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Expansion of Medicare Advantage Business Is One of WellPoint's Biggest Ever
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Written by TAC Staff: Yellow Pages   
Sunday, 18 December 2011 01:50
INDIANAPOLIS, IN - WellPoint affiliated plans are adding Medicare Advantage (MA) products in 136 counties in 11 states this year, encompassing a population of more than 1 million people eligible for Medicare.

MA plans incorporate Medicare Parts A (hospital) and B (medical) into one convenient product that may include additional benefits. Part D also can be added for drug coverage (MAPD). More than 12 million people across the country have a MA plan, according to America's Health Insurance Plans.

"We're very excited to get approval from the Centers for Medicaid & Medicare Services for this expansion, which is one of our biggest ever," said Julie G. Smith, a vice president in WellPoint's senior business. "These plans will help provide people eligible for Medicare with more choices for their health care within their respective markets."

As a result of the expansion, Medicare eligibles in 74 counties in six states will have access to a WellPoint affiliated health plan for the very first time. The largest expansions to new counties are occurring in Georgia, Missouri, Virginia and Wisconsin. Premiums vary by geography, including some $0 premium plans. Additionally, people in many counties that were already served by WellPoint affiliated plans will have access to new products. For example, they may have access to a WellPoint local PPO or HMO plan for the very first time.

The products are being sold during the 2011 plan Annual Election Period (AEP), which runs from Oct. 15 to Dec. 7 this year, with an effective date of Jan. 1, 2012. Also during AEP, the WellPoint affiliated plans are offering Optional Supplemental Benefits (OSBs) in 12 states. OSBs cover additional services that may not be covered in the member's Medicare Advantage health plan, such as dental, vision, chiropractic services and acupuncture. Medicare beneficiaries can enroll in an optional supplemental benefit package when they enroll in their 2012 MAPD or for up to 90 days after their plan effective date. OSBs require an additional premium.

"Baby Boomers are aging into Medicare with many interests and goals," Smith said. "We're developing products like OSBs to give them a variety of choices."

In addition to MA and MAPD plans and OSBs, WellPoint affiliated plans offer Medicare Supplement plans with extra benefits available for purchase called "Anthem Extras." Medicare has neither reviewed nor endorsed this information. Benefits and premium may change on January 1, 2013. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.

Source: WellPoint, Inc.
Houston Chiropractor Convicted of Health Care Fraud in State and Federal Probe
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Written by TAC Staff: Yellow Pages   
Sunday, 18 December 2011 01:46
HOUSTON, TX - Justina Okehie aka Dr. Tina Collins, 55, of Richmond, Texas, has pleaded guilty to one count of conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today.
The conspiracy resulted in fraudulent physical therapy and chiropractic claims being paid by the Medicare and the Texas Medicaid programs. From January 2007 through August 2010, Medicare and Medicaid paid approximately $2.1 million to Okehie.
Okehie owned and operated Adom Rehabilitation Services and Healthcare and Wellness Medical Center which were both located in southwest side Houston. As part of the conspiracy, Okehie would pay patient recruiters to refer Medicare beneficiaries to her clinics. Okehie also paid the Medicare beneficiaries themselves for just showing up at the clinics. In many instances, the physical therapy and chiropractic services billed to the government health care programs were not performed and were not medically necessary. Some of the Medicare beneficiaries were actually receiving medical services at inpatient hospital facilities at the time Okehie was purportedly providing them physical therapy and chiropractic services in her clinics.
Co-defendant Cassandra Tasby Barnes, 48, of Houston, who was employed by Barnes as an office manager, had previously pleaded guilty in this case to one count of conspiracy to violate the anti-kickback statute. Barnes pleaded guilty for her role in paying Medicare beneficiaries and patient recruiters for referring Medicare beneficiaries for physical therapy and chiropractic services. Both Okehie and Barnes are currently on bond and are scheduled to be sentenced on May 21, 2012, before U.S. District Judge Nancy Atlas.
The investigation into Adom Rehabilitation and Healthcare and Wellness Medical Center was the result of joint efforts by agents and investigators of the Inspector General's Office of the U.S. Department of Health and Human Services, the Texas Attorney General's Medicaid Fraud Control Unit, the Railroad Retirement Board and the FBI. Special Assistant U.S. Attorney Justin Blan and Assistant U.S. Attorney Julie Redlinger are prosecuting this case. 

Source: The U.S. Attorney for the Southern District of Texas 
State Accuses Chiropractor Of Unethical Practices; Functional Endocrinologist Accused of Practicing Medicine
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Written by TAC Staff: Yellow Pages   
Saturday, 19 November 2011 04:38
aroundtheworldDENVER, CO -- The state of Colorado took action against a chiropractor, handing down pages of violations, accusing him of unethical practices, after a television investigation exposed his business practices.  Over the past year, many former patients of chiropractor Brandon Credeur told 7NEWS that they paid thousands of dollars upfront, seeking help for thyroid and diabetes problems from someone they thought was an endocrinologist.

Credeur has been hit with 25 counts including negligent chiropractic practice, false or misleading advertising, unethical advertising, ordering unnecessary tests, failing to make essential entries on patient records, or falsifying them, abandoning a patient, and performing a procedure beyond the scope of authorized services.

CJ Omelian, a former Credeur patient, believes that Credeur's license should be pulled.
"He abused that," Omelian said.

Until she saw an investigation by CALL7, a local television program, the patient believed Credeur was an endocrinologist."I hope he has to answer to every charge he has against him," Omelian said.

"Patients are sometimes not understanding the qualifications of the people they're dealing with. And we think this is one of those cases," said Dr. Brent Keeler, president of the Colorado Medical Society. The Colorado Medical Society is calling for more transparency. And it is Credeur's own words, seen in Web videos posted online, that raises even more questions as he tutors others chiropractors on his business model.

"I would take the spines out of the office or at least hide them," Credeur instructed in one video.

"These patients are desperate," Credeur said in another video.

Source: – CALL7 News
D.C. Loses Insurance Case and Pays Big for Fraud
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Written by TAC Staff: Yellow Pages   
Saturday, 19 November 2011 04:29
aroundtheworldBOSTON, MA-- For the second time this year, The Norfolk & Dedham Group has won a significant insurance fraud/racketeering case filed against a chiropractor and his treatment facilities. By a Memorandum of Decision issued September 15, 2011, a judge sitting in the Massachusetts Suffolk Superior Court ordered Jason Corbett, and his chiropractic clinics (including Franklin Field, Hyde Park and Union Street Chiropractic) pay Norfolk & Dedham $1,138,453.42 dollars in damages.The litigation began when Jason Corbett's Clinics filed hundreds of individual lawsuits against Massachusetts automobile insurers, including Norfolk & Dedham, in Courts throughout Massachusetts. In these complaints, Corbett sought payment for treatments allegedly provided to automobile accident victims. Norfolk & Dedham consolