News


Pennsylvania Chiropractor Sentenced for Healthcare Fraud Scheme
News
Written by TAC Staff   
Saturday, 12 March 2011 22:27

aroundtheworld

PHILADELPHIA—Dr. Neil H Hollander, 55, of Huntingdon Valley, PA, was sentenced February 18th  to one year and one day in prison for health care fraud, mail fraud, and making false statements in a health care matter, announced United States Attorney Zane David Memeger. Hollander, who maintained a chiropractic office at the Hollander Chiropractic Center in Philadelphia, billed Independence Blue Cross (“IBC”) approximately $ 914,503.19 for chiropractic treatments that he had not actually rendered to the insured patients. IBC paid approximately $304,096.28.fraud

In 2005, when IBC requested patient files from Hollander, Hollander created false documents to submit to IBC in an effort to justify the fraudulent billings that had been submitted. Hollander pleaded guilty to the charges on June 10, 2010. In addition to the prison term, United States District Court Judge Petrese Tucker ordered Hollander to pay restitution in the amount of $304,096.28 and to serve three years’ supervised release upon completion of the prison term. Hollander was ordered to begin serving his sentence on April 28, 2011.

The case was investigated by the Federal Bureau of Investigation and the United States Postal Inspection Service. It was prosecuted by Assistant United States Attorney Emily McKillip.

Source: FBI

 
Preclinical Studies Published in Neurosurgery and the Journal of Neurotrauma Evaluate Effect of DHA Supplementation on Prevention and Treatment of Traumatic Brain Injury
News
Written by Martek Biosciences   
Tuesday, 08 March 2011 10:38

martekdhaStudies Utilize Martek Biosciences’ Algal DHA Omega-3

COLUMBIA, Md. — February 21, 2011 – Preclinical studies recently publishedin the February 2011 issue of Neurosurgery and the September 2010 issue of the Journal of Neurotrauma indicate that algal DHA intake either prior to traumatic brain injury (TBI) or post-TBI helps to protect the brain by reducing the number of injured brain fibers following trauma.  The studies, led by neurosurgeon Dr. Julian Bailes, used Martek’s algal DHA and were conducted at the Department of Neurosurgery at the West Virginia University School of Medicine.

These studies were funded by grants from Martek Biosciences for which Dr. Bailes serves as a consultant. Journal of Neurotrauma study co-author, Kevin Hadley, PhD, is a senior clinical research scientist at Martek Biosciences.

Neurosurgery, February 2011

In this study, adult male Sprague-Dawley rats were subjected to a TBI after receiving administration of algal DHA in doses of 4, 12 and 40 mg per kg of body weight for 30 days prior to the trauma.  Results revealed that DHA supplementation prior to TBI significantly reduced the number of amyloid precursor protein (APP) positive axons to levels similar to what have been found in uninjured animals.  APP is a marker of axonal injury. The group receiving the highest dosage of DHA also demonstrated significant improvement in the outcome measures compared with the control group, including measures of injured axon counts, inflammatory markers, indicators of pre-programmed cellular death, and memory testing. These findings suggest that DHA supplementation prior to TBI reduces the impact of the injury, for the first time suggesting that a prophylactic supplement may protect the brain or reduce the potential for subsequent TBI.

Journal of Neurotrauma, September 2010

This study subjected adult male Sprague-Dawley rats to the same injury model used in the Neurosurgery paper.  After the injury they received either 10 mg or 40 mg per kg of body weight of algal DHA for 30 days.  Results revealed that DHA supplementation after TBI significantly reduced the number of APP-positive axons to levels similar to what have been found in uninjured animals.  In addition to a reduction in injured axons as measured by APP counts, caspase-3 els – a marker of brain cell death – were reduced with DHA administration.

“We’ve known for a long time that DHA is a building block of the brain and important to optimal brain development and health throughout life, and now this preclinical data suggests that further clinical research be undertaken to determine the potential benefits of DHA on head injury,” commented Dr. Julian Bailes, a founding member of the Brain Injury Research Institute, professor, and a recognized leader in the field of neurosurgery and on consequences of brain injury on cognitive function.  “The results of these studies are extremely timely as they come at a point when traumatic brain injuries, including concussions, are growing more prevalent.”

Sections of this release contain forward-looking statements. These statements are based upon numerous assumptions which Martek cannot control and involve risks and uncertainties that could cause actual results to differ. These statements should be understood in light of the risk factors set forth in the company's filings with the Securities and Exchange Commission, including, but not limited to, the company's Form 10-K for the fiscal year ended October 31, 2010 and other filed reports on Form 10-K, Form 10-K/A, Form 10-Q and Form 8-K.

 

For more information contact Andrea Martin at Martek Biosciences.  Call 240-512-2639, or e-mail  This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
United Health Group Sued by Pomerantz for Improper Recoupment Practices
News
Written by TAC Staff   
Monday, 07 March 2011 16:21

aroundtheworld

NEW YORK, NY:  Pomerantz Haudek Grossman & Gross LLP, one of the country's preeminent class action firms and a leader in combating the abuses of the health insurance industry, filed a class action lawsuit against UnitedHealth Group and Health Net of the Northeast, Inc., on behalf of a putative nationwide class of health care providers, as well as the Ohio State Chiropractic Association. United's acquisition of Health Net of the Northeast's health insurance business closed in December 2009, adding to United's status as the nation's largest private health plan by revenue. The suit challenges the Defendants' abusive practices in using post-payment audits and reviews, and improper repayment demands, to pressure providers to repay substantial sums that had previously been paid as health insurance benefits.

gavelandscalesofjusticeThe action alleges that the post-payment audit and review process, as applied by the Defendants, violates the Employee Retirement Income Security Act of 1974 ("ERISA"), in that its repayment demands are retroactive determinations that particular services are not covered under the terms of the United and Health Net health care plans, but without proper appeal or other protections otherwise available under ERISA for both self-funded and fully insured health care plans offered through private employers.

