Addiction Recovery Care says it’s cooperating with FBI investigation into possible fraud

Addiction Recovery Care, Kentucky’s largest provider of
drug and alcohol treatment, has offices and other facilities
 in Louisa. (Kentucky Lantern photo by Matthew Mueller)

By Deborah Yetter
Kentucky Lantern

Kentucky’s largest provider of addiction treatment services, Addiction Recovery Care, or ARC, is the subject of an FBI investigation into possible health care fraud, according to a July 30 post on a website of the federal agency’s Louisville office.

ARC, which is funded almost entirely through Kentucky’s Medicaid program, has not been charged with any crime but the agency is asking people with information to fill out an online form “if you believe you were victimized by ARC or have information relevant to this investigation.”

ARC, a for-profit company based in Louisa, and whose CEO and affiliates have emerged as prolific political donors in recent years, said in a statement from spokesman Kyle Collier that it is cooperating with the FBI.

“We have recently learned that there is a federal investigation into ARC,” the statement said. “As we all know, healthcare is one of the most highly regulated fields in the country, and addiction treatment is among the most highly scrutinized healthcare services. ARC is a trailblazer in the field of addiction services. We are confident in our program and in the services we offer. We, and our legal counsel, are cooperating fully in the investigation.”

Collier directed further inquiries to ARC’s chief legal officer, Jessica Burke, who provided a similar statement.

ARC has developed a reputation for aggressive expansion since it was launched by Tim Robinson, a Lawrence County lawyer who founded the company with a single halfway house for alcohol treatment in 2010. Fueled by the availability of new Medicaid funds for substance use disorder treatment since 2014 under the Affordable Care Act, ARC operates some 1,800 treatment beds in 24 counties and reaches hundreds more clients through outpatient services, the Kentucky Lantern reported in July.

Last year, ARC took in $130 million in Medicaid funds, the government health plan which gets most of its money from the federal government, making it by far the state’s largest provider of substance use services.

Robinson and his wife, Lelia, own ARC and some related entities which provide them with an annual income of $533,400, according to a 2022 tax filing of a related non-profit company, Odyssey Inc.

The company has been singled out for praise by politicians including Kentucky Gov. Andy Beshear, who spoke at an ARC ribbon cutting for a new ARC facility in March.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said.

He also praised Robinson, ARC’s founder, in his State of the Commonwealth speech in January.

“With us today,” Beshear said, “is Tim Robinson, founder and CEO of ARC, an essential partner in our fight against addiction. … I’m proud to say we now have more treatment beds per capita than any other state in the country.”

From mid-2021 through the end of 2023 Robinson, his corporations and employees gave at least $252,500 to political committees supporting Beshear, according to reporter Tom Loftus’ analysis in the Kentucky Lantern of campaign finance records.

The donations to Democrat Beshear were a shift in the giving pattern for Robinson, a lifelong and loyal Republican. He also gave big to Beshear’s opponent in the 2019 governor’s race, Republican incumbent Gov. Matt Bevin.

The Lantern’s analysis shows that — including money contributed to Beshear committees — Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew.

He also has donated to Kentucky Republican lawmakers, including some who wrote recent letters on ARC’s behalf, asking that rate cuts proposed to ARC and other addiction providers be suspended until further study.

The rate cuts of 15% to 20% proposed by three of the six private insurance companies that process state Medicaid claims became public recently at a legislative hearing. ARC and another provider told lawmakers that such cuts would devastate Kentucky’s efforts to turn the tide of addiction to drugs and alcohol.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for ARC, told a July 30 legislative committee. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

Six national insurance companies known as managed care organizations, or MCOs, handle the majority of the state’s $16 billion a year Medicaid business. Under contracts with the state, they are paid a fixed rate per member to cover the cost of care.

Brown, the ARC official, told lawmakers this is no time to cut payments for addiction services, citing some indicators of success.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest annual overdose report, released in June, shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

In a statement released after the hearing on the cuts, the Kentucky Association of Health Plans, which represents the MCOs, said its members “are proud to work collaboratively with quality, trustworthy providers of behavioral health and substance use disorder treatment” and access to those services is “top of mind” to ensure those in need receive care.

“Health plans strive for the best networks possible and are encouraged by the state to prioritize plan member outcomes and value-based care,” it said.

The FBI posting on the website seeking information on ARC does not provide further information about the nature of the investigation,

A spokeswoman did not immediately respond to a request for comment.

A questionnaire people are asked to fill out includes several questions including whether they have been or are a patient at ARC and if so, what services were received. It also asks whether the person responding has ever made a complaint before about ARC and if so, to whom.

Norton Healthcare says it will alert 2.5 million patients whose personal information may have been compromised by cyberattack

Image from Spectrum News

About two and a half million people may have been affected by a ransomware attack on Norton Healthcare, the Louisville hospital company said Tuesday. It said they will get letters soon, alerting them that the attack "exposed a wide array of sensitive information," Valerie Chinn of WDRB reports.

The attack occured May 7-9. Norton spokeswoman Renee Murphy declined to tell WDRB how the incident was resolved. She said "We did not make any ransom payment" but would not say whether "the stolen information was returned as a result of an insurance claim," WDRB reports.

Last week, for the first time, Norton said it was the victim of a ransomware attack, had notified federal law enforcement officials and was "working with a respected forensic security provider to investigate and terminate the unauthorized access." It said its medical-record system and MyChart system for patients were not violated.  

However, Norton said the accessed files included personal information "primarily" about patients, employees and dependents. "Impacted information varied from person to person, and may have included name, contact information, Social Security number, date of birth, health information, insurance information, and medical identification numbers, Norton said. Driver's license numbers and other government ID numbers, financial account numbers or digital signatures may have also been included in the data," WDRB reports.

Norton said "Individuals whose information may have been impacted can sign up for two years of credit monitoring by following the instructions in written notification letters that are being mailed." It urged them to "remain vigilant and continue reviewing account statements for unusual activity."

Adrian Lauf, a computer science and engineering professor at University of Louisville, told WDRB that the compromised information suggested that insurance fraud is a possible threat, so past Norton patients shoulkd watch out for fraudulent insurance claims.

"Lauf also said to err on the side of caution, and suggests contacting a national credit bureau to either submit a fraud alert and/or initiate a credit freeze," WDRB reports. "He also suggests to verify or double-check and unknown numbers or emails that contact you."

Norton said the incident's "nature and scope . . . required time to analyze, a process that was substantially completed in mid-November."

A federal class-action lawsuit filed against Norton July 21 by employees and patients whose personal information was stolen from Norton's servers alleges that the company failed to notify those affected or the attorneys general of Kentucky and Indiana. A similar lawsuit was filed Dec. 14 "on behalf of Margaret Garrett of Crestwood and others nationwide who are or were patients or were affiliated with Norton," WDRB reports. Murphy told the station, "We take safeguarding personal information seriously and plan to vigorously defend ourselves in any litigation associated with the ransomware attack."

WDRB notes, "A hacker group called BlackCat claimed responsibility for the attack and leaked files as proof. . . . Employees' names, social security numbers and birth dates as well as patients' personal information, credit card numbers and medical history are contained in documents obtained by WDRB News and available publicly on the dark web, a corner of the internet accessible via specialized web browsers. They had not been redacted, and appear to be authentic.

