NHCAA SmartBrief
La. chiropractor pleads guilty to $3M COVID-19 test scheme | Medical supplier accused of upcoding Medicaid claims | Fla. veteran receives 33-month sentence for benefit fraud
Created for np3kckdy@niepodam.pl |  Web Version
January 14, 2025
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La. chiropractor pleads guilty to $3M COVID-19 test scheme
(Pixabay)
Chiropractor Dennis Peyroux of Slidell, La., has pleaded guilty to conspiracy to commit health care fraud, admitting to a scheme that involved billing Medicare $3.3 million for over-the-counter COVID-19 test kits that were not requested. Peyroux worked with others to buy Medicare beneficiary information and fabricated recordings of supposed beneficiaries, and misappropriated a former nurse practitioner's credentials to submit false claims, for which he received $3.2 million in reimbursements, officials said.
Full Story: Department of Justice (1/13) 
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Law Enforcement & The Courts
Benson Ejindu has been accused by North Carolina and the federal government of submitting false claims to Medicaid through a durable medical equipment business from 2017 to 2019. The complaint says Ejindu knowingly upcoded claims for specialized nutritional formulas while providing cheaper products such as Ensure and Boost.
Full Story: WJZY-TV/WMYT-TV (Charlotte, N.C.) (1/13) 
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Kevin McMains of Milton, Fla., has been sentenced to 33 months in prison for defrauding government benefit programs of more than $779,000 over about 14 years. Authorities say that McMains, a veteran, submitted false claims of service-related injuries and documentation, including a fake Purple Heart award, to receive disability benefits from the Department of Veterans Affairs, Social Security Administration and Medicare.
Full Story: WKRG-TV (Mobile, Ala.) (1/13) 
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Policy & Regulatory News
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Tools & Technology
Va. bills target AI in health care, other sectors
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Legislation in Virginia aims to regulate high-risk AI systems in sectors including health care. The measure would require AI developers to document technology origin and development history, making that information publicly available; create consistent definitions of terminology related to AI tech; and outline responsibilities for those that distribute and integrate AI systems. A companion bill would establish requirements for public bodies using AI.
Full Story: Virginia Mercury (Richmond) (1/13) 
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Amazon Web Services and General Catalyst, a venture capital firm, have formed a multi-year collaboration to accelerate development of artificial intelligence tools for health systems. General Catalyst portfolio companies Aidoc and Commure will be the first to use AWS services to create AI solutions, addressing challenges such as staff burnout and labor shortages.
Full Story: CNBC (1/13) 
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Health Insurance Industry News
House Republicans are considering a list of potential spending cuts totaling $5.7 trillion, meant to support President-elect Donald Trump's initiatives, which include border security and tax cuts. The proposed cuts are not a formal proposal but rather a "menu" of options for members to consider and target the Affordable Care Act and Medicaid. The cuts to Medicaid could save an estimated $2.3 trillion, lawmakers say, by implementing per capita caps for states, shifting Medicaid from an open-ended entitlement to a population-based model, and instituting work mandates.
Full Story: Politico (1/10) 
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Medical News