"ERISA establishes the procedures that insurance companies must follow when making benefit determinations—whether prior to payment or retroactively," says Plaintiffs' counsel, D. Brian Hufford of Pomerantz. "The Defendants here, as is true for many insurance companies, are violating their ERISA obligations in order to recover funds that simply do not belong to them."

In the complaint, Plaintiffs allege that, as a means to maximize their profits, United and Health Net used their post-payment audit and review process to make retroactive adverse benefit determinations, whereby they demand that providers repay funds they had previously received for providing services to United and Health Net subscribers. Moreover, Defendants frequently withhold new benefit payments for unrelated services to apply toward the alleged overpayments, even where there has been no valid appeal process or validation that any sums are, in fact, owed by the providers, a practice called "offsetting."  Plaintiffs' Co-Counsel, Vincent Buttaci of Buttaci & Leardi, LLC, states that "providers are placed in an untenable position as a result of false fraud allegations made against them in an effort to coerce and intimidate, and through our lawsuit they are now fighting back."

Pomerantz and Buttaci & Leardi have pending actions against a number of Blue Cross and Blue Shield entities, as well as Aetna, Inc., asserting similar claims. Robert J. Axelrod of Pomerantz notes that "the current defendants represent some of the largest insurers in the country, but certainly are not the only ones engaged in this improper conduct against all type of providers, including both individuals and health care facilities and hospitals."

Counsel for plaintiffs are continuing to investigate these claims, and other related claims that may be added to the litigation.

This e-mail address is being protected from spambots. You need JavaScript enabled to view it


 
Fairfield Chiropractor Indicted
News
Written by TAC Staff   
Thursday, 17 February 2011 16:46

aroundtheworld

OHIO:  A Fairfield chiropractor has been indicted on charges of workers' compensation fraud and theft.

Bruce Holaday, owner of Back and Spine Center on Mack Road, was indicted by a Franklin County grand jury after an investigation by the Ohio Bureau of Workers' Compensation Special Investigations Department.

BWC SID initiated an investigation after receiving an allegation that Holaday was concealing from BWC his direct involvement in the treatment of injured workers.  Holaday was unlawfully using the names and provider identification numbers of the chiropractors with whom he practiced after being permanently decertified as a BWC health care provider, prohibiting him from seeking and receiving reimbursement from BWC.

workmanscompensationHoladay also pleaded guilty to a charge of workers' compensation fraud in December of 1996, when he was proprietor of Advantage Care Chiropractic, Inc. He billed BWC for $13,006 in services that he did not provide.

Workers' compensation fraud threatens the integrity and solvency of the State Insurance Fund," said BWC Administrator Steve Buehrer. "Our investigative team works aggressively to root out and prosecute health care providers, as well as employers and injured workers, who are attempting to cheat Ohio's workers' compensation system."

Ohio Attorney General Mike DeWine's office assisted in the investigation.

"This case demonstrates the commitment of the Attorney General's office to vigorously prosecute anyone who tries to circumvent the rules and cheat Ohio workers through abuse of the workers compensation program," said DeWine.

Holaday also pleaded guilty to a charge of workers' compensation fraud in December of 1996, when he was proprietor of Advantage Care Chiropractic, Inc. He billed BWC for $13,006 in services that he did not provide.

FOX19

 
Pennsylvania Chiropractor Convicted of Fraud
News
Written by TAC Staff   
Thursday, 17 February 2011 16:41

aroundtheworld

PENNSYLVANIA:  Dr. Joseph J. Lerner, 50, of Chalfont, PA, was sentenced in early January to 36 months in prison for a $3 million scheme to defraud Independence Blue Cross, Aetna Health Management, Highmark Blue Shield and five other health insurance companies.

According to charges brought by the U.S. Attorney’s Office, Lerner, a chiropractor who owned a gym and health club in Horsham, PA, fraudulently billed the insurance companies for chiropractic treatments that Lerner neither provided nor supervised between 2007 and March 2010.

fraudLerner hired masseuses and personal trainers to work at Horsham Fitness, to provide massages and personal training to gym members whose health insurance Lerner would bill fraudulently for chiropractic services that Lerner never provided, according to the U.S. Attorney’s Office.

Lerner suggested to people seeking to join the gym that they could obtain massages and personal training for the very low price of only a co-payment, usually $10, by having their health insurance pay for those massages and personal training sessions.

The U.S. Attorney alleged that Lerner caused the submission of fraudulent medical bills to the eight insurance companies totaling about $3 million, resulting in payments from the insurers of more than $1.9 million.

In addition to the prison term, U.S. District Court Judge Cynthia M. Rufe ordered Lerner to pay restitution in the amount of $1,932,910.95 to the insurance companies. The government seized cash and bank accounts from Lerner totaling $432,834.12.

Philadelphia Business Journal

 
«StartPrev12345678NextEnd»

Page 7 of 8
 
TAC Cover
TCA Cover
BL Cover

Click on image above
to view the
Digital Edition


Advertisement

Advertisement

Advertisement

requestmagazinebutton

 

TAC Publications

The American Chiropractor Magazine: Digital Issues | Past Issues | Buyer's Guide

 

More Information

TAC Editorial: About | Circulation | Contact

Sales: Advertising | Subscriptions | Media Kit