Guest guest Posted September 4, 2011 Report Share Posted September 4, 2011 Your Daily Posterous subscriptions September 3rd, 2011 Medicare fraud cases move forward - Business - Press and Guide<http://ptmanagerblog.com/medicare-fraud-cases-move-forward-business-pr> Posted 4 days ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67635040> Medicare fraud cases move forward Published: Monday, August 29, 2011 By J. Pepper Press & Guide Newspapers Medicare fraud cases against the owners of a shuttered Dearborn medical clinic moved forward this week, with a prison sentence for one man and guilty pleas from the other co-owners. rio, 54, was sentenced Thursday in U.S. District Court in Detroit to 48 months in prison, three years of supervised release and was ordered to pay some $10.7 million in restitution for an alleged $15 million fraudulent billing scheme connected to Dearborn Medical Rehabilitation Clinic. U.S. District Judge Gerald Rosen ordered the sentence to run consecutive to a 46-month sentence rio received in connection with an unrelated mortgage fraud case in Florida. In addition, DMRC co-owners and former international fugitives Clara and Caridad Guilarte on Wednesday pleaded guilty in a Florida courtroom to one count each of conspiracy to commit health care fraud, and one count of conspiracy to commit money laundering. They face a maximum sentence of 10 years in prison. The sisters fled authorities after being charged in an indictment unsealed in June 2009 and were arrested this March in Colombia. The Guilartes admitted that Medicare beneficiaries were not referred to DMRC by their primary care physicians, or for any other legitimate medical purpose, but were recruited to come to the clinic through the payment of cash kickbacks. DMRC specialized in infusion treatments that could cost more than $1,000 a dose. In exchange for those kickbacks, the Medicare beneficiaries would visit the clinic and sign documents indicating that they had received the services billed to Medicare. Patients were prescribed medications not based on need, but based on what medications were likely to generate the greatest reimbursements from Medicare. Between 2005 and 2007, DMRC submitted fraudulent claims totaling $9.1 million, with Medicare paying about $6 million worth. Continued...<http://www.pressandguide.com/articles/2011/08/29/business/doc4e57d7\ 353cdd3558469329.txt?viewmode=fullstory?viewmode=2> According to court documents, Caridad and Clara Guilarte laundered the proceeds of the health care fraud through shell corporations in order to conceal the source and ownership of the funds stolen from Medicare. rio also was co-owner of two other metro Detroit clinics that ran similar schemes. By J. Pepper Press & Guide Newspapers Health care fraud prosecutions on pace to rise 85% – USATODAY.com<http://ptmanagerblog.com/health-care-fraud-prosecutions-on-pace-to-\ ris> Posted 4 days ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67635112> Health care fraud prosecutions on pace to rise 85% By Kennedy, USA TODAY Updated 15h 32m ago WASHINGTON – New government statistics show federal health care fraud prosecutions in the first eight months of 2011 are on pace to rise 85% over last year due in large part to ramped-up enforcement efforts under the Obama administration. - [image: Attorney General Holder listens as Health and Human Services Secretary Kathleen Sebelius speaks about the Medicare Fraud Strike Force in February.]<http://i.usatoday.net/news/_photos/2011/08/29/Health-care-fraud-prose\ cutions-rising-G6BAOKN-x-large.jpg> By Jacquelyn , AP Attorney General Holder listens as Health and Human Services Secretary Kathleen Sebelius speaks about the Medicare Fraud Strike Force in February. By Jacquelyn , AP Attorney General Holder listens as Health and Human Services Secretary Kathleen Sebelius speaks about the Medicare Fraud Strike Force in February. The statistics, released by the non-partisan Transactional Records Access Clearinghouse, show 903 prosecutions so far this year. That's a 24% increase over the total for all of fiscal year 2010, when 731 people were prosecuted for health fraud through federal agencies across the country. Prosecutions have gone up 71% from five years ago, according to TRAC. " This was a fairly dramatic number of prosecutions, " said Burnham, co-director of TRAC. TRAC is a research organization at Syracuse University<http://content.usatoday.com/topics/topic/Organizations/Schools/Syracu\ se+University>that submits Freedom of Information Act<http://content.usatoday.com/topics/topic/Freedom+of+Information+Act>requests for government data, and then reports the results. Justice Department<http://content.usatoday.com/topics/topic/Organizations/Government+Bod\ ies/United+States+Department+of+Justice>officials said the increase runs parallel with what they're seeing when looking at health care fraud broadly, in part because of a couple of big busts this year, as well as several cases involving fraud in the private sector. " The trend certainly looks accurate and on track with our data, " said Justice spokeswoman Alisa Finelli, though she said she could not confirm the exact numbers. She cited