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Kentucky dentist who pulled good teeth sentenced to prison | Lexington Herald Leader

MM Curator summary:

 
 

A Kentucky dentist plead guilty to stealing $70,000 from Medicaid in an upcoding scheme.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Crime


By Bill Estep

December 17, 2020 09:27 AM

An Eastern Kentucky dentist who admitted getting higher payments from Medicaid through inflated bills has been sentenced to four months in prison.

Denver “Dickie” Tackett also must serve six months of home detention after his prison sentence, repay $70,012 to Medicaid and pay the government $20,000.

U.S. District Judge Gregory F. Van Tatenhove sentenced Tackett on Tuesday.

Tackett, who practiced for more than 30 years at McDowell, in Floyd County, pleaded guilty in August to a charge of health care fraud.

Tackett acknowledged that he submitted claims for treating patients that were not reasonable and necessary between 2003 and 2018.

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One example was that he filed claims to be paid for performing more complex surgical tooth extractions when he had only done simple extractions, which were reimbursed at a lower rate, according to the plea agreement.

Tackett billed Medicaid for some medically unnecessary procedures; submitted claims for providing emergency care without sufficient justification; and filed claims to get paid for procedures related to an earlier unnecessary extraction, the plea agreement said.

Tackett acknowledged pulling people’s teeth when it wasn’t necessary, but his attorney, Andrew L. Sparks, said patients asked Tackett to do that.

It was not uncommon for people to ask to have their teeth pulled while the service was covered by Medicaid out of concern that they would lose coverage later, Sparks said in a sentencing memorandum.

The indictment in the case also charged Tackett with 15 counts of improperly distributing opioid pain pills, but those charges were dropped as part of the plea.

Sparks sought probation for Tackett, noting letters of support that described Tackett as a caring, dedicated dentist who worked long hours to help people, treated patients even if they couldn’t pay and sometimes paid for a patient’s prescription.

One woman described how her son damaged a front tooth playing basketball and Tackett opened his office at 7 p.m. on Christmas Eve to treat him, saving the tooth.

Tackett, who is an ordained minister through the United Methodist Church and the Assembly of God Pentecostal Church, was not motivated by a desire for wealth, according to the sentencing memo.

“Dr. Tackett’s history and characteristics show a man dedicated to his faith, his family and his patients,” the memo said. “These letters make clear that Denver Tackett is a good and decent man.”

Sparks argued Tackett had been punished enough by losing his practice.

Prosecutors argued for a sentence of 18 to 24 months, saying the health care system depends on providers being trustworthy and assumes that they will only bill for necessary services they actually perform.

A review by a consultant at the University of Kentucky showed a pattern by Tackett of prolonging treatment and performing procedures patients didn’t need, resulting in payments to him, prosecutors said.

Prosecutors also argued that prescriptions Tackett wrote for opioid painkillers played a role in the drug problem.

“Several of these patients told investigators that they became addicts as a result of Dr. Tackett’s prescriptions or that Dr. Tackett contributed to their addictions by continuing to prescribe controlled substances to them,” prosecutors wrote.

Tackett was among 60 health providers in seven states charged in April 2019 as part of an investigation of alleged improper prescribing.

Some other providers charged in Kentucky in the roundup have also been convicted.

Clipped from: https://www.kentucky.com/news/local/crime/article247913615.html

 
 

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Two area home health agency owners charged in health care fraud and illegal kickback scheme | Woodlands Online

MM Curator summary:

 
 

Charlz and Angela Bisong of Texas paid Medicare members to sign up for unneccessary services so they could steal $10M from Medicare.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

HOUSTON, TX — Two home health agency owners are set to appear in federal court on charges they fraudulently billed more than $10 million to Medicare, announced U.S. Attorney Ryan K. Patrick.

Authorities arrested Tataw Charlz Bisong and Angela Bisong, both 57 and from Stafford, today. They are expected to make their initial appearances before U.S. Magistrate Judge Frances H. Stacy at 2 p.m.


A federal grand jury in Houston returned the indictment under seal Dec. 9, which was unsealed today. It alleges the Bisongs co-owned SierCam Healthcare Services LLC. From 2012 through 2020, SierCam allegedly billed Medicare for home health services that were not medically necessary and often not provided as billed to Medicare. The charges allege the Bisongs paid SierCam patients to sign up for medically unnecessary home health services and provided free transportation and covered the copayments and other fees at doctor’s office visits to facilitate their health care fraud scheme. Additionally, the Bisongs created phony medical records to make it appear the services met Medicare’s criteria for reimbursement, according to the indictment.


Charlz and Angela Bisong are both charged with one count of conspiracy to commit health care fraud, six counts of health care fraud and one count of conspiracy to pay and receive health care kickbacks.


Conspiracy to commit health care fraud and each of the six counts of health care fraud carry a maximum sentence of 10 years in federal prison and a maximum $250,000 possible fine, upon conviction. If convicted of conspiracy to pay and receive health care kickbacks, they also face up to five years in federal prison and a possible $25,000 maximum fine.


The FBI, Department of Health and Human Services?Office of Inspector General and Texas Attorney General’s Medicaid Fraud Control Unit conducted the investigation. The Stafford and Sugar Land Police Departments assisted in the arrests. Special Assistant U.S. Attorney Kathryn Olson is prosecuting the case.


An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.

 
 

 
 

Clipped from: https://www.woodlandsonline.com/npps/story.cfm?nppage=68674

 
 

 
 

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Centene Is Climbing on Its Plans to Buy Magellan Health for $2.2 Billion

MM Summary

Centene adds a giant pharmacy services component with the purchase of Magellan.

M&A activity continues to pick up in the health-care space.

Centene (ticker: CNC) announced Monday that it will pay $95 per share for Magellan Health (MGLN), a 14.7% premium over Magellan’s closing price last Thursday of $82.84. Shares of Magellan were up 12.3%, to $93.00, in early trading on Monday.

Shares of Centene, meanwhile, were up 1% at the open of trading Monday, to $60.62.

The deal comes a year after Centene closed its $17.3 billion acquisition of WellCare Health Plans, another insurer focused on government-sponsored health plans. Centene is one of the largest players in that sector, with a managed care membership of 25.2 million people, with roughly half of them enrolled in Medicaid plans.

Centene said that it expects the Magellan deal to bring in 5.5 million members on government-sponsored plans, 2 million members of Magellan’s pharmacy benefit manager plans, and a behavioral health platform with 41 million members, among other businesses.

“This acquisition accelerates our diversification strategy and enhances our ability to build next generation capabilities in our specialty care business by leveraging our scale and investments in technology,” said Centene CEO Michael Neidorff in a statement.

In an interview with Barron’s on Monday morning, Neidorff said that he chiefly wanted Centene to have access to Magellan’s behavioral-health network, which contracts with states, employers, and other insurers to offer various behavioral health care services.

Behavioral health is probably the most underserved area,” Neidorff said. “This gives us access to a very broad network… It gives them access to our technology.”

Neidorff said that Magellan will be treated as an independent company within Centene, and that outside clients will have equal access to its behavioral-health product.

“If you have a newly diagnosed diabetic, after they see their endocrinologist, they should go see a psychologist to help them deal with it,” Neidorff said. “You end up with better compliance and a healthier situation.”

Neidorff said that he expects the deal to close in the second half of the year.

On an analyst call Monday, Neidorff said that regulatory approval for the deal wouldn’t pose a major challenge. “It’s complex, but it’s something we’re very used to. We’ve had some that are far more complex,” Neidorff said. “I don’t anticipate any divestitures.”

Magellan recently sold off its Magellan Complete Care business, which offers Medicaid and Medicare plans in certain states, to Molina Healthcare (MOH) for $820 million. Molina Healthcare announced Monday that the transaction closed last Thursday.