"The documents appeared to show a large amount of Norton's financial information, including operating accounts and payroll accounts with a balance of tens of millions of dollars, credit card information, confidentiality agreements, patient imaging orders, vendor and bank information and business invoices. Norton serves about 600,000 patients a year with nearly $5 billion in assets."

Beware of scams citing Medicare, Medicaid, other health plans

By Kentucky Voices for Health

Fall brings open enrollment season, and while this year looks a little different with the ongoing renewals for Medicaid enrollees, scammers are still busy targeting Kentuckians looking for Medicare, Medicaid, or marketplace plans.

Medicare open enrollment runs through Dec. 7. There are a number of things to be excited about this year including a new cap on insulin costs, more covered vaccines (including the updated 2023 Covid-19 vaccine and the new RSV vaccine for seniors), and a cap on out-of-pocket drug costs that will start when coverage begins in 2024. But misleading marketing and unsolicited calls continue to plague members. Fortunately the Centers for Medicare and Medicaid Services is enforcing new advertising rules that are designed to cut down on the confusion.

We also continue hearing about increased scam attempts since Medicaid renewals returned earlier this year. With redeterminations on hold since the pandemic began, many members are new or unfamiliar with the renewal process and scammers are looking to take advantage. While it’s very possible that Kentucky Medicaid will need new information from you to complete your renewal, remember you will never have to pay to complete your renewal.

Lastly, open enrollment for health coverage from the Kynect marketplace begins Nov. 1. With Medicaid disenrollments, this will likely be a big year for enrollment in Kynect's qualified health plans. Beyond scam attempts, marketplace enrollees should also take careful consideration of so-called “junk plans.” These short-term plans are intended to fill temporary coverage gaps, but some exploit this loophole to offer cheap plans that come with usage restrictions, hidden fees, and major coverage limitations. It’s always important to do your research and remember that if something sounds too good to be true, it probably is.

Regardless of coverage, all enrollees need to be on guard for outright fraud and identity theft. If someone calls claiming to be from the government, but lacks your Medicare, Medicaid, or Social Security numbers or asks for credit card or banking info, it’s probably time to hang up. If something seems off, it's always best to make contact yourself through a verified channel and make changes directly rather than offering your personal info immediately to someone you don’t know.

Aleria Companies and bankrupt Trinity HealthShare told to pay $4.7 million in Lexington class-action lawsuit that is still going on

"A purported health care cost-sharing company . . . has lost a class-action lawsuit resulting in a nearly $4.7 million judgment" in U.S. District Court at Lexington, reports Jeremy Chisenhall of the Lexington Herald-Leader. 

After representatives of The Aliera Companies "failed to appear in court multiple times, according to records, Senior Judge Joseph M. Hood "declared that the company should have been subjected to Kentucky insurance laws because their claims of selling health care sharing ministry plans were inadequate," Chisenhall reports. "Members in health care sharing ministries share medical expenses among themselves. Health-care sharing ministry plans aren’t subject to the same regulations as insurance, but they have to meet strict requirements. Aliera didn’t meet those requirements, Hood ruled."

Jay Prather, one of the plaintiffs' attorneys, said “Aliera and its partners have taken advantage of hundreds of Kentuckians, many of whom trusted the company because it professed Christian beliefs. “Aliera’s customers sought affordable healthcare coverage to protect their families in times of need. But when those times of need came, Aliera was more likely to shut the door in the face of its own customers. This ruling by Judge Hood is the first step in helping those families recover what they have lost.”

"Aliera created, marketed, sold and administered health care plans for Unity HealthShare and Trinity HealthShare, companies that were purported to be health-care sharing ministries, according to the lawsuit. Unity HealthShare later rebranded itself as OneShare Health, according to court records," Chisenhall reports. "Hood sided with the victims that purchased a plan while Aleria was partnered with Trinity. Assuming each policyholder would elect to receive the higher payout of those two options, Hood reached an aggregate judgment of $4.7 million, according to court records. Trinity has since filed for bankruptcy, according to court records."

The lawsuit continues because Hood's ruling applies only to policies sold through Trinity. Attorneys for the plaintiffs said Aleria sold plans to "hundreds, if not thousands, of Kentucky residents" and kept 84 percent of their payments. Conversely, insurance companies are required to pay out 80% of the premiums they received, but the law doesn't apply to health care cost-sharing companies.

Aleria denies that it was a health care cost-sharing company. It said in a court filing, “It is a for-profit entity that contracted with Unity and then Trinity (through its subsidiaries) to market memberships in their sharing programs and to create processes to facilitate member-to-member sharing of medical expenses. Aliera has created a system that is designed to afford members the ability to consent to their contributions being shared on a real-time, case-by-case basis with other members as their needs arise. But, as previously noted, all members are informed that their requests for sharing payments may not be met — there are no payment guarantees or indemnification.”

As case numbers and positive-test rates tick up, Beshear warns a fourth wave is possible, pleads with Kentuckians to get a vaccine

Kentucky Health News graph from initial, unadjusted daily case reports

By Melissa Patrick

Kentucky Health News

Citing rising case numbers and percentage of positive tests, Gov. Andy Beshear said Thursday, “It is at least a warning that a fourth wave is possible here. . . . We can prevent it. We should prevent it. It requires people to get vaccinated and continue to mask up."

 

The state reported 834 new cases of the coronavirus on Thursday, bringing the seven-day rolling average to 614, which is higher than yesterday, but lower than Tuesday (although that included last week's backlog). The average is now what it was on March 25. 

"There's reason to be concerned, with so many other states seeing an uptick in cases," Beshear said. "We are so close to the end, and . . . now that we have vaccines, there's no excuse not to get everyone to the finish line. Let's make sure that a family doesn't have to grieve because we weren't willing to wear a mask for the last month, month and a half, we weren't willing to do what it takes to get there; we weren't willing to get our own vaccine, not because we were against it, but we just didn't think this thing would hurt us in particular. Let's make sure that we continue to do the right things." 

Beshear said 166 of Thursday's new cases were in Kentuckians 18 and younger, and that 47 of those were between 16 and 18, an age-group that recently became eligible for vaccination. 

The percentage of Kentuckians testing positive for the virus in the past seven days is "ticking up and up and up," said Beshear. Thursday, it was 3.45%, higher for the sixth day in a row. 

The seven-day average of daily new cases has gone up nine days in a row, from a low of 9 cases per 100,000 residents on April 6. On Thursday, that rate was 12.23 cases per 100,000 people, the highest it's been since mid-March. The New York Times data tracker ranks Kentucky's rate 35th among the states.

Counties with rates double the statewide rate were Bracken, 55.1 cases per 100,000 residents; Lewis, 47.4; Bath, 43.4; Harlan, 39; Mason, 34.3; Wolfe, 33.9; Robertson, 27.1; Morgan, 26.8; and Todd, 24.4.

Hospital numbers were down a bit today, but Beshear noted that they starting to trend up a bit. In Kentucky 416 people are hospitalized with Covid-19, four fewer than yesterday, with 102 of them in intensive care (down 13); and 49 of those on a ventilator (down two). 

Two of the hospital readiness regions have 80% or more of their intensive-care beds occupied: Lake Cumberland, at 80% and the easternmost region, from Pike County to Lee County, at 83.8%. 

Beshear said 1,662,924 Kentuckians have received at least one dose of a coronavirus vaccine, with 46% of those 16 and older having received at least one dose, and 48% of those 18 and older. 