a February case that brought in 111 people — the largest take-down to date for the Medicare Fraud Task Force — as a factor. In that case, doctors, nurses and executives were accused of falsely billing Medicare more than $225 million. Task force convictions have also risen, according to Justice's criminal division Assistant Attorney General Lanny Breuer. In 2010, the task force saw 23 trial convictions for Medicare fraud. In the first eight months of this year, they've had 24. " That's just a stunning number when you see it in the first eight months, " Breuer said of the task force. " We're just going to build on this model, and we're going to hold those responsible who are stealing from the government. " The government beefed up its staffing this year, adding two health care fraud teams in February. In 2010, the government recovered a record $4 billion from health fraud cases after the federal health care law created one agency and expanded another. The actuary for Medicare predicted provisions of the law would ultimately net $4.9 billion in fraud and abuse savings over the next 10 years, which will be rolled back into Medicare. Over the past couple of years, the task force has used data from the Centers for Medicare and Medicaid Services to find people stealing millions of dollars. Jerry <http://content.usatoday.com/topics/topic/Jerry+>, chief of the FBI<http://content.usatoday.com/topics/topic/Organizations/Government+Bodies/Fed\ eral+Bureau+of+Investigation>'s health care fraud criminal investigation unit, said he has seen an increase in cases, though not at the levels TRAC found. " We started to change our focus, " he said. His team homed in on criminal enterprises — such as 73 Armenians who defrauded the government of $163 million last fall, as well as major providers who defraud the government — such as corporations or hospitals. Usually, those cases come after a whistle-blower comes forward. In 2010, the government paid $300 million to whistle-blowers. In January, the FBI went after 533 people in Puerto Rico<http://content.usatoday.com/topics/topic/Places,+Geography/States,+Territor\ ies,+Provinces,+Islands/Puerto+Rico>who worked with doctors to send bogus accidental injury claims to American Family Life Insurance Company — ultimately bilking the company of $7 million. Some individuals submitted hundreds of accident claims, while paying a doctor $10 to $20 per claim to fraudulently approve them. " The San <http://content.usatoday.com/topics/topic/Places,+Geography/Towns,+Cities,+C\ ounties/San+>case just shows our desire to work the private insurance and the public insurance sides, " said. The case also boosted the government's prosecution numbers. via usatoday.com<http://www.usatoday.com/news/washington/story/2011-08-29/Health-car\ e-fraud-prosecutions-on-pace-to-rise-85/50180282/1> CA POPTS Issue Uglier than Ever-We Request You Cast a Vote of No Confidence<http://ptmanagerblog.com/ca-popts-issue-uglier-than-ever-we-request-y\ o> Posted 4 days ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67655022> <http://feedproxy.google.com/~r/EvidenceInMotion/~3/evYK5e5SODk/ca-popts-issue-u\ glier-than-ever-we-request-you-cast-a-vote-of-no-confidence.html><http://feedpro\ xy.google.com/~r/EvidenceInMotion/~3/evYK5e5SODk/ca-popts-issue-uglier-than-ever\ -we-request-you-cast-a-vote-of-no-confidence.html>CA POPTS Issue Uglier than Ever-We Request You Cast a Vote of No Confidence<http://feedproxy.google.com/~r/EvidenceInMotion/~3/evYK5e5SODk/ca-pop\ ts-issue-uglier-than-ever-we-request-you-cast-a-vote-of-no-confidence.html> from MyPhysicalTherapySpace.com<https://www.google.com/reader/view/feed/http%3A%2F%2F\ feeds.feedburner.com%2FEvidenceInMotion> by Dedicated PT [image: Failure]<http://blog.evidenceinmotion.com/.a/6a00d8341c6c5d53ef015434f98275970c-\ pi> Hayashi, the CA legislator that attempted to legalize POPTS in CA has now called for an investigation of the CA Physical Therapy Board. She's doing this because the CA PT Board is now starting to enforce the California law which clearly states that it is illegal for medical corporations to employ physical therapists. Bitter about the defeat of her legislation, she received the greenlight to have the PT Board investigated at the cost of $188,000 to CA taxpayers. The real reason she is doing this is to delay the enforcement of the law. As such, the group PORK (People Opposing Referral for profit Kickbacks) has created an Vote of No Confidence petition. We Need a Massive Outporing of Support If you are against POPTS, we strongly encourage you to sign this petition. You can find it here: http://www.ipetitions.com/petition/hayashi-must-go/ We also would like you to chime in on Twitter at @stoppopts and Facebook: www.facebook.com/stoppopts We expect even more foul play. Thank you to everyone that is supporting our pro-consumer movement to end POPTS in CA. We won't give in and we look forward to returning the favor! #physicaltherapy #POPTS #Hayashi Older Brains Benefit From Learning By Trial And Error<http://ptmanagerblog.com/older-brains-benefit-from-learning-by-trial-a> Posted 2 days ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67886032> Older Brains Benefit From Learning By Trial And Error Canadian researchers have found the first evidence that older brains get more benefit than younger brains from learning information the hard way - via trial-and-error learning. The study was led by scientists at Baycrest's world-renowned Rotman Research Institute in Toronto and appears online in the journal *Psychology and Aging *, ahead of the print edition. The finding will surprise professional educators and cognitive rehabilitation clinicians as it challenges a large body of published science which has shown that making mistakes while learning information hurts memory performance for older adults, and that passive " errorless " learning (where the correct answer is provided) is better suited to older brains. " The scientific literature has traditionally embraced errorless learning for older adults. However, our study has shown that if older adults are learning material that is very conceptual, where they can make a meaningful relationship between their errors and the correct information that they are supposed to remember, in those cases the errors can actually be quite beneficial for the learning process, " said Andreé-Ann Cyr, the study's lead investigator. Cyr conducted the research at Baycrest as a doctoral student in Psychology (University of Toronto), in collaboration with senior author and scientist Dr. of Baycrest's Rotman Research Institute. Dr. specializes in cognitive rehabilitation research with older adults. In two separate studies, researchers compared the memory benefits of trial-and-error learning (TEL) with errorless learning (EL) in memory exercises with groups of healthy young and older adults. The young adults were in their 20s; the older adults' average age was 70. TEL is considered a more effortful cognitive encoding process where the brain has to " scaffold " its way to making richer associations and linkages in order to reach the correct target information. Errorless learning (EL) is considered passive, or less taxing on the brain, because it provides the correct answer to be remembered during the learning process. The researchers presented participants with a meaningful " cue " (e.g. type of tooth). The correct target word (e.g. molar) was shown to learners in the EL condition. In the TEL condition, the cue was presented alone, and participants made two guesses (such as canine, incisor) before the correct target " molar " was shown. After a short while, participants performed a memory test that required them to remember the context in which the words were learned (i.e. were they learned through trial-and-error or not). In both studies, participants remembered the learning context of the target words better if they had been learned through trial-and-error, relative to the errorless condition. This was especially true for the older adults whose performance benefited approximately 2.5 times more relative to their younger peers. The findings from the Baycrest study may have important implications for how information is taught to older adults in the classroom, and for rehabilitation procedures aimed at delaying cognitive decline - procedures which rely on knowledge of how to train an aging brain, said Cyr. The authors say future studies are needed to determine how different study materials and memory tasks impact the effect of errors on memory in aging. This will help to clarify the learning contexts in which errors should be avoided or harnessed. The study was funded by a doctoral award and research grant from the Natural Sciences and Engineering Research Council. via medicalnewstoday.com<http://www.medicalnewstoday.com/releases/233314.php?utm_cam\ paign=Psychology++-++Psychiatry+News+From+Medical+News+Today & utm_term=%23ModernM\ indsFL & utm_content=%23mentalhealth+%23Tampa+%23Counseling+%23Psychology+%23Thera\ pist+%23Therapy & utm_source=twitterfeed & utm_medium=twitter> ALLEN PARK: Doctor facing federal charges opens clinic in city - thenewsherald.com<http://ptmanagerblog.com/allen-park-doctor-facing-federal-char\ ges-open> Posted 2 days ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67899122> ALLEN PARK: Doctor facing federal charges opens clinic in city Published: Thursday, September 01, 2011 By Dave Herndon ALLEN PARK — A doctor facing federal charges of prescription and Medicare fraud has opened a physical therapy clinic in the city. Dr. Linares, 53, previously operated the Monroe Pain Clinic. On Sept. 15, he will face a pretrial hearing at U.S. District Court in Detroit. He is free after posting a $10,000 bond. Linares could not be reached for comment. Multiple calls to his office were not returned. The U.S. Drug Enforcement Agency alleges that Linares prescribed controlled substances to 250 patients in one day and that from April 1, 2008, to October 2010, he prescribed more than 5 million doses of schedule II and schedule III narcotics. He also is being charged for fraudulently billing Medicare more than $5.7 million for making patients take tests that did not fit with their symptoms. If convicted, he faces up to 20 years in prison. , a DEA task force officer, collected data through Michigan and Ohio automated prescription reporting systems and an undercover investigation into the clinic. The investigation lasted for more than 15 months. “Prescription monitoring programs are used to identify and prevent drug diversion at the prescriber, pharmacy and patient levels,” he said in an affidavit. Linares opened the physical therapy clinic, 14825 Southfield Road, a little more than a mile from the police station, but there is nothing that the police can do from a legal standpoint. According to the Michigan Department of Licensing and Regulatory Affairs, Linares still maintains his medical license “We are aware of the arrest, but we have to give him his due process,” said Rae Ramsdell, acting director of the Bureau of Professions within the licensing department. “If he is convicted, we will start our own investigation into the nature of the crime. At that point, we would decide if and for how long to suspend his license.” “There is nothing is his bond agreement that stops him from practicing medicine, only from prescribing narcotics,” said Plochinski, U.S. Attorney’s Office spokeswoman. Linares was arrested March 23. Monroe Pain Clinic was at 14750 LaPlaisance Road, Monroe, as was his house. That day, seizure warrants’ were issued for four bank accounts, seven luxury vehicles and two watercraft that were in whole or in part paid for with funds that were obtained illegally, according to the federal government. According to the affidavit, Linares’ patient load went up exponentially in recent years. An employee at his office, speaking on the condition of anonymity, said the office had about 40 patients a day in 2008. That number rose to an average of 200 a day before the clinic was closed. The same employee said employees were offered bonus payments of $25 per patient for every patient over 200 seen in a day. Patients were charged a minimum of $150 per visit. According to the affidavit, Linares said he did prescribe a lot of very powerful drugs, but that they were all needed for the patients. He also said he required all patients to fill out a questionnaire and sign an opioid agreement. Patients were coming to his office from multiple states. The affidavit said that the parking lot had vehicles in it from Kentucky, Ohio, Illinois, Pennsylvania and Tennessee, many of which contained more than two patients who each received prescriptions while in the office. <http://thenewsherald.com/articles/2011/09/01/news/doc4e5d20d83bc82732450423.txt\ ?viewmode=fullstory?viewmode=3> “He was my primary care doctor for a lot of years, then all of sudden a few years ago he stopped paying much attention to me,” former patient Domzalski told The News-Herald Newspapers. “He couldn’t figure out what was wrong with me and just ignored me, and then all this came out. I guess I know why now.” Multiple patients interviewed by the DEA said they rarely saw the doctor; one didn’t even know his name until reading the pill bottle after having it filled. Linares also has had offices in Flat Rock and Lincoln Park. He has been practicing medicine since graduating from Universidad Central Del Este in the Dominican Republic in 1981. He has been licensed as a medical doctor in Michigan since January 1983. *Contact Dave Herndon at 1- or dherndon@...<http://thenewsherald.com/articles/2011/09/01/news/doc4e5d2\ 0d83bc82732450423.txt?viewmode=fullstory/mailto:dherndonheritage> ..* via thenewsherald.com<http://thenewsherald.com/articles/2011/09/01/news/doc4e5d20d83\ bc82732450423.txt?viewmode=fullstory> Lightning Striking Eiffel Tower Is All Shades of Awesome and Frightening<http://ptmanagerblog.com/lightning-striking-eiffel-tower-is-all-shad\ es> Posted 2 days ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67899927> [image: Media_httpfastcachega_iesja]<http://posterous.com/getfile/files.posterous.com/pt\ manager/lIfxEcjwygybgqoADwycouAoiEqlHGsrIfgutoDFxpzyklCxtsCscoElflsv/media_httpf\ astcachega_IesjA.jpg.scaled1000.jpg> via gizmodo.com<http://gizmodo.com/5836559/lightning-striking-eiffel-tower-is-all-sh\ ades-of-awesome-and-frightening> California PT Notes **Special Edition** SB 543 - POPTS END RUN BY LEGISLATURE<http://ptmanagerblog.com/california-pt-notes-special-edition-sb-543-\ po> Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67939852> ---------- Forwarded message ---------- From: Bacci Date: Thursday, September 1, 2011 Subject: FW: California PT Notes **Special Edition** SB 543 - POPTS END RUN BY LEGISLATURE To: Larry Benz , Kovacek < kovacek.peter@...>, Laurie Kendall Ellis , Tim Richmond Please see below M. Bacci, PT, DPT Bacci & Glinn Physical Therapy Inc. (P) <tel:> (F) <tel:> www.bandgpt.com <http://www.bandgpt.com/> www.twitter.com/bgptbob www.facebook.com/home.php?#!/BandGPT < http://www.facebook.com/home.php?#%21/BandGPT> --------------------------------------------------------------------------------\ --------------------------------------------------------------------------------\ --------------------------------------------------------------------------------\ ---------------------------------------------------------- This e-mail contains PRIVILEGED AND CONFIDENTIAL INFORMATION intended only for the use of the Individual(s) named above. If you are not the intended recipient of this e-mail, or the employee or agent responsible for delivering this to the intended recipient, you are hereby notified that any dissemination or copying of this e-mail is strictly prohibited. If you have received this e-mail in error, please immediately notify us by telephone at <tel:> or by e-mail at bgptbob@... From: admin@... To: bgptbob@... Date: Thu, 1 Sep 2011 14:06:14 -0500 Subject: California PT Notes **Special Edition** SB 543 California PT Notes An electronic memo produced by the California Physical Therapy Association < http://www.ccapta.org/> Mark your calendar for the 2011 CPTA Annual Conference September 22-23 in Long Beach ________________________________ Physician Referral for Profit Senate President Pro Tempore Darrell Steinberg is seeking to add language to SB 543 to prevent the Physical Therapy Board of California from enforcing the law pertaining to physical therapists that are employed by medical, chiropractic and podiatric corporations. Physician-owned physical therapist services or “POPTS,” have repeatedly shown in medical literature that a lower quality of care is often provided while allowing millions of dollars in inappropriate billings to occur. Four states have now banned POPTS, and Medicare is looking carefully into new rules that will significantly restrict such practices. Further, this practice has resulted in thousands of independent physical therapy practitioners and their staff being shoved out of business, into bankruptcy, and into the unemployment line. Doctors are now using their advantage in the marketplace to: • Refer patients only to the physical therapy services they own, including NOT giving the patients the diagnosis slip they need to see a different physical therapist. They say they “can’t control the quality of care THAT physical therapist provides” or other similar excuses to “capture” the patient and bill for physical therapy services. • Seek to hire community-based physical therapy clinic owners, and threatening to put out of business those that don’t “get on board.” • Get around watered down federal and state conflict of interest laws that previously prevented physicians from self-referral and obvious conflict of interest. The ethical, business and legal aspects of these types of relationships are being closely scrutinized in terms of restraint of trade and competition, and interference with consumer choice. We need your help! Here is what you can do: Email the Physician Referral for Profit OPPOSE letter through the CPTA Legislative Action Center < http://www.congressweb.com/cweb2/index.cfm/siteid/cpta>. Your letters will protect California consumers and the future of the physical therapy profession. Thank you for participating in our efforts! For more information on Physician Referral for Profit and how you can get involved in our efforts contact Tameka Island at tisland@... or <tel:>. ________________________________ Did you know that CPTA has a webpage dedicated to health, fitness and wellness services? Click here <http://www.ccapta.org/displaycommon.cfm?an=15> to access the Practice page. If you feel you have received this message in error or if you no longer wish to receive this electronic communication, please send an email to hpino@... with <hpino@...%20with> the word " UNSUBSCRIBE TO LEGISLATIVE UPDATES " and your FULL NAME in the subject field. California Physical Therapy Association <http://www.ccapta.org/>A Component of the American Physical Therapy Association 1990 Del Paso Road Sacramento CA 95834 <tel:%28916%29%20929-2782> <tel:%28800%29%20743-2782> Fax <tel:%28916%29%20646-5960> www.ccapta.org <http://www.ccapta.org/> The Greatest Physical Therapy Playlist: Geriatrics<http://ptmanagerblog.com/the-greatest-physical-therapy-playlist-geria\ t> Posted about 23 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=68040710> PTManagers I think it is about time that this list had some fun. I am tired of Fraud, Policy and Professionalism discussions for now Here is what I propose I want each and everyone of you to identify your favorite musical song to be played in a PT or OT clinic during patient care times. You can choose whatever song you want - for whatever reason you want. You may want to pick something inspirational, motivating, or just a song that you or your patients like. Remember this first one is for Geriatric patients - I doubt that rap or hip hop will be very popular. Just pick what you and your patients like. First we'll do Geriatric patients [others later] Send a response to the PTManager list [just reply to this message] with: Name of the Song Artisit No reason to justify your choice or even explain it I will compile the entire playlist Most of all - have fun with this Kovacek, PT, DPT, MSA PKovacek@... Cell (313) 492-4293 Personal Fax www.PTManager.com [image: Posterous] <http://posterous.com> Want your own?<http://posterous.com> Change your email settings<http://posterous.com/email_subscriptions/hash/gspsqucxgqviGogjvCufJwAxB\ xkgmH> Quote Link to comment Share on other sites More sharing options...
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