (HHS-OIG); and Pam Bondi, Florida Attorney General.
Source: United States Attorney's Office, Southern District of Florida

Report: Medical Errors Injure Upwards Of 488,900

By Steve Rensberry 

srensberry@rensberrypublishing.com
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   (RPC) - 2/19/2016 - A recent report by the Heartland Health Research Institute estimates that between 281,000 and 488,900 patients in Illinois hospitals are injured each year to do preventable medical errors or events. The estimate nationally is between 6.6 million and 11.5 million patients.

Preventable injuries occurring in Illinois hospitals.

    “If the Centers for Disease Control (CDC) were to include preventable medical errors in U.S. hospitals as a category, it would be the third leading cause of death in the United States, behind heart disease and cancer,” an HHRI press release about the report states.
   Fatalities occur in Illinois hospitals due to preventable adverse events (PAE) at an estimated rate of about 1 death for every 139 hospital admissions. By comparison, 11 patients die in hospitals from such errors for every vehicle fatality, 15 patients die for every murder committed in the state, and altogether nearly 3 percent of the state's entire population is harmed each year by PAEs. The frequency and volume translates into about one fatality every 50 minutes in the state due to such errors.
   The annual cost of such errors? The HHRI report estimates that in Illinois the annual social cost of such fatalities is about $5.2 billion. Nationally the cost is estimated between $23.1 billion and $103.4 billion. The number of injured patients annually in Illinois, based on the most common types of preventable medical errors, is as follows: adverse drug events (72,600 patients); venous thromboembolisms/, VTEs – blood clots that form within a vein (48,800); decubitus ulcers, bed soars (36,400); catheter-related urinary tract infections (17,500); falls in the hospital (16,200); nosocomial pneumonia (12,600); catheter, related bloodstream infections (6,300).  
   "Preventable medical errors in our hospitals is clearly alarming, both in the number of lives affected and in cost." Heartland Health Research Institute President David Lind stated. "Is Illinois making progress on preventable medical errors? The quick answer is, we don't really know because reporting yields a healthy dose of under-counting and under-reporting of medical errors. Without having stringently-coordinated regulations and policies that effectively hold providers accountable through transparent reporting, medical errors will continue and the public will remain in the dark. The Federal Aviation Administration has such regulations - shouldn't our safety be just as important when we enter a hospital as it is when we board an airplane? The public deserves transparency and accountability on this issue."
   A study by USA Today in 2013, using data from the National Practitioner Data Bank and other sources, point to an additional worry for potential patients – unnecessary surgeries, which the article states might account for as much as 10-20 percent of all operations in some specialties. Cites are cardiac procedures such as stents, angioplasty and pacemaker implants, spinal surgeries, hysterectomies, cesarean sections, and knee replacements.
   “Tens of thousands of times each year, patients are wheeled into the nation's operating rooms for surgery that isn't necessary,” authors Peter Eisler and Barbara Hensen write.
   What makes the size of the problem difficult to calculate is that only the worse cases are likely to become public knowledge, and if a surgery by chance takes care of a problem that could have been alleviated with lesser therapy or a non-surgical procedure, little suspicion is raised because the problem is gone.
   “Hospitals around the country do not report PAEs accurately and consistently - if at all,” the HHRI report states. “National experts acknowledge that most PAEs are either under reported or unreported. The Department of Health and Human Services Office of Inspector General issued a report in 2012 stating, 'Hospital staff did not report 86 percent of [patient harm] events to incident reporting systems, partly because of staff misperceptions about what constitutes patient harm.' This behavior reflects our culture of silence.”
   An October 27, 2015 Harvard Business Review report, written by Rebecca Wentraub, Yannis K. Valtis and Peter Bonis, claims there are many as 44,000 deaths in the Unites States each year due to preventable medical errors, with a price tag of roughly $17 billion.