Beshear has said he will lift capacity limits on most businesses and activities when 2.5 million Kentuckians receive at least one dose of a vaccine, which is 70% of the state's adult population.  

"We're not trying to set a goal to force anybody to do something, that just is when it becomes safer," he said. "It's math and science. Math and science aren't political." 

He said 877,076 more Kentuckians are needed to reach that goal, and with 499,735 doses of the Pfizer BioNTech and Moderna vaccines available this week, "We can get more than halfway of the distance left to get to our 2.5-million vaccination challenge and lift restrictions this week if everybody would go out and sign up." 

That would be almost a quadrupling of the state's recent vaccination rate. Over the last three weeks, 125,000 to 130,000 Kentuckians were vaccinated each week. 

In noting vaccination sites with many open slots, he pointed to the Christian County Health Department, which serves in a county that has state's second- lowest rate of fully vaccinated people: 12.4%, according to the Centers for Disease Control and Prevention. Spencer County remains last, at 11.1%. Woodford County has the highest rate, 37%. 

Beshear stressed that there are thousands of vaccine slots available in every region of the state. Click here to find a location near you. "Remember, we are in a race against these variants," he said. "We have to vaccinate and as quickly as possible."

Calling it a miracle, Beshear noted that vaccines have virtually eliminated Covid-related deaths in long-term care facilities. He added that deaths in all congregate settings, which include prisons, have dropped from 68% of the state's total at one time to under 38%. 

The governor reported only four new resident cases and six new staff cases in long-term care facilities, for a total of 48 active resident and 79 active staff cases. He reported no new deaths. So far, there have been 2,281 Covid-related deaths in long-term care. 

Beshear reported 17 new deaths from the virus on Thursday, all of them from regular health-department reports and none from an ongoing audit of death certificates. That brings the total to 6,302.

The fatalities included two Barren County men, 40 and 61; a Bell County woman, 66; a Caldwell County woman, 49; a Clinton County woman, 83; a Cumberland County man, 89; A Garrard County man, 83; a Grayson County man, 70; a Henderson County woman, 73; a Jessamine County woman, 61; a Laurel County woman, 68; a Madison County man, 63; a Meade County woman, 68; a Mercer County woman, 85; a Muhlenberg County woman, 44; a Pike County man, 56; and a Whitley County woman, 83. 

Gill Scott

Memorial: Today, Beshear honored the life of Gill Scott, who died from Covid-19 on March 26. Beshear said Scott was one of nine children and was born and raised in Adair County. He moved to Louisville as a teenager, where he met and married his wife of 60 years, Mary. Beshear said Scott loved his family, the outdoors and God. 

"Remember, these are the souls that we lose right now in the fourth quarter in defeating this virus. If we let up, we lose somebody special," Beshear said.

Based on CDC data that estimates the biweekly prevalence of variant cases among more than 40,000 genomic sequences done Jan. 3 to March 27, Becker's Hospital Review reports that the proportion of the highly contagious B.1.1.7 variant, first identified in the United Kingdom, is 18.7 percent in Kentucky. It is the dominant variant in the U.S.

Using the CDC data tracker, Becker's ranks Kentucky 19th in percentage of distributed vaccines that have been administered, 80.46%. It ranks Kentucky 21st for percentage of residents fully vaccinated, 24.87%.

In other pandemic news Thursday: 

• Counties with 10 or more new cases were Jefferson, 149; Fayette, 54; Warren, 49; Daviess, 33; Henderson, 29; Boone, 24; Kenton, 20; Harlan, 18; Christian, 17; McCracken, 16; Hardin and Mason, 14; Bracken and Oldham, 13; Clark and Knox, 12; Pulaski, 11; and Jessamine, Logan and Whitley, 10. 
• Alex Acquisto of the Lexington Herald-Leader takes a deep dive into the myths and challenges faith leaders in Harlan County have dealt with as they work to get their followers vaccinated. “A lot of people are worried about control. That the mask mandate, the social distancing, right down to the vaccine [are ways] they think that the government is out to control them,” Sean Daniels, pastor at Friendship Missionary Baptist Church in Cawood, told Acquisto. “People really don’t like to be told what to do.”
• The Herald-Leader offers tips on to avoid scammers who are targeting Americans who need help paying for funeral expenses for loved ones who have died from Covid-19. 
• McClatchy News reports that a top Food and Drug Administration scientist has said that coronavirus vaccines should provide protection against Covid-19 for at least nine months, and a booster shot may become necessary after that. 
• Sarah Ladd of the Louisville Courier Journal writes about what the pause in Johnson & Johnson vaccine means for Kentucky. 
• University of Louisville researchers have received $8.6 million from the Centers for Disease Control and Prevention for coronavirus wastewater research, WDRB reports. Researchers are already testing wastewater for coronavirus in Jefferson County, which will help them estimate how many people in the neighborhoods being tested have the virus. “This could revolutionize the way we track and contain pandemics, and not just Covid-19,” said Aruni Bhatnagar, a U of L professor of medicine. “It gives us an invaluable tool that could offer a clearer view of where and how the virus spreads.”
• The CDC told CNN that about 5,800 out of nearly 77 million people vaccinated for the coronavirus have contracted Covid-19 afterward. Of those, 396 have required hospitalization and 74 have died. CNN reports that the CDC will be looking for clues about who is most prone to become re-infected despite having been vaccinated. "Vaccine-breakthrough infections were reported among all people of all ages eligible for vaccination. However, a little over 40% of the infections were in people 60 or more years of age," the CDC said. Questioned about Kentucky, Beshear said he did not have an exact number of "breakthrough" cases in the state, but said there had been "a couple."
• Click here for Thursday's press release that includes an unemployment-insurance update, including information about the 13 regional career centers opening to in-person appointments, federal tax refunds, and the temporary shutdown for security reasons over last weekend.
  

Virus cases set a record, deaths a near-record; Beshear says he might ask that all Ky. social gatherings stop for a week or two

Kentucky Health News graph, based on numbers in initial, unadjusted daily reports

By Melissa Patrick
Kentucky Health News

Kentucky had the highest day of new coronavirus cases and second highest number of deaths Wednesday, reporting 1,487 new cases and 21 deaths.

"The third escalation is very real and it's very concerning. It’s already more concerning than the [escalation] we had in July,” Gov. Andy Beshear said at his daily briefing.

The state recorded 2,398 new cases on Oct. 7, but that included 1,426 backlogged cases from Fayette County.

Beshear listed the reasons why the current surge is so much more concerning. The escalation is starting at a significantly higher number of cases; the whole country is experiencing an escalation at the same time; the state's hospitalizations, intensive-care occupancy and deaths are all increasing; and because this surge is happening when the weather is getting colder and people are moving inside, the risk of virus spread becomes even greater. 

Beshear said there is still much to learn about the virus, "but we do know how to stop the spread," which includes wearing a mask, limiting contacts and keeping gatherings small.  

"Think about it," he said. "It's like being in a challenge or a battle of your lifetime. It's like being in a war, because we are at war with this virus. Except, you know 100 percent how to win. And the question is, are you going to execute the plan to win?"

Beshear said 794 people are hospitalized with covid-19, an increase of 18 from Tuesday and another record. He said 203 are in intensive care and 94 are on a ventilator. 

Citing the latest White House Coronavirus Task Force report, Beshear called on Kentuckians in the most dangerous red and orange zones to stop holding social gatherings with anyone outside their immediate families. The state's current guidance limits non-commercial social gatherings to 10 or fewer people.

Beshear often says he has rules in place that will work, if only people will follow them, but today he suggested that he might consider asking Kentuckians to stop all social gatherings for a short while.

"It may be, if we continue to see our numbers going up the way they are," he said, "we may need to ask that we have a period of a week or a couple of weeks where we just don't have any of these backyard barbecues or the rest at all, because we can over the course of a couple of weeks make a real impact in the spread of this virus, but we got to be willing to.

To demonstrate how small social gatherings can lead to an outbreak, Beshear offered examples from Kentucky's contact tracers in September and October. One wedding was connected to 44 cases, a family gathering was connected to 14 cases, a college party was connected to 63 cases, a bingo-hall event was connected to five cases, a yard sale was connected to seven cases, a funeral was connected to six cases and a coffee gathering was connected to eight cases and two deaths.

"There is so much spread at family gatherings, events at the house, weddings and funerals. It's where we are seeing a huge amount of spread," Beshear said. “What we need at the very least is for people to be a lot more cognizant of the danger of these gatherings, a lot more diligent in making sure that everybody wears the mask the whole time that they are at one of these."

Beshear acknowledged many Kentuckians feel like they've had enough of the virus and its restrictions, but said, "It hasn't had enough of us. And so, while it's tough, I need you to do these things," including wearing a mask, social distancing, washing hands, staying home if sick and getting tested for the virus.

The governor mandated mask wearing indoors in early July, but compliance has been spotty. He said Wednesday, "The effectiveness of any steps we take depend on the number of people who are willing to follow them."

The share of people testing positive for the virus in Kentucky in the last seven days was 4.99%. 

Beshear announced 21 more deaths from covid-19, the second highest number yet, bringing the state's death toll to 1,363. 

Beshear honored the life of Ed Pantoja of Louisville who died at 84 from covid-19 in September. He said Pantoja was married for 60 years, a father of three, ran 20 miles a week and worked out daily at the gym. His son asked the governor to share his father's story and emphasized the importance of wearing a mask, saying, "Those who knew Ed loved him." 

In other covid-19 news Wednesday:

• Jefferson County continues to be hit hard by the virus, with 346 new cases. Other counties with 10 or more new cases were Hardin, 75; Kenton, 53; Boone, 45; Fayette, 42; Elliott, 39; Hopkins, Laurel, and Pike, 35 each; Madison, 34; Bullitt and Campbell, 28 each; Barren, 27; Knox and Whitley, 26 each; Oldham and Warren, 24 each; Nelson, 23; Marion, 21; Shelby, 20; Daviess, 19; Hart, 17; Christian and McCracken, 16 each; Meade, 15; Jessamine, 14; Scott, 13; Boyd, Greenup and Logan, 12 each; Washington, 11; and Boyle and Calloway, 10 each. 
• The release from Beshear's office said the 21 fatalities were "an 84-year-old Kentuckian, gender unknown;" an 81-year-old man from Adair County; a 65-year-old woman from Boyd County; a 91-year-old woman from Christian County; a 69-year-old man from Clark County; a 52-year-old man from Clinton County; a 74-year-old woman from Daviess County;  two women, 84 and 89, and two men, 84 and 93, from Henderson County; four women, 70, 82, 85 and 86, and two men, 63 and 83, from Jefferson County; two women, 42 and 77, from Madison County; a 76-year-old woman from Marion County; and a 57-year-old man from Todd County.
• In long-term care, 70 more residents and 40 more staff have tested positive for the virus, with 960 active resident cases and 537 active staff cases. There have been 818 resident and five staff deaths attributed to covid-19 in the facilities. 
• Beshear said the Thomson-Hood Veterans Center in Wilmore has 71 veterans who have tested positive for the virus, 13 veterans in the hospital, and six veterans who have died from covid-19.  Beshear said this is the only one of the state's four veterans' nursing homes with any active cases. 
• The K-12 dashboard reports 86 more students and 28 more staff and faculty have tested positive, and 587 more students and 77 more staff are quarantined. So far this week, 199 students and 113 staff have tested positive and 1,817 students and 318 staff have been quarantined. 
• The latest Centers for Disease Control and Prevention report, published in the Morbidity and Mortality Weekly Report, says that at least two-thirds of this year's "excess deaths," the number above the typical total during the same period in previous years, were from covid-19. The report says, "Overall, an estimated 299,028 excess deaths occurred from late January through Oct. 3, 2020, with 198,081 (66%) excess deaths attributed to covid-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latinx persons.
• The CDC released an updated definition for what it means to be in "close contact" with someone with the virus. It now says close contact means you were within six feet of someone who has tested positive for the coronavirus for a total of 15 minutes at any time over a 24-hour period. The prior guidance said the 15 minutes had to be all at one time. Dr. William Schaffner, a Vanderbilt University infectious diseases expert, told The Associated Press that this shows  the virus can spread more easily than many people realize. The change was prompted by a study of a 20-year-old Vermont correctional officer who wore a mask and goggles, but ended up testing positive for the virus after video footage showed he had had 17 minutes of brief interactions with other prisoners, some with mask and others without, during an eight-hour shift. "In a statement, CDC officials said the case highlights again the importance of wearing masks to prevent transmission," AP reports.
• Peer-reviewed studies cited by NPR shows that the rate of covid-19 deaths in hospitalized patients has dropped. The research found patients had a 25.6% chance of dying at the start of the pandemic; they now have a 7.6% chance. That is a great improvement, but it's still higher than many other infectious diseases, including influenza, Leora Horwitz, an author of one of the studies, told NPR. Another study set out to determine if the drop was due to improvements in treatment or because more young people are being hospitalized with covid-19. It found that after adjusting for age and other diseases, the death rates dropped for all groups.
• More than $780,000 in federal funding has been awarded to Kentucky public-safety agencies and offices to help protect seniors and other Kentuckians against pandemic scams and fraud, and respond to price gouging. Most of the funding went to the attorney general's office, according to a news release form Beshear's office.

Attorney general has online form to report Medicaid fraud, abuse

Kentuckians have a new tool for reporting suspected Medicaid fraud and patient abuse to the Office of the Attorney General. They can now electronically report abuse, neglect, and exploitation by completing an online complaint form located at ag.ky.gov/medicaidfraud.

“Providers who fraudulently bill Medicaid for healthcare goods and services steal taxpayers dollars and can endanger the health and welfare of beneficiaries,” Attorney General Daniel Cameron said in a news release. “We want to ensure our seniors are treated with dignity and respect by making it easier for Kentuckians to report suspected fraud and abuse.”

The new form allows Kentuckians to submit complaints from electronic devices, including smart phones, computers, and tablets. It allows users to mark their complaint as related to Medicaid fraud, patient abuse, or both, and prompts them to provide information such as the facility, the health-care provider’s information, the patient’s name, and the suspected abuser’s name.

"While Kentuckians are encouraged to report as many details as possible when completing a complaint, the Medicaid fraud and abuse form allows the reporting party to choose to include their name or to remain anonymous," the release said.

