Charges Filed in $97 Million Medicare Fraud Case

   (USDOJ) - July 31/2012 - A superseding indictment was unsealed on July 26 charging two owners of a Houston mental health care company, Spectrum Care P.A., some of its employees and the owners of Houston group care homes for their alleged participation in a $97 million Medicare fraud scheme, according to a joint announcement by the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.
    Mansour Sanjar, 79, Cyrus Sajadi, 64, and Chandra Nunn, 34, were originally charged in December 2011, and are expected to make their initial appearances on the superseding indictment in the coming days. The indictment was originally returned on July 24.
    Adam Main, 31, Shokoufeh Hakimi, 65, Sharonda Holmes, 38, and Shawn Manney, 50, all from the Houston area, were arrested and were expected to make their initial appearances in U.S. District Court for the Southern District of Texas in Houston on July 26 or 27.
   The superseding indictment charges Sanjar, Sajadi, Main, Terry Wade Moore, 51, Hakimi and Nunn each with one count of conspiracy to commit health care fraud; Sanjar, Sajadi, Main and Moore are charged with various counts of health care fraud; Sanjar, Sajadi, Hakimi, Nunn, Holmes and Manney each are charged with one count of conspiracy to defraud the United States and to pay health care kickbacks; and Sanjar, Sajadi, Hakimi, Nunn, Holmes and Manney are charged with various counts of payment and receipt of healthcare kickbacks. The superseding indictment also seeks forfeiture.
    According to the indictment, Sanjar and Sajadi orchestrated and executed a scheme to defraud Medicare beginning in 2006 and continuing until their arrest in December 2011. Sanjar and Sajadi owned Spectrum, which purportedly provided partial hospitalization program (PHP) services. A PHP is a form of intensive outpatient treatment for severe mental illness. The Medicare beneficiaries for whom Spectrum billed Medicare for PHP services did not qualify for or need PHP services. Sanjar, Sajadi, Main and Moore signed admission documents and progress notes certifying that patients qualified for PHP services, when in fact, the patients did not qualify for or need PHP services. Sanjar and Sajadi also billed Medicare for PHP services when the beneficiaries were actually watching movies, coloring and playing games – activities that are not covered by Medicare.
    Sanjar, Sajadi and Hakimi paid kickbacks to Nunn, Holmes, Manney and other group care home operators and patient recruiters in exchange for delivering ineligible Medicare beneficiaries to Spectrum, according to the indictment. In some cases, the patients received a portion of those kickbacks. The indictment alleges that Spectrum billed Medicare for approximately $97 million in services that were not medically necessary and, in some cases, not provided.
   The charges were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office; Special Agent in Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU); Joseph J. Del Favero, Special Agent in Charge of the Chicago Field Office of the Railroad Retirement Board, Office of Inspector General (RRB-OIG); and Scott Rezendes, Special Agent in Charge of Field Operations of the Office of Personnel Management, Office of Inspector General (OPM-OIG).
   An indictment is merely a formal accusation. Defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.
    The case is being prosecuted by Trial Attorneys Laura M.K. Cordova and Allan J. Medina and Deputy Chief Sam S. Sheldon of the Criminal Division’s Fraud Section with assistance from Trial Attorneys Jennifer Ambuehl and Aixa Maldonado-Quinones of the Criminal Division’s Asset Forfeiture and Money Laundering Section. The case was investigated by the FBI, HHS-OIG, MFCU, RRB-OIG and OPM-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas.
    Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,330 defendants who have collectively billed the Medicare program for more than $4 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
   Source: www.stopfraud.gov/

Health Experts Denounce Flawed House Farm Bill

   Washington, D.C. – (EWG) - 7/27/2012 0- More than 60 leading chefs, authors, food and agriculture policy and nutrition experts, business leaders and environment and health organizations have sent an open letter to Capitol Hill objecting that the House agriculture committee’s proposed farm bill would “steer the next five years of national food and farm policy in the wrong direction.”
   The notable signatories urged lawmakers “to vote a resounding ‘no’ should the legislation come to a House floor vote (before the August recess), unless the bill is extensively rewritten through the amendment process.”
   Signers include Chefs Mario Batali and Ann Cooper, Food Inc. film director Robert Kenner, authors Michael Pollan and Laurie David, New York University nutrition professor Marion Nestle, pediatrician Dr. Harvey Karp and medical expert Dr. Andrew Weil.
   “The House bill will leave millions of people without enough food to eat, help fewer farmers and contribute to the loss of millions of acres of wetlands and grasslands,” said Ken Cook, president of Environmental Working Group. “Meanwhile the cost of crop insurance is poised to set another record---at the expense of the American taxpayer.”
   You can read the full letter and list of signers here.
   Kari Hamerschlag of Environmental Working Group and authors Dan Imhoff and Anna Lappé initiated the group letter to express frustration that the House Agriculture Committee slashes $16 billion in nutrition assistance and $6.1 billion from conservation programs while spending $36 billion on new farm subsidies and failing to include meaningful reforms to the costly federal crop insurance program.
   Hamerschlag, Imhoff, and Lappé organized a similar letter denouncing the Senate version of the farm bill last month.
   "We are speaking up for the millions of Americans who share the belief that the farm bill should use taxpayer dollars wisely and fairly,” Lappé said. “The 2012 legislation should promote healthy food, reward farmers who are good stewards of the land, and provide the much-needed resources for struggling families to put food on the table."
   The letter sent to the House acknowledges that the committee retained some of the Senate bill’s modest but positive elements, including programs that scale up local production and distribution of healthy foods and bolster marketing and research for fruit, nut and vegetable farmers.
   “On the whole, however, this is a huge step backward in almost every other regard,” the letter says. “We are deeply concerned that the bill would continue to give away tens of billions of taxpayer dollars to the largest commodity crop growers, insurance companies, and agribusinesses while drastically underfunding programs to protect natural resources, invest in beginning and disadvantaged farmers, revitalize local food economies, and promote health and food security.”
   The letter strongly criticizes the House panel’s failure to retain the Senate-approved conservation compliance amendment. Moreover, its version contains dangerous anti-environmental provisions that would roll back fundamental regulatory and constitutional protections, gut common-sense rules that protect water quality and wildlife from agricultural pesticides, exempt GMO crops from meaningful environmental review and federal oversight, and prevent states from setting their own standards for farm and food production.
   "Rather than making real reforms to alleviate hunger, strengthen stewardship, and boost rural economies, the House farm bill would continue sending billions to agribusinesses and weaken regulations around pesticides and genetically modified crops,” Imhoff said. “Americans deserve better."
   Signers of the letter hope that floor action on the bill would give House lawmakers the opportunity to dramatically improve the legislation. They are calling on lawmakers to pass amendments that eliminate harmful extraneous provisions, support local, healthy and organic food, provide full funding for nutrition assistance programs and include fiscally responsible reforms to crop insurance and commodity programs.

Economist Says U.S. Growth Slow But On Track

   NEW YORK- (BUSINESS WIRE) - 7/21-2012 - Moody’s Analytics, an independent provider of economic forecasting, recently released Chief Economist Mark Zandi’s latest U.S. monthly economic outlook. According to “U.S. Macro Outlook: Policymakers Must Get It Right,” Zandi expects the U.S. economy to gain traction going into 2014 and to return to full employment, meaning a jobless rate lower than 6 percent, by late 2015. However, such optimism depends heavily on the decisions of policymakers in the U.S. and abroad.
   “The U.S. economy is growing, but uncomfortably slowly. Real GDP is expanding at an annual rate of only 2 percent and recent payroll job gains have averaged 75,000 per month. At this pace, unemployment will remain stuck above 8 percent for some time,” Zandi said.
    Action will be needed after the November election to address the fiscal cliff to avoid a new recession in the U.S. The tax increases and spending cuts slated for next year constitute more than 4.5 percent of GDP, which an economy growing at 2 percent cannot withstand. Zandi said that while the current consensus view holds that Washington is likely to take the path of least resistance, extending the Bush-era tax cuts and canceling most of the scheduled spending cuts, doing so will delay progress toward making the government’s finances sustainable. By early 2013, the next president and Congress may have to behave differently than their predecessors to avoid this.
    The U.S. outlook also depends on the actions of policymakers globally. U.S. businesses are reluctant to hire because of the threat of a potential break‐up of the euro area and a hard landing in the emerging world.
    “Still, despite the difficulties, the U.S. economy can indeed rebound,” Zandi said.

Gene mutations linked to ALS, cell dysfunction

    (NIH) - 7/18/2012 - Researchers have linked newly discovered gene mutations to some cases of the progressive fatal neurological disease amyotrophic lateral sclerosis — ALS, also known as Lou Gehrig’s disease. Shedding light on how ALS destroys the cells and leads to paralysis, the researchers found that mutations in this gene affect the structure and growth of nerve cells.
   ALS attacks motor neurons, the nerve cells responsible for controlling muscles. People with ALS experience such early symptoms as limb weakness or swallowing difficulties. In most people, the disease leads to death three to five years after symptoms develop, usually as a result of respiratory failure.
   Scientists at the University of Massachusetts Medical School, Worcester, collaborated with international ALS researchers to search for gene mutations in two large families with an inherited form of ALS. The researchers used a technique to decode only the protein-encoding portions of DNA, known as the exome, allowing an efficient yet thorough search of the DNA regions most likely to contain disease-causing mutations. This deep sequencing of the exome led to the identification of several different mutations in the gene for profilin (PFN1) which were present only in the family members that developed ALS. Further investigations of 272 other familial ALS cases across the world showed that profilin mutations were also found in a small subset (about 1 to 2 percent) of the familial ALS cases studied.
   The protein profilin is a key part of the creation and remodeling of a nerve cell's scaffolding or cytoskeleton. In fly models, disrupting profilin stunts the growth of axons — the long cell projections used to relay signals from one neuron to the next or from motor neurons to muscle cells. After identifying the PFN1 mutations in ALS patients, the researchers demonstrated that these mutations inhibited axon growth in laboratory-grown motor neurons as well. They also found that mutant profilin accumulated in clumps in neural cells, as has been seen for other abnormal proteins associated with ALS, Parkinson's and Alzheimer's. Neural cells with PFN1 mutations also contained clumps of a protein known as TDP-43. Clumps of abnormal TDP-43 are found in most cases of ALS, further linking profilin to known ALS mechanisms.
   John Landers, Ph.D., associate professor of neurology at the University of Massachusetts Medical School, described how studying ALS in large families is challenging. "ALS is a late-onset, rapidly progressive disease. Unless you’ve been following a family for decades, it is hard to get DNA samples to study," Dr. Landers said. "We were very fortunate to obtain the DNA samples with the help of our research collaborators and the affected families."
   Over a dozen genes have been linked to ALS, and these findings support existing studies which suggest that cell cytoskeleton disruptions play a major role in ALS and other motor neuron diseases. Motor neurons are large cells with long axons that connect to muscle, and cytoskeleton proteins are especially important in the transport of proteins along the axon to the remote parts of the neuron. This information could be useful in developing strategies for detection and treatment of ALS.
   "In all of the causative genes that we identify, we look for common pathways," Dr. Landers said. "Every time we are able to identify a new gene, we have another piece of the puzzle. Each one of these genes helps us to understand what's going on. The more of these we can find, the more we're going to know about what's going wrong in ALS."
   Familial ALS accounts for 10 percent of all ALS cases, but the majority of ALS cases are sporadic, where the cause is unknown. Even though this new mutation is linked to familial ALS, it reveals information about the mechanisms underlying motor neuron degeneration in general, and also may have broader implications for understanding sporadic ALS.
   "This discovery is highly significant and opens a new avenue of research," said Amelie Gubitz, Ph.D., program director at the National Institute of Neurological Disorders and Stroke (NINDS), which funded the research. "There is growing evidence that ALS may be caused by a variety of cellular defects, and that it is a not a disorder with a single origin. Whether and where these disease pathways converge is an active area of research with important implications for therapy development."
  Motor neurons that have mutant versions of the profilin protein grow shorter, less complex axons (right) than motor neurons with normal profilin (left). From Wu et al., Nature, July 15, 2012.
   This research was published online by Nature. Scientists from research institutions in several countries contributed to the paper. In the United States, researchers from the University of Massachusetts Medical School, Emory University of Medicine, Atlanta, and Duke University School of Medicine, Durham, N. C., contributed to the study. In Italy, researchers from the University of Milan, the Institute of Hospitalization, Care and Scientific Research and the University of Pisa contributed to the study. In Israel, researchers from Tel Aviv Sourasky Medical Center contributed to the study. Additionally, researchers from the University Medical Centre Utrecht in the Netherlands, University of Guelph in Canada, and the Salpetriere Hospital in Paris contributed to the study.
   The work was supported by grants from the NINDS, funded in part through the Recovery Act (NS065847, NS050557, NS070342). It was also supported by the Muscular Dystrophy Association, Agency of Research for Amyotrophic Lateral Sclerosis (AriSLA), SMA Europe, ALS Therapy Alliance, Project ALS, Partners in ALS Research, the Angel Fund, the Pierre L. de Bourgknecht ALS Research Foundation, the Al-Athel ALS Research Foundation, the ALS Family Charitable Foundation and a donation from Francesco Caleffi.
   For more information about ALS, visit: http://www.ninds.nih.gov/ALS.