Undiagnosed Disease Network Portal Launched

   (NIH) - 9/20/2015 - The Undiagnosed Diseases Network (UDN), a clinical research initiative of the National Institutes of Health, has opened an online patient application portal called the UDN Gateway. Introduction of this application system sets the stage for the network to advance its core mission: to diagnose patients who suffer from conditions that even skilled physicians have been unable to diagnose despite extensive clinical investigation. These diseases are difficult for doctors to diagnose because they are rarely seen, have not previously been described or are unrecognized forms of more common diseases. 
   The new system streamlines the application process. All applications for the UDN will go through the Gateway, rather through individual clinical sites in the network. The Gateway replaces what had previously been a paper-and-mail application process for the NIH Undiagnosed Diseases Program (UDP), which is now part of the UDN.
   “Although undiagnosed conditions present an array of challenges for clinicians, once identified, they may lead to treatments for individual patients. They also may lead to new, generalizable medical insights,” said James M. Anderson, M.D., Ph.D., director of NIH’s Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI), which provides financial support and joint leadership for the network via the NIH Common Fund. “The UDN Gateway will provide patients and their families access to the nation’s leading diagnostic teams and sophisticated diagnostic tools.”
   The UDN grew out of both the success of the Undiagnosed Diseases Program at the NIH Clinical Center in Bethesda, Maryland. Since its 2008 launch, the UDP has reviewed more than 3,100 applications from patients around the world. More than 800 patients have been enrolled for a one-week evaluation. While approximately 25 percent of those have received some level of clinical, molecular or biochemical diagnosis, many patients remain undiagnosed.
   By adding six additional clinical sites to the original NIH UDP, the UDN will broaden its diagnostic expertise while expanding the opportunity for patients to participate. These additional clinical sites are:
   -- Baylor College of Medicine, Houston.
   -- Duke Medical Center, Durham, North Carolina, with Columbia University, New York City.
   -- Harvard Teaching Hospitals (Brigham and Women’s Hospital, Boston Children’s Hospital    Massachusetts General Hospital), Boston.
   -- Stanford Medical Center, Stanford, California.
   -- University of California at Los Angeles Medical Center.
   -- Vanderbilt University Medical Center, Nashville, Tennessee.    By the summer of 2017, each new clinical site will accept about 50 patients per year. The network has also brought on board two DNA sequencing facilities. One is at the Baylor College of Medicine, and the other is at the HudsonAlpha Institute for Biotechnology in Huntsville, Alabama, with Illumina in San Diego.
   The broader geographic distribution of sites in the UDN is intended to better serve patients. To support this collaboration on undiagnosed diseases, the UDN Coordinating Center at Harvard Medical School Department of Biomedical Informatics (DBMI) created the UDN Gateway as a centralized online application site.
   “The Gateway is an important part of the infrastructure that we are establishing for the UDN,” said Rachel Ramoni, D.M.D., Ph.D. “Our goal is to match 21st century medicine with 21st century technology by creating a comprehensive and streamlined online application process.” Dr. Ramoni serves as executive director and a principal investigator of the UDN Coordinating Center at DBMI.
   Those who are accepted will be seen by researchers and physicians from a wide array of medical specialties and may have their DNA sequenced to detect variations in genes that may underpin their disorders.
   “The UDN aims to improve the level of diagnosis and care for patients with undiagnosed diseases,” said Anastasia Wise, Ph.D., program director, NHGRI Division of Genomic Medicine and co-coordinator for the NIH Common Fund's Undiagnosed Diseases Network. “Based upon the experience of the NIH UDP, we know that the need and potential are great. The UDN Gateway will expand our ability to connect with patients who may benefit from the UDN. We want to make it as easy as possible for patients and their families to apply to participate in the network.”
For access to the UDN Gateway, go to apply.undiagnosed.hms.harvard.edu.
For more information about the UDN, including related funding announcements, visit http://commonfund.nih.gov/Diseases/index.
  Souce: National Institutes of Health.

Antipsychotic prescriptions a source of concern

   (NIH) - 7/8/2015 - Boys are more likely than girls to receive a prescription for antipsychotic medication regardless of age, researchers have found. Approximately 1.5 percent of boys ages 10-18 received an antipsychotic prescription in 2010, although the percentage falls by nearly half after age 19. Among antipsychotic users with mental disorder diagnoses, attention deficit hyperactivity disorder (ADHD) was the most common among youth ages 1-18, while depression was the most common diagnosis among young adults ages 19-24 receiving antipsychotics. Despite concerns over the rising use of antipsychotic drugs to treat young people, little has been known about trends and usage patterns in the United States before this latest research, which was funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health. Mark Olfson, M.D., M.P.H., of the Department of Psychiatry, College of Physicians and Surgeons and Columbia University and New York State Psychiatric Institute, New York City, and colleagues Marissa King, Ph.D., Yale, New Haven, Connecticut, and Michael Schoenbaum, Ph.D., NIMH, reported their findings on July 1 in JAMA Psychiatry.
   “No prior study has had the data to look at age patterns in antipsychotic use among children the way we do here. What’s especially important is the finding that around 1.5 percent of boys aged 10-18 are on antipsychotics, and then this rate abruptly falls by half, as adolescents become young adults," Schoenbaum said.  “Antipsychotics should be prescribed with care. They can adversely affect both physical and neurological function and some of their adverse effects can persist even after the medication is stopped.”
   The U.S. Food and Drug Administration (FDA) has approved antipsychotics for children with certain disorders, particularly bipolar disorder, psychosis/schizophrenia, and autism. However, the research team found that the medication use patterns do not match the illness patterns. The mismatch means that many antipsychotic prescriptions for young people may be for off-label purposes, that is, for uses not approved by FDA.
  For example, maladaptive aggression is common in ADHD, and clinical trial data suggest that at least one antipsychotic, risperidone, when used with stimulants, can help reduce aggression in ADHD. To date, FDA has not approved the use of any antipsychotic for ADHD, making its use for this diagnosis off-label. In the current study, the combination of peak use of antipsychotics in adolescent boys and the diagnoses associated with prescriptions (often ADHD) suggest that these medications are being used to treat developmentally limited impulsivity and aggression rather than psychosis.
   Olfson and colleagues worked with the IMS LifeLink LRx database, which includes 63 percent of outpatient prescriptions filled in the U.S. The team looked at prescription data for 2006-2010 and found antipsychotic use increased with age in both boys and girls, beginning at 0.11 percent in 2010 for ages 1-6 years, increasing to 0.80 percent for ages 7-12 years and increasing again to 1.19 percent for youth ages 13-18 years before dropping substantially to 0.84 percent for ages 19-24.
   In children ages 1-6, boys were more than twice as likely as girls to receive an antipsychotic prescription (0.16 vs. 0.06 percent in 2010). This pattern held true for boys and girls ages 7-12 (1.20 vs. 0.44 percent in 2010) before narrowing for the 13-18 age group (1.42 vs. 0.95 percent) and finally becoming more comparable for young men and women ages 19 to 24 (0.88 to 0.81 percent in 2010). Among young people treated with antipsychotics in 2010, the youngest children, ages 1-6, were the least likely to receive the prescription from a psychiatrist (57.9 vs. 71.9, 77.9, and 70.4 percent for the other three age groups). This is a source of concern, as practice guidelines caution practitioners on the use of antipsychotic medications for young children in particular.
   Among young people receiving antipsychotic prescriptions, fewer than half had any medical visit that included a mental disorder diagnosis. That may be in part due to stigma about mental illness, or because primary care providers are concerned about reimbursement for treatment related to such diagnoses.
   “In addition to having a new look at antipsychotic use among youth, one positive finding coming from this study is that around 75 percent of these kids have at least some contact with a psychiatrist,” said NIMH Director Thomas Insel, M.D.
   Source: National Institutes of Health

Stem Cell Transplants May Halt MS Progression

   (NIH) - 12/31/2014 - Three-year outcomes from an ongoing clinical trial suggest that high-dose immunosuppressive therapy followed by transplantation of a person's own blood-forming stem cells may induce sustained remission in some people with relapsing-remitting multiple sclerosis (RRMS). RRMS is the most common form of MS, a progressive autoimmune disease in which the immune system attacks the brain and spinal cord. The trial is funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and conducted by the NIAID-funded Immune Tolerance Network (ITN).
   Three years after the treatment, called high-dose immunosuppressive therapy and autologous hematopoietic cell transplant or HDIT/HCT, nearly 80 percent of trial participants had survived without experiencing an increase in disability, a relapse of MS symptoms or new brain lesions. Investigators observed few serious early complications or unexpected side effects, although many participants experienced expected side effects of high-dose immunosuppression, including infections and gastrointestinal problems. The three-year findings are published in the Dec. 29, 2014, online issue of JAMA Neurology.
   “These promising results support the need for future studies to further evaluate the benefits and risks of HDIT/HCT and directly compare this treatment strategy to current MS therapies,”  NIAID Director Anthony S. Fauci said. “If the findings from this study are confirmed, HDIT/HCT may become a potential therapeutic option for people with this often-debilitating disease, particularly those who have not been helped by standard treatments.”
   Scientists estimate that MS affects more than 2.3 million people worldwide. Symptoms can vary widely and may include disturbances in speech, vision and movement. Most people with MS are diagnosed with RRMS, which is characterized by periods of relapse or flare up of symptoms followed by periods of recovery or remission. Over years, the disease can worsen and shift to a more progressive form.
  In the study, researchers tested the effectiveness of HDIT/HCT in 25 volunteers with RRMS who had relapsed and experienced worsened neurological disability while taking standard medications. Doctors collected blood-forming stem cells from participants and then gave them high-dose chemotherapy to destroy their immune systems. The doctors returned the stem cells to the participants to rebuild and reset their immune systems.
   “Notably, participants did not receive any MS drugs after transplant, yet most remained in remission after three years,” NIAID Division of Allergy, Immunology and Transplantation Director Daniel Rotrosen said. “In contrast, other studies have shown that the best alternative MS treatments induce much shorter remissions and require long-term use of immunosuppressive drugs that can cause serious side effects.”
  The study researchers plan to follow participants for a total of five years, recording all side effects associated with the treatment. Final results from this and similar studies promise to help inform the design of larger trials to further evaluate HDIT/HCT in people with MS.
   The work was sponsored by NIAID, NIH, and conducted by the ITN (contract number N01 AI015416) and NIAID-funded statistical and clinical coordinating centers (contract numbers HHSN272200800029C and HHSN272200900057C). The ClinicalTrials.gov identifier for the study High-Dose Immunosuppression and Autologous Transplantation for Multiple Sclerosis (HALT-MS) is NCT00288626.
   Source: National Institutes of Health