In the interview with Barron’s, Neidorff said that the sale of that business was necessary to allow regulatory clearance of the deal.

The immediate reaction to the deal from Wall Street analysts appears to be positive. In a note out early Monday, Cantor Fitzgerald analyst Steven Halper said the transaction looked good for Centene.

“We believe [Magellan Health] is a solid acquisition with modest near term accretion,” Halper wrote. “The company’s leverage ratios will certainly increase again, but given a relatively low cost of capital, the company should be able to drive incremental returns.”

Shares of Centene were down 1.8% over the past 12 months, as of Friday’s close. The stock trades at 11.4 times expected earnings over the next 12 months, according to FactSet, below its five-year average of 14 times earnings. Of the twenty-one analysts who cover the stock tracked by FactSet, 19 rate it a Buy or Overweight, while two rate it a Hold.

Clipped from: https://www.barrons.com/articles/centene-is-climbing-on-its-plans-to-buy-magellan-health-for-2-2-billion-51609771065

 
 

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Data Set Review- 2020 MACStats Data Book

Summary

While MACPA puts out a Medicaid and CHIP data book each year, this one is especially important because it is the first one to use the T-MSIS data. If you watch Macpac.gov throughout the year, you will have seen much of the components of this compilation.

What’s in it

166 pages of charts and key statistics about all aspects of the Medicaid and CHIP programs, including data on:

  • Enrollment (including demographics trends)
  • Spending (health services and administrative)
  • Eligibility levels by state
  • Utilization

A detailed explanation of methodology used by the research team, including specifics on:

  • The use of the T-MSIS data
  • Adjustments for spending data
  • A section on understanding managed care enrollment and spending data

Data sources included

National Health Interview Survey (NHIS)

The National Health Interview Survey (NHIS) has monitored the health of the nation since 1957. NHIS data on a broad range of health topics are collected through personal household interviews. Survey results have been instrumental in providing data to track health status, health care access, and progress toward achieving national health objectives.

https://www.cdc.gov/nchs/nhis/index.htmv

The Medical Expenditure Panel Survey (MEPS)

The Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States. MEPS is the most complete source of data on the cost and use of health care and health insurance coverage.

https://meps.ahrq.gov/mepsweb/

Transformed Medicaid Statistical Information System (T-MSIS)

The T-MSIS data set contains:

  • Enhanced information about beneficiary eligibility
  • Beneficiary and provider enrollment
  • Service utilization
  • Claims and managed care data
  • Expenditure data for Medicaid and CHIP
https://www.medicaid.gov/medicaid/data-systems/macbis/transformed-medicaid-statistical-information-system-t-msis/index.html

Key implications of this data set

The trends section allows for some macro observations:

  1. The percent of Aged, blind or disabled members of the program was 28% in 1975. In 2018 it was 18%- giving credibility to the argument that the Medicaid program has experienced significant mission drift over the past 40 years or so.
  2. The financial burden of Medicaid on states has doubled in the past twenty years, despite unprecedented levels of federal funding under the Affordable Care Act enhanced reimbursement for Medicaid expansion. In 1992, states spent 10% of their own money on Medicaid (as a percent of their entire state budget). In other words, 1 out of every 10 state dollars went to Medicaid. In 2018, it was 20%. Meaning 1 out of every 5 state dollars now must be spent on Medicaid.
  3. While trending data is not provided, it is interesting to see the percentages of Medicaid funds spent by benefit type. In descending order:
    1. Fee for service / direct payments
      1. Facilities – 22.5%
        1. Hospitals (13%)
        2. LTSS (“nursing homes”)- Institutional (9.5%)
        3. Clinics and health centers (2%)
      2. Providers – 14%
        1. Physicians (1.3%)
        2. Dentists (0.007%)
        3. Other practitioners (0.003%)
        4. LTSS- Home and Community Based (13%)
      3. Other acute services (7%)
      4. Drugs (0.008%)
    2. Managed Care – 50%
    3. Medicare Premiums – 3%