"In addition to the newly developed online form, Kentuckians may also report suspected Medicaid fraud and abuse by calling the Attorney General’s Medicaid Fraud and Abuse Hotline at 1-877-ABUSE TIP (1-877-228-7384). Kentucky law requires any person who knows or has reasonable cause to believe that Medicaid fraud or abuse is being committed to report it to the Medicaid Fraud and Abuse Hotline. Any person who reports the offenses of another in good faith is given immunity from civil or criminal action. Moreover, any person who makes a good-faith report is protected from discharge, discrimination, or retaliation in the workplace."

House passes public-assistance bill with plan for temporary health coverage for people who earn too much to stay on Medicaid

By Melissa Patrick
Kentucky Health News

A bill aimed at moving Kentuckians off public assistance includes several health-related provisions, including a new coverage plan for people who lose their Medicaid benefits if their income rises above the limit for the program.

House Speaker Pro Tem David Meade
presents House Bill 1. (LRC photo)

A heavily revised version of House Bill 1 passed the House Feb. 21 by a vote of 58-32. It was along party lines, except one Democrat who voted for it: Rep. John Sims of Flemingsburg.

Other Democrats said the bill was rushed, but Speaker Pro Tem David Meade, R-Stanford, its lead sponsor, said "We are trying to find a good balance between compassion to help those folks in those situation who truly need care and help in these public assistance programs, but also a balance of accountability."

Most of the bill is aimed at cracking down on fraud, but a major part of it would provide a temporary state health-insurance option for Kentuckians who stop being eligible for Medicaid because their income exceeds 138 percent of the federal poverty level, $17,609 for a single person. It would be available for those earning up to 200% of the poverty line, $25,520 for an individual.

This provision addresses the "benefit cliff," the term for the loss of public benefits by people whose earnings exceed limits for programs but who are unlikely to have jobs with health insurance or the money to afford it. Republicans said they had heard stories of people who ask employers not to give them raises so they can keep their Medicaid benefits.

This health insurance program would require premiums and cost sharing to rise 25% for every 15% in income above 138% of the poverty line. Participants could stay in the program for a year after exiting Medicaid, with a possibility of extension on a case-by-case basis.

The Supplemental Nutrition Assistance Program is a major focus of the bill, as is Temporary Assistance for Needy Families. It would remove from the programs individuals who fraudulently misuse their benefits card, or are completely able-bodied adults with no dependents who choose not to participate in a community engagement program, including work, school or volunteering, if such requirements are implemented. It would expand many benefits, with task groups formed to explore further expansions.

Democratic objections

Some Democrats said they agreed with the goals of the bill, but said it was rushed. They questioned its enforcement costs and said it would lead to lawsuits.

"Although there are good elements in this piece of legislation that I'm glad to see move forward, they are really stamped and trampled on by the bad parts of this legislation," said Rep. Charles Booker, D-Louisville.

Meade said, "What you're hearing today is, we like the expansion of benefits, we want to continue to give people more but we don't want to hold anyone accountable."

The House adopted two amendments from Rep. Kim Moser, R-Taylor Mill, one of which had to do with health. It would require the state to apply for a waiver of the rules to allow Medicaid to pay for substance-use disorder treatment for people who are incarcerated.

The bill would ban from Medicaid and other programs people who violate the rules.

For example, those who are convicted of a drug-related felony who are released from incarceration and fail to sign up for substance-use treatment within 90 days of release would be banned from getting Medicaid, but the bill makes provisions for regaining coverage.

Dustin Pugel, policy analyst for the Kentucky Center for Economic Policy, wrote that "a similar ban in SNAP in Kentucky has led to thousands losing food assistance and likely more who never applied due to a past conviction." Further, he writes that "Medicaid law doesn't allow bans contingent on recovery status or for people with a drug-related felony conviction."

If passed, Gov. Andy Beshear's administration would be required to implement the measures within 120 days. Beshear said Friday, "I want to continue to see where they're going, but I don't believe in a system that pushes people off of benefits." Mark Vanderhoff reports for WLKY-TV.

Beshear added, "I believe in a system that encourages people and gives them the tools to get jobs with higher wages where you naturally move off of them. I believe in providing people opportunity -- not consequences."

Medicaid work requirements?

Reflecting Republicans' concern about the cost of the 2014 Medicaid expansion, the bill says that if the state General Fund appropriation for this population reaches half of General Fund spending on Medicaid overall, those who have been on the expansion for a year would have to participate in at least 80 hours a month of "qualifying activities," presumably work, school or volunteering.

That seems unlikely; the Kentucky Center for Economic Policy reports that it is currently only 10.7% of the budget. Such requirements were an integral part of former Gov. Matt Bevin's plan to overhaul the state's Medicaid program. It and a similar plan in Arkansas were blocked twice by a federal judge, and Beshear rescinded the plan soon after taking office in December.

Several lawmakers predicted that this part of the bill would be challenged in court, noting that a federal appeals court recently upheld the rulings against Arkansas's plan. The Supreme Court may or may not hear an appeal.

Meade said it is "well worth the risk" of a legal challenge to these community engagement requirements for able-bodied workers because they have been shown to move people off public assistance and increase their income in other states.

Concerns about fraud

Much of the debate was around the issue of fraud in public assistance programs, an issue that Rep. Nima Kulkarni, D-Louisville, said likely has to do more with perception than reality.

The U.S. Department of Agriculture reports that public-assistance fraud is 1%, and it was mentioned during the debate that it's reported at 2% in Kentucky.

"My concern here is that we are ignoring actual facts, actual numbers . . . and going with opinions and potential numbers that are not in existence, that we have not heard about in this body," Kulkarni said. "In our zeal to counteract the tiny fraction of fraud that may be occurring in Kentucky, we are potentially impacting millions of lives that are using these programs to simply lift their families out of poverty, to put food on the table at night. I really urge the body to think long and hard about the unintended consequences of this bill to those individuals that are properly using the benefits that they so desperately need."

Early in the two-and-a-half-hour debate, Meade corrected a statement he made Feb. 20 that there were studies showing upwards of 40% of fraud in public assistance programs. He corrected that to say that a group had told him that with its current detection systems, Kentucky was likely only catching 30 to 40% of the fraud in the system. When asked who that group was, he declined to answer. But he said he thinks it is higher than 2% because people are very creative when they commit fraud. "To say that we only have a 2 percent fraud rate, that we feel we are catching it all, is just not imaginable in my mind."

But House Minority Leader Joni Jenkins, D-Louisville, said, "I think what we have here is an attempt to go after a gnat, and when you go after a gnat with a sledgehammer, you tend to destroy the whole darn thing."

States crack down on opioid treatment scams that can kill

An opioid treatment scam is snaring young adult victims across the nation, sometimes leading to patients' deaths after enrolling in programs that provide poor or nonexistent treatment. The scam hasn't been reported in Kentucky, but the state is susceptible to it because of its high levels of addiction and prescriptions for the most common drug used in medication-assisted treatment.

"Here’s how the scam works: Seemingly caring people join recovery-related online chat groups, answer addiction hotlines advertised online, or show up at fundraisers for addiction recovery. They typically say they’re in recovery themselves and are therefore uniquely qualified to help," Christine Vestal reports for Stateline. "People with addiction and their families often don’t want to ask their doctors or pastors for help because they’re ashamed and want to hide their illness. So, turning to a stranger can be appealing."