Cadiologist Sentenced to 78 Months for Fraud

Patients Given Treatments Deemed to be Unnecessary
   NEWARK, N.J. – 11/30/2013 - A well-known cardiologist and the founder, CEO and sole owner of two large medical services companies in New Jersey and New York was sentenced on Nov. 20 to 78 months in prison and ordered to pay $19 million in restitution for conspiring in a multimillion-dollar health care fraud scheme that subjected thousands of patients to unnecessary tests and potentially life-threatening, unneeded treatment, as well as treatment by unlicensed or untrained personnel.
   The sentence was announced by New Jersey U.S. Attorney Paul J. Fishman.
   Jose Katz, 69, of Closter, N.J., previously pleaded guilty before U.S. District Judge Jose L. Linares to an information charging him with one count of conspiracy to commit health care fraud and one count of Social Security fraud arising from a separate scheme to give his wife a “no show” job and make her eligible for Social Security benefits. Judge Linares imposed the sentence in Newark federal court.
   “Katz prized illegal profits over patients to a staggering degree, committing record-breaking fraud and compromising care,” Fishman said. “Prison is an appropriate consequence for ripping off the government and insurance companies through the shocking exposure of patients to unneeded or untrained treatment.”
   As part of his plea agreement with the government, Katz agreed that the loss amount sustained by Medicare, Medicaid and other insurers victimized by the fraudulent billings was $19 million. U.S. Department of Health and Human Services, Office of Inspector General and FBI records indicate the loss amount suffered by the victims is the largest recorded in New Jersey, New York and Connecticut for an individual practitioner convicted of health care fraud.
   According to documents filed in this case and statements made in court:
   Katz was the founder, CEO and sole equity-holder of Cardio-Med Services LLC (Cardio-Med), and Comprehensive Healthcare & Medical Services LLC (Comprehensive Healthcare). From 2004 through 2012, Cardio-Med had offices in Union City, Paterson and West New York, N.J., and Comprehensive Healthcare had offices in Manhattan and Queens, N.Y. Both Cardio-Med and Comprehensive Healthcare provided cardiology, internal medicine and other medical services to individual patients. During that time period, Katz conspired to bill Medicare Part B, Medicaid, Empire BCBS, Aetna and others for unnecessary tests and unnecessary procedures based on false diagnoses and for medical services rendered by unlicensed practitioners.
   Between July 2006 and February, 2009, Katz spent more than $6 million for advertising on Spanish-language television and radio stations. The ads attracted hundreds of patients to Cardio-Med and Comprehensive Healthcare every day. Overall, Katz was able to bill Medicare and Medicaid more than $75 million for his services from 2005 through 2012.
   Over the course of the conspiracy, Katz ordered and performed essentially the same battery of diagnostic tests for nearly all the patients he treated, regardless of their symptoms. Katz also instructed his non-physician employees to order and perform diagnostic tests for patients of other doctors working at his offices, even though he had not examined those patients and the other physicians had not ordered the tests.
   Most significantly, Katz admitted that he falsified patient charts with fictitious and boilerplate symptoms and falsely diagnosed a majority of his Medicare and Medicaid patients with coronary artery disease and debilitating and inoperable angina. He also admitted to making the diagnoses to justify prescribing and administering an unnecessary treatment for those patients called enhanced external counter pulsation, or EECP. Katz even prescribed EECP treatments for some patients with contraindications for the treatment, therefore subjecting those patients to a substantial risk of serious injury or death.
   From 2005 through 2012, Medicare and Medicaid paid Katz more than $15.6 million just for his EECP treatments, most of which were fraudulent.
   In addition, Katz ordered conspirator Mario Roncal, 62, of Woodland Park, N.J. – who had a medical degree from San Juan Bautista School of Medicine in San Juan, Puerto Rico, but did not have a license to practice medicine in any of the 50 states – to treat patients, knowing he was not licensed. At Katz’s direction, Roncal held himself out to fellow employees and to patients as “Dr. Roncal,” examined new patients as well as Katz’s follow-up patients, ordered diagnostic tests, diagnosed patients with medical conditions and diseases and recommended and prescribed courses of treatment and surgery – including falsely diagnosing patients with angina and prescribing EECP treatments for those patients.
   To conceal this illegal and unlicensed practice of medicine, Roncal forged Katz’s signature on paperwork associated with Roncal’s unlawful medical services, including on patient charts. During the conspiracy, Katz used his own billing numbers to bill Medicare Part B and Medicaid for the illegal services Roncal provided as though they were provided by Katz.
   Roncal was indicted on March 2, 2012, for conspiracy to commit health care fraud. He entered a guilty plea on Jan. 4 and awaits sentencing.
   Katz also admitted to a Social Security fraud scheme in which, from 2005 through 2012, he kept his wife on Cardio-Med’s payroll though she performed little or no work. During the course of the scheme, Katz sent false W-2 forms for calendar years 2005 through 2011 to the U.S. Social Security Administration purportedly reflecting $1,251,604 in earnings for his wife, making her eligible for an estimated $263,000 in Social Security benefits to which she was not entitled.
    In addition to the prison term and restitution, Judge Linares sentenced Katz to serve three years of supervised release.
   U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford; the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Thomas O’Donnell; the U.S. Postal Inspection Service, under the direction of Inspector in Charge Maria Kelokates; the Social Security Administration, Office of the Inspector General, under the direction of Special Agent in Charge Edward J. Ryan; IRS-Criminal Investigation, under the direction of Special Agent in Charge Shantelle P. Kitchen; and criminal and civil investigators with the U.S. Attorney’s Office for the investigation leading to today’s sentence. He also thanked the Medicaid Fraud Division of the Office of the New Jersey State Comptroller for its assistance.
   The government is represented by Assistant U.S. Attorney Scott B. McBride of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.
   Source: U.S. Department of Health and Human Services; U.S. Department of Justice