The scammers, who call themselves "patient brokers," usually sweeten the deal by offering free plane tickets and pocket money as well as waiving insurance deductibles. Patient brokers can make as much as $2,000 in commissions per patient, plus extra money when they re-enroll the same patients after relapse, Vestal reports.

"Within two to four weeks of a patient checking into a sober home where treatment is subpar or nonexistent, insurers may stop paying claims under standard protocols for that type of service, and the fraudulent operators dump their young clients on the street, prosecutors say," Vestal reports. Many then begin using drugs again and many end up homeless.

Some get lured into other fraudulent treatment programs, which insurers are required to pay for. "Past cases show that the cycle can continue until the insurance company stops paying on the patient’s 26th birthday, when the Affordable Care Act allows insurers to drop dependent care coverage under a parent’s policy," Vestal reports. In addition to spotty or nonexistent treatment, many of the fraudulent programs make extra cash by ordering excessive numbers of urine drug tests to extract more money from insurance companies.

Several states have enacted laws to outlaw patient brokering and crack down on the bogus treatment programs: Arizona, California, Florida, New York, Tennessee, and Utah. Donna Johnson, who lost her son after falling for a treatment scam in Florida, says she worries scammers are setting up shop in Maryland, and has persuaded state Rep. Karen Lewis Young to draft a similar bill, Vestal reports. Florida officials are talking to advocates in Georgia, North Carolina, New Jersey, Ohio and Pennsylvania about creating their own laws.

The anti-kickback laws work, according to Florida officials. The state enacted the nation's first such law in 2016, which has served as a template for other states' laws, Vestal reports. In Palm Beach County, for example, where fraudulent treatment programs were popular, drug overdose deaths dropped from 647 in 2017 to 400 in 2018, a nearly 40 percent decline.

There's a federal anti-kickback law, but it "only applies to federal health care programs and is not broad enough to address the full range of false marketing, insurance fraud and patient brokering that is occurring in the industry," Vestal reports.

Sham charity in Nashville, caught in 7-state probe prompted by tip from Maysville hospice, agrees to dissolve, pay costs and fines

A tip from a hospice employee in Maysville led Kentucky's attorney general and those in seven other states to shut down a sham charity that said it was for the benefit of local hospices.

The New Hope Foundation Inc. of Nashville agreed to dissolve, and three of its officers will "be banned from any charity or fundraising activities in perpetuity," said a news release from Attorney General Andy Beshear. "New Hope agreed to repay the cost of the investigation and pay more than $74,000 in civil penalties to the states, which were calculated based on an even split and money made in each state. Kentucky’s general fund will receive more than $6,000."

The release explained, "New Hope raised funds through telemarketing and direct mail and allegedly provided education regarding hospice services. It sent 'local area appeals' which appeared to donors to be solicitations from their local hospice providers but were not."

The case "began when Michael Parker, director of public relations and development of Hospice of Hope in Maysville, made a report" to Beshear's office, the release said. "Parker reported that Hospice of Hope is the only hospice service provider in the Maysville area and its donors were receiving solicitations from the Hospice Support Fund for a “Maysville Area Appeal” and those donors were confused. The Hospice Support Fund was a program of New Hope, but Hospice for Hope did not receive any money from this solicitation or from New Hope in general."

Retired Ashland cardiologist gets five years in prison for fraud

A retired Ashland cardiologist has been sentenced to five years in prison and ordered to pay $1.1 million in restitution after being convicted two and a half years ago of doing hundreds of unnecessary heart operations.

Dr. Richard E. Paulus, 71, who practiced at King’s Daughters Medical Center, "billed more to Medicare for certain heart procedures than any cardiologist in the country from 2006 through 2011, according to a court record,"reports Bill Estep of the Lexington Herald-Leader. "The hospital paid him a total of $10 million between 2009 and mid-2013, when Paulus retired, according to court records."

Dr. Richard E. Paulus (Ashland Daily Independent file photo)

U.S. District Judge David L. Bunning sentenced Paulus May 2. Bunning could have imposed a 10-year sentence or placed Paulus on probation, which his lawyers requested. "Defense attorneys plan to ask that he be allowed to remain free on bond pending an appeal," Estep reports.

"The sentencing comes after Bunning turned down three separate requests by Paulus for a new trial," following his conviction in October 2016, reports Mike James of the Ashland Daily Independent. "It follows a dizzying succession of legal events — Paulus’s indictment, trial and conviction were followed by Bunning’s reversal of the verdict and then by an appeals court reinstating the conviction and sending the matter back to Bunning. Based on the appeals court ruling, Bunning ruled against a new trial and scheduled the sentencing."

James reports, "Evidence at his trial showed he performed numerous invasive heart procedures on patients who did not need them, and to justify the procedures he falsified medical records to exaggerate their medical condition and to make it appear that the heart procedures were necessary and qualified for payment." Estep reports, "The jury ruled Paulus put false information in patients’ records saying they had more severe blockages than tests showed, in order to justify putting stents in them."

In asking for probation, Paulus's attorneys said "he had provided years of selfless service to patients and the community," Estep writes. "Paulus worked fanatical hours to help patients, never inquired about someone’s ability to pay and often treated people free of charge, his defense attorneys said. One former co-worker said Paulus wore shoes held together with duct tape for a year because he was too busy to get a new pair, his attorneys said."

Eight Kentuckians among 60 indicted for illegal prescribing or health-care fraud as a result of major federal investigation

Rob Duncan, U.S. attorney for the Eastern
District of Kentucky, announced the cases.
(Associated Press photo by John Minchillo)

Sixty health professionals in five Appalachian states, including Kentucky, were charged Wednesday with "illegal prescribing of more than 32 million pain pills, including doctors who prosecutors said traded sex for prescriptions and a dentist who unnecessarily pulled teeth from patients to justify giving them opioids," report Sari Horwitz and Scott Higham of The Washington Post.

Those indicted included "31 doctors, seven pharmacists, eight nurse practitioners and seven other licensed medical professionals" who wrote more than 350,000 illegal prescriptions in Ohio, West Virginia, Kentucky, Tennessee and Alabama, according to federal indictments filed in Cincinnati. “That is the equivalent of one opioid dose for every man, woman and child in the five states in the region that we’ve been targeting,” Brian Benczkowski, the assistant attorney general in charge of the Justice Department’s Criminal Division, told the Post.

Those indicted in Kentucky, according to the USA Today Network, include:

•  Dr. Denver Tackett, who ran a dental clinic in McDowell, is accused of prescribing Oxycodone and hydrocodone that were not reasonable for the treatment of a patient's illness or injury. He also is accused of pulling teeth from six patients who had no need for extractions, as well as submitting claims to Medicare and Medicaid for procedures he did not perform.

•  Dr. Christopher Nelson of Louisville's Bluegrass Pain Consultants, is accused of teaming with a Florida pharmacy, AssuredRx, to defraud Medicare and Tricare, a health-insurance plan for veterans, by inflating drug costs. Nelson is accused in a kickback and bribe scheme to funnel customers to Assured Rx for drugs used for pain, including controlled substances. Nelson has pleaded not guilty.

•  Dr. Ijaz Mahmood, who operates a clinic in Elizabethtown, charged with authorizing prescriptions for drugs, including controlled substances, through presigned, blank prescriptions and directing employees, including some who weren't licensed to practice medicine, to perform medical services on patients. Mahmood told a Courier Journal reporter that he didn't want to discuss the charges.

•  Dr. Scotty Akers and Serissa L. Collier, who also used the last name Stamper, are charged in an indictment with distributing the opioids hydrocodone, oxycodone and fentanyl between August 2016 and May 2018. Both are from Pikeville.

•  Dr. Mohammed A.H. Mazumder of Prestonsburg, who owned Appalachian Primary Care, is charged with telling his employees, who were not doctors, to receive patients at the clinic when he was not there. The indictment says a medical technician evaluated patients, then two receptionists called pharmacies with prescription orders for opioids and other controlled substances under Mazumder’s name. The clinic then submitted claims to Medicare and Medicaid as if Mazumder had examined the patients and ordered the prescriptions.

•  Dr. Sai P. Gutti, who has offices in Pikeville, Harold, Paintsville, Whitesburg and Belfry and also saw patients in Frankfort and other Kentucky towns, is accused of eight counts of health-care fraud by ordering medically unnecessary drug tests for Medicare and Medicaid patients.

•  Gary Green of Louisville is accused of failing to inform the Drug Enforcement Administration when he transferred and stored controlled substances in the offices of Guaranteed Total Construction, for which he acted as a registered agent; of furnishing false and fraudulent information in, and omitting material information from documents required to be made, kept, and filed.

The Justice Department says it has targeted doctors, health-care companies and drug manufacturers and distributors for their roles in the opioid epidemic that killed 47,600 Americans in 2017. "Benczkowski said he created the Appalachian Regional Prescription Opioid Strike Force late last year to target the region, which has been devastated by the epidemic," the Post reports. "The department analyzed several databases to identify suspicious prescribing activity and sent 14 prosecutors to 11 federal districts there. . . .Once they had the data indicating suspicious prescriptions, investigators used confidential informants and undercover agents to infiltrate medical offices across the region. Cameras and tape recorders were rolling as they documented how medical professionals used their licenses to peddle highly addictive opioids in exchange for cash and sex, officials said."

The indictments merited a statement from Attorney General William Barr: “The opioid epidemic is the deadliest drug crisis in American history, and Appalachia has suffered the consequences more than perhaps any other region.”

London doctor convicted of implanting unneeded pacemakers sentenced to 3½ years, fined $50,000, told to repay $257,515

Image from MGN Online via WKYT-TV

A Kentucky doctor convicted of "implanting pacemakers that weren’t medically necessary in order to make money" was sentenced Oct. 30 to three years and six months in prison, fined $50,000 and ordered to repay insurance companies and taxpayer-funded health programs $257,515, Bill Estep reports for the Lexington Herald-Leader.

Dr. Anis Chalhoub, 60, is expected to appeal his April conviction and ask U.S. District Judge Gregory F. Van Tatenhove to allow him to remain free while appealing. At sentencing in London, the judge told Chalhoub, “You’ve engaged in conduct that has harmed our community.”

Chalhoub was charged with implanted pacemakers into patients who didn’t need them between March 2007 and July 2011. He implanted about 230 pacemakers at the St. Joseph London hospital during that period, U.S. Attorney Robert M. Duncan Jr. said in a news release.

The unneeded pacemakers “will adversely impact these patients’ lives as they age and may compromise their ability to seek certain medical treatments in the future,” Asst. U.S. Attys. Andrew E. Smith and Paul C. McCaffrey said in a sentencing memorandum.

"Former coal miner Mark Meadows, for instance, told Van Tatenhove the experience had helped doom his marriage of 30 years and eroded his trust in doctors," Estep reports, quoting him: “It’s a dirty low-down rotten shame.”

Chalhoub practiced at the hospital "during a period when the hospital and doctors there allegedly took part in performing hundreds of unnecessary heart procedures," Estep notes. "Saint Joseph Health Systems agreed in January 2014 to pay $16.5 million to settle allegations that it engaged in a scheme to pump up revenue by billing federally-funded health programs for unnecessary procedures from January 2008 to August 2011. That was before the company merged with two others in 2012 to form KentuckyOne Health."

Somerset doctor convicted of Medicaid fraud; sentenced to five years for falsifying smoking-cessation counseling sessions

Dr. Ezekiel Akande
(Photo from Twitter)

A Pulaski County judge sentenced a Somerset doctor on Friday, April 21, to five years in prison for felony Medicaid fraud.

A Pulaski County jury convicted Ezekiel Akande, who ran the Somerset Regional Pain Center, in March for receiving Medicaid payments for tobacco-cessation counseling sessions that he did not perform. The jury also convicted Akande of theft and ordered that he pay $10,000 in restitution.

The state Office of Medicaid Fraud and Abuse accused Akande of billing Medicaid for counseling sessions with patients who were not smokers, and smokers who did not wish to quit.

"Holding accountable those who defraud the government and Kentuckians is a responsibility my office takes very seriously," Attorney General Andy Beshear said in a news release. "We are working every day to protect Kentucky families from those who seek to exploit our health services for personal gain."

Only 1.4 percent of Kentucky Medicaid members who smoke received smoking-cessation counseling in 2015, the state said last year; 17 percent received smoking-cessation medications.

Noted heart surgeon found guilty of health care fraud; exaggerated patient conditions to get Medicare payments

UPDATE, July 11, 2018: A federal appeals court reinstated the conviction but left open the possibility of a new trial, Bill Estep reports for the Lexington Herald-Leader. (Earlier update: Judge Bunning overturned the conviction and the government appealed his ruling, Mike James reports for The Independent.)

Dr. Richard Paulus
(Ashland Independent photo)

In the latest judgment of health-care fraud in Kentucky, a well-respected cardiologist in Ashland was found guilty last week of performing unnecessary heart procedures on patients. From 2006 to 2012, Dr. Richard E. Paulus at King's Daughters Medical Center billed Medicare "for more heart procedures than any other cardiologist in Kentucky and was fifth in the nation in the amount paid by Medicare for stent procedures," Andrew Wolfson reports for The Courier-Journal.

"Attorneys for Paulus have asked U.S. District Judge David L. Bunning to acquit Paulus, arguing that, at most, the evidence showed only honest mistakes or disagreements among cardiologists," Rachel Adkins reports for The Independent of Ashland. If Bunning refuses, Paulus lawyer Robert Bennett of Washington, D.C., said they will appeal.

A Covington jury convicted Paulus "after a seven-week trial and four days of deliberations . . . of performing numerous invasive heart procedures on patients who did not need them from 2008 to 2013, and to justify the procedures, falsifying their medical records to exaggerate their medical condition so he could qualify for government payments," Wolfson writes. "Ten cardiologists testified on behalf of the United States, and Paulus was convicted on 11 counts and acquitted on five counts."

Paulus, for whom the hospital's vascular center is named, is the third Kentucky cardiologist to be convicted of health-care fraud. Published reports say he earned $2.6 million in 2011 alone. He was specifically convicted for placing unnecessary coronary stents and performing unnecessary diagnostic catheterizations in patients, Wolfson writes, noting that stents "can save lives of heart-attack victims, but their use in stable patients has been disputed by medical researchers."

Hospital vascular center named for Paulus (Independent photo)

Paulus retired last summer. The hospital said in a statement: "Since the beginning, King’s Daughters has stood behind our cardiac program. Our heart program has continued to meet or exceed national performance standards. Independent experts have been reviewing our cases and agree that the heart care we provide is excellent."