COPD Study: Patient-Provider Dialogue Lacking

   (NIH) - 11/23/2013 - Lack of communication between patients and health care providers about chronic obstructive pulmonary disease (COPD) remains a major barrier to diagnosis of this disease, according to the results of a Web-based survey released on Nov. 15 by the National Heart Lung, and Blood Institute (NHLBI) of the National Institutes of Health. More Americans, particularly smokers, are talking to their doctor or health care provider about the symptoms of COPD, which is an encouraging sign that awareness efforts are taking hold. Patients and providers, though, can still do more.
   “A good conversation between patients and providers about COPD can make a real difference for disease sufferers. It’s no secret that early diagnosis and treatment can improve daily living for those who have COPD – but you can’t get there without an open line of dialogue in the exam room,” Director of the NHLBI Division of Lung Diseases Dr. James Kiley said.. “That’s why patients and providers need to be aware of COPD, its risk factors and symptoms, how it affects daily life and what can be done to help get them back to doing the things they love.”
   COPD, which in 2010 surpassed stroke to become the third leading cause of death in the United States, is a serious lung disease which over time makes it harder to breathe. It affects an estimated 24 million Americans, but as many as half of those affected remain undiagnosed. This is partially because symptoms of the disease – such as shortness of breath, chronic coughing or wheezing, production of excess sputum, or a feeling of being unable to take a deep breath – come on slowly and worsen over time, leaving many to dismiss their symptoms and delay seeking diagnosis and treatment until the disease is advanced.
   The survey found a dramatic increase in the numbers of current smokers, a key COPD risk group, who had discussed their symptoms with their doctors - from 42 percent in 2009 to 67 percent in 2013. Overall, 26 percent of adults who reported experiencing these symptoms stated they had not discussed these symptoms with their doctor or health care provider. Physicians also missed opportunities; 82 percent of current smokers who reported symptoms had a conversation with their doctor about their smoking history, but only 37 percent of former smokers, who are also at risk, reported a similar conversation.
   According to the survey, COPD awareness issues contribute to this missed dialogue. For example, three of the top reasons cited by people with COPD symptoms who did not talk to a doctor were “I did not think of it,” “I’ve had these problems for years,” and “these problems will just go way in time.” Also, only 18 percent of symptomatic people who discussed their symptoms heard their provider mention COPD.
   “Regardless of positive developments, the challenge remains that more than one in three Americans do not know what COPD is or how it affects them – and less than half understand that COPD can be treated,” said Kiley. “COPD is the only major chronic disease where deaths are not decreasing. It is critical for people to understand whether they may be at risk and recognize their symptoms as early as possible.”
   Kiley said the NHLBI will continue to lead in public education and outreach, primarily through the COPD Learn More Breathe Better campaign. COPD Learn More Breathe Better, the first national awareness campaign on COPD, aims to improve knowledge among those with and at risk for the disease, as well as health care providers – particularly those in a primary care setting. Now in 50 states and the District of Columbia, the Breathe Better Network of state and local organizations will be conducting activities and events throughout November as part of National COPD Awareness Month. The COPD Learn More Breathe Better campaign also has developed tools to facilitate discussions between providers and patients in the exam room.
   As part of the NHLBI’s broader effort to bolster the federal dialogue on COPD, the institute also recently hosted a workshop attended by representatives from 22 federal agencies and institutes invested in COPD research and education, to discuss ways to enhance the federal response to this serious public health problem. The attendees shared information about current COPD activities and identified areas where collaboration could improve disease prevention, ascertainment, diagnosis, and treatment. The representatives next aim to meet with external, non-federal stakeholders to discuss ways to respond to the growing COPD burden.
   COPD most often occurs in people age 40 and older with a history of smoking. However, as many as 1 in 6 people with COPD have never smoked. COPD also can occur in people with a genetic condition known as alpha-1 antitrypsin deficiency or through long-term exposure to substances that can irritate the lungs, such as dust or fumes.
   COPD is diagnosed with a simple test called spirometry, which can be conducted in a doctor’s office. The test involves breathing out as hard and fast as possible into a tube connected to a machine that measures lung function.
  The NHLBI analyzed the results of the annual HealthStyles survey of public health attitudes, knowledge, practices, and lifestyle habits among a nationally-representative sample of U.S. adults, conducted each year by Porter Novelli, the communications contractor for the NHLBI’s COPD Learn More Breathe Better campaign.
   The latest survey was conducted in summer 2013; results represent a sample of 4,703 U.S. adults, and have a margin of error of 1.4 percentage points. Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders.
   The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at http://www.nhlbi.nih.gov 
   Source: National Institutes of Health

Health Care Fraud Efforts Recover $4.5 Billion

   WASHINGTON – 3/3/2013 - Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius released a new report on February 11 showing that for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $7.90.
   The government’s health care fraud prevention and enforcement efforts recovered a record $4.2 billion in taxpayer dollars in Fiscal Year (FY) 2012, up from nearly $4.1 billion in FY 2011, from individuals and companies who attempted to defraud federal health programs serving seniors and taxpayers or who sought payments to which they were not entitled. Over the last four years, the administration’s enforcement efforts have recovered $14.9 billion, up from $6.7 billion over the prior four-year period. Since 1997, the HCFAC Program has returned more than $23 billion to the Medicare Trust Funds.
   These findings were released in the annual HCFAC Program report.
   The success of this joint Department of Justice and HHS effort was made possible by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs and to crack down on individuals and entities that are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with new tools and resources provided by the Affordable Care Act.
   “This was a record-breaking year for the Departments of Justice and Health and Human Services in our collaborative effort to crack down on health care fraud and protect valuable taxpayer dollars,” Holder said. “In the past fiscal year, our relentless pursuit of health care fraud resulted in the disruption of an array of sophisticated fraud schemes and the recovery of more taxpayer dollars than ever before. This report demonstrates our serious commitment to prosecuting health care fraud and safeguarding our world-class health care programs from abuse.”
   About $4.2 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and others in FY 2012. This is an unprecedented achievement for the HCFAC Program, a joint Justice Department and HHS effort to coordinate federal, state and local law enforcement activities to fight health care fraud and abuse, officials said.
   The administration is also using tools authorized by the Affordable Care Act to fight fraud, including enhanced screenings and enrollment requirements, increased data sharing across the government, expanded recovery efforts for overpayments and greater oversight of private insurance abuses.
   Since 2009, the Justice Department and HHS have improved their coordination through HEAT and increased the number of Medicare Fraud Strike Force teams to nine. The Justice Department’s enforcement of the civil False Claims Act and the Federal Food, Drug and Cosmetic Act have produced similar record-breaking results. These combined efforts coordinated under HEAT have expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. In FY 2012, the two departments continued their series of regional fraud prevention summits, and the Justice Department hosted a training conference for federal prosecutors, FBI agents, HHS Office of Inspector General agents and others.
   The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that inter-agency teams can target emerging or migrating schemes as well as with chronic fraud by criminals masquerading as health care providers or suppliers. In July, Attorney General Holder and Secretary Sebelius announced the launch of a ground-breaking partnership among the federal government, state officials, leading private health insurance organizations and other health care anti-fraud groups to share information and best practices to improve detection of and prevent payments to scams that cut across public and private payers.
   In FY 2012, the Justice Department opened 1,131 new criminal health care fraud investigations involving 2,148 potential defendants, and a total of 826 defendants were convicted of health care fraud-related crimes during the year. The department also opened 885 new civil investigations.
  The strike force coordinated a takedown in May 2012 that involved the highest number of false Medicare billings in the history of the strike force program. The takedown involved 107 individuals, including doctors and nurses, in seven cities, who were charged for their alleged participation in Medicare fraud schemes, involving about $452 million in false billings. As a part of the May 2012 takedown, HHS also suspended or took other administrative action against 52 providers using authority under the health care law to suspend payments until an investigation is complete.
   Strike force operations in the nine cities where teams are based resulted in 117 indictments, charges and complaints against 278 defendants who allegedly billed Medicare more than $1.5 billion in fraudulent schemes. In FY 2012, 251 guilty pleas and 13 jury trials were litigated, with guilty verdicts against 29 defendants, in strike force cases. The average prison sentence in these cases was more than 48 months.
   The new authorities under the Affordable Care Act granted to HHS and the Centers for Medicare & Medicaid Services (CMS) were instrumental in clamping down on fraudulent activity in health care. In FY 2012, CMS began the process of screening all 1.5 million Medicare-enrolled providers through the new Automated Provider Screening system that quickly identifies ineligible and potentially fraudulent providers and suppliers prior to enrollment or revalidation to verify the data. As a result, nearly 150,000 ineligible providers have already been eliminated from Medicare’s billing system.
  CMS also established the Command Center to improve health care-related fraud detection and investigation, drive innovation and help reduce fraud and improper payments in Medicare and Medicaid.
   From May 2011 through the end of 2012, more than 400,000 providers were subject to the new screening requirements and nearly 150,000 lost the ability to bill the Medicare program due to the Affordable Care Act requirements and other proactive initiatives.
   The Department of Justice and HHS also continued their successes in civil health care fraud enforcement during FY 2012. The Justice Department’s Civil Division Fraud Section, with their colleagues in U.S. Attorneys’ offices throughout the country, obtained settlements and judgments of more than $3 billion in FY 2012 under the False Claims Act (FCA). These matters included unlawful pricing by pharmaceutical manufacturers, illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks.

   This marked the third year in a row that more than $2 billion has been recovered in FCA health care matters. Additionally, the Civil Division’s Consumer Protection Branch, working with U.S. Attorneys’ offices, obtained nearly $1.5 billion in fines and forfeitures, and obtained 14 convictions in matters pursued under the Federal Food, Drug and Cosmetic Act.
  The HCFAC annual report is available at www.oig.hhs.gov/publications/hcfac.asp. For more information on the joint DOJ-HHS Strike Force activities, visit: www.StopMedicareFraud.gov/.