In 2014 King's Daughters agreed to pay the federal government $40.9 million to settle civil allegations that it made millions of dollars by falsely billing federal health programs for performing heart procedures on patients who did not need them, Wolfson notes. He also recounts other recent health-care fraud cases.

Paulus faces a maximum of 20 years for health care fraud and up to five years for making false statements. His sentencing is scheduled for April 25. About 100 people attended a Sunday prayer service for Paulus, Adkins reports.

Kindred agrees to pay $125 million for Medicare fraud claims against subsidiaries it bought after most wrongdoing occurred

Louisville-based Kindred Healthcare Inc. has agreed to pay $125 million to settle federal allegations that it knowingly submitted false claims to Medicare for rehabilitation therapy, according to a U.S. Department of Justice news release.

The lawsuit, brought by two whistleblowers, focused on contract providers RehabCare Inc. and RehabCare Group East Inc., which Kindred bought in 2011, after most of the alleged wrongdoing occurred. RehabCare is the largest provider of therapy in the nation, according to the release.

The Justice Department announcement alleged that RehabCare had set "unrealistic financial goals" and scheduled therapies "to achieve the highest reimbursement level," regardless of the needs of the patients, providing services that were not "reasonable, necessary and skilled, or that never occurred."

"This False Claim Act settlement addresses allegations that RehabCare and its nursing facility customers engaged in a systematic and broad-ranging scheme to increase profits by delivering, or purporting to deliver, therapy in a manner that was focused on increasing Medicare reimbursement rather than on the clinical needs of patients,” U.S. Attorney Carmen M. Ortiz of Massachusetts said in the release.

Allegations against RehabCare include: placing patients in therapy at the highest reimbursement level, regardless of the patients actual therapy need; ramping up the amount of reported therapy during the Medicare assessment period; scheduling therapies even after the patient had been discharged by their therapist; arbitrarily shifting the amount of time to other therapy disciplines, like physical or speech therapy, to achieve maximum reimbursement levels, regardless of patient need; providing "significantly higher amounts of therapy" at the end of therapy to achieve the highest level of therapy reimbursement; inflating initial reimbursement levels by reporting evaluation time as therapy time; rounding up actual therapy minutes provided; and billing for services for patients while they slept or couldn't benefit from them.

RehabCare denied any illegal activity, "but in order to provide clarity for contract customers, shareholders, and government oversight entities," and to "avoid the cost and distraction of protracted litigation" has agreed to the settlement without any admission of wrongdoing, according to the Kindred news release.

Since January 2009, the Justice Department has recovered more than $27.1 billion through False Claims Act cases, with more than $17.1 billion from cases involving fraud against federal health-care programs, according to the department.

Three doctors, nine others in western half of Kentucky are indicted in the largest-ever federal 'takedown' of Medicaid fraud

Former Dr. Fred Gott of Bowling Green was arrested.
(Photo: Miranda Pederson, Bowling Green Daily News)

Twelve people in the western half of Kentucky, including three doctors, have been charged with Medicaid fraud in what the federal government calls its biggest-ever "takedown" of the problem, Andrew Wolfson of The Courier-Journal reports.

The indictments allege "a half-dozen schemes involving nearly $8 million in alleged fraudulent billings," Wolfson writes. "The offenses include $5 million in false billings for muscle-relaxant injections that were never delivered to patients, as well as a staged car wreck in which three people allegedly conspired to get controlled substances and fraudulent reimbursements."

In another case, Wolfson reports, "a medical practice that treated car wreck patients is accused of using the DEA numbers of nurse practitioners to order hydrocodone for herself and falsely billing it to an insurance company. Nationally, the sweep resulted in charges against 243 people, including 46 doctors, nurses and other licensed medical professionals."

John Kuhn, acting U.S. attorney for the Western District of Kentucky, told Wolfson that about $1 billion of annual Medicare and Medicaid expenses are fraudulent. Medicare is the federal health-insurance program for people over 65; Medicaid is the federal-state program for the poor and disabled.

Former Dr. Fred Gott of Bowling Green, a 63-year-old cardiologist, was charged with "conspiracy to dispense controlled substances, health care fraud and money laundering," Deborah Highland reports for the Bowling Green Daily News. "The Bowling Green-Warren County Drug Task Force opened an investigation into Gott’s practices after Warren County Coroner Kevin Kirby alerted the task force about drug overdose deaths involving Gott’s patients, task force director Tommy Loving said."

Scammers taking advantage of new health-insurance system

Scammers are using the new health-insurance system "as an opportunity to try to collect consumers’ personal information or to make false claims," Gov. Steve Beshear and Attorney General Jack Conway warned Tuesday.

Conway's office sent civil investigative subpoenas and cease-and-desist orders Monday to the operators of two websites that had brought complaints from consumers to the Cabinet for Health and Family Services, which oversees Kynect, the state's health-insurance marketplace.

Scam sites try to mimic legitimate government sites, the officials said. People who register on the sites have reported getting telephone calls as a result. That is not the way the secure, state-operated website works. Its web address is Kynect.ky.gov; beware of sites ending in .com or .net, Conway advised.

“If something seems suspicious, do not share your personal information, and if you suspect fraud, report it immediately,” Conway said. He also warned Kentuckians to be on guard for attempts by identity thieves to collect personal or financial information by email, phone or mail.

Scammers may also try to sell bogus “discount medical plans” or mislead older consumers on Medicare by making false claims that Medicare coverage is affected by the new law, Conway said. It is not, but the annual Medicare re-enrollment period runs through Dec. 7, perhaps creating confusion.

“It’s appalling to think there are individuals out there who would prey on Kentuckians during this process,” Beshear said. “Everyone should be on guard and report any questionable websites or businesses. There is a lot of misinformation on the Affordable Care Act, which is why we have qualified staff who can answer questions and point consumers in the right direction.”

The attorney general's Office of Consumer Protection offered these tips:

• Make sure you’re working with a registered insurance agent or certified Kynector. Only legitimate insurance agents and government-contracted assisters, called “kynectors,” are authorized to assist Kentuckians with signing up for health care. A list of approved agents and kynectors maintained by the Cabinet for Health and Family Services can be found online or by calling 1-855-459-6328.
• Protect your personal information. Only a registered insurance agent, a certified Kynector, or customer-service representative at a contact center should ask for your personal information to help you apply. Keep personal and account numbers private to any others who offer assistance. Don’t give your Social Security number, credit card or banking information to companies or individuals you didn’t contact. Never give your information to someone whose identity you question.
  
• Do not pay for help. Insurance agents and Kynectors will not solicit money. There is no charge to use Kynect services with the help of an insurance agent or certified Kynector. If consumers get an offer to register for a fee, they should hang up the phone or walk away.
• Remember that you can only get tax credits through Kynect. Most Kentuckians who buy insurance through Kynect will qualify for tax credits to subsidize their premiums. No one but Kynect can offer these credits, and there is no charge to apply for them.
  
• Beware of phishing scams online. Consumers should be cautious of any email claiming to be connected to the Affordable Care Act, including any emails claiming to be affiliated with kynect and asking for personal information.
  
• Ask questions. Don’t sign anything you don’t fully understand, and verify the answers you get with trained kynect representatives.

If people think their personal information may have been compromised, they can visit www.ag.ky.gov, the attorney general’s website, which has an identity-theft toolkit.