Neuron Firing Pattern Tied To Reward Circuit

   (NIH) - 12/24/2012 - A specific pattern of neuronal firing in a brain reward circuit instantly rendered mice vulnerable to depression-like behavior induced by acute severe stress, a study supported by the National Institutes of Health has found. When researchers used a high-tech method to mimic the pattern, previously resilient mice instantly succumbed to a depression-like syndrome of social withdrawal and reduced pleasure-seeking — they avoided other animals and lost their sweet tooth. When the firing pattern was inhibited in vulnerable mice, they instantly became resilient.
   "For the first time, we have shown that split-second control of specific brain circuitry can switch depression-related behavior on and off with flashes of an LED light," explained Ming-Hu Han, Ph.D., of the Mount Sinai School of Medicine, New York City, a grantee of NIH’s National Institute of Mental Health (NIMH). "These results add to mounting clues about the mechanism of fast-acting antidepressant responses."
   Han, Eric Nestler, M.D., Ph.D.,of Mount Sinai, and colleagues, report on their study online, Dec. 12, 2012, in the journal Nature.
   In a companion article, NIMH grantees Kay Tye, Ph.D., of the Massachusetts Institute of Technology, Cambridge, Mass., and Karl Deisseroth, M.D., Ph.D., of Stanford University, Stanford, Calif., used the same cutting-edge technique to control mouse brain activity in real time. Their study reveals that the same reward circuit neuronal activity pattern had the opposite effect when the depression-like behavior was induced by daily presentations of chronic, unpredictable mild physical stressors, instead of by shorter-term exposure to severe social stress.
   Prior to the new studies, Han's team suspected that a telltale pattern — rapid firing of neurons that secrete the chemical messenger dopamine in a key circuit hub — makes an animal vulnerable to the depression-like effects of acute severe stress, and that slower firing supports resilience. But they lacked direct, real-time evidence.
   To pinpoint cause-and-effect, they turned to a research technology pioneered by Deisseroth, called optogenetics. It melds fiber optics and genetic engineering to precisely control the activity of a specific brain circuit in a living, behaving animal. Genetically modified viruses are used to inject light-reactive proteins, borrowed from primitive organisms like algae, to make the circuitry similarly light-responsive.
   The researchers had previously shown that neurons in the reward circuit hub deep in the brain, called the ventral tegmental area (VTA), fire at normal rates in social stress-resilient mice, but at high rates in social stress-susceptible mice. So they embedded an LED-lit optical fiber aimed at the VTA circuitry of genetically modified resilient mice to convert them into susceptible mice by triggering high firing rates.
   Normally, it takes 10 days of repeated encounters with a dominant animal — an experimental procedure called social defeat stress — to induce depression-related behaviors. Even after that, some mice emerge seemingly unscathed. But these resilient animals — in which the reward circuit had been genetically modified for optogenetic control — instantly succumbed to a long-lasting depression-like syndrome after light pulses triggered neural activity mimicking the high firing rates seen in the susceptible animals.
   In subsequent experiments, using similar optogenetic strategies, the researchers discovered that inhibiting the reward circuit activity pattern in stress-susceptible mice instantly converted them into stress-resilient animals. The reward circuit projects from the VTA to an area in the center front of the brain, called the nucleus accumbens. This study suggests that dopamine neurons firing at high rates in this specific circuit projection encode a signal for susceptibility to depression induced by acute, severe stress. By contrast, a circuit projection from the VTA to the prefrontal cortex, in the top front of the brain (see diagram), was found to serve an opposite function
   Depression in humans often stems from milder stressors over longer periods of time. Tye and Deisseroth used optogenetics to probe reward circuit workings related to depression-like behaviors in rodents exposed to stressors like white noise, crowded housing, or continuous darkness or illumination. Exposure to some of these milder stressors lasted 10 weeks, compared to the 10-days of social defeat stress.
   "We sought to mimic gradual, stress-induced transitions to depressed-like states, as are often seen clinically," explained Deisseroth, who is a practicing psychiatrist as well as a neuroscientist.
   In contrast to the Han-Nestler results after social defeat stress, following 10 weeks of unpredictable chronic mild stress, optogentically inducing high firing rates in VTA dopamine neurons instantly reversed such depression-like behaviors induced by chronic mild stressors — and vice versa. Also opposite to the social defeat stress findings, optogenetically inhibiting VTA dopamine neurons induced depression-like states.
   "The variable effects that stressors of different types induce in the dopamine system may point to the need for distinct treatment strategies for patients whose depressions stem from different types of experiences," said Tye, who is leading a research group studying the neural underpinnings of motivational and emotional processing.
   When Tye and Deisseroth infused agents that block binding of the chemical messenger glutatmate in the nucleus accumbens, they produced an antidepressant response – mice struggled more to escape the stressor. They note that this is consistent with the effects of the fast-acting antidepressant ketamine, which similarly blocks glutamate.
   While optogenetics is providing insights into rapid antidepressant mechanisms, the technique is not suitable for treatment of depression in humans.
   "These stunning demonstrations that depression-like states can literally be switched on and off underscore that context — stressor type and intensity — is pivotal in the workings of the neurons and circuit implicated," said NIMH Director Thomas R. Insel, M.D. "These new, precise circuit breakers are advancing our understanding of how specific brain pathways regulate behavior."

   Source: National Institutes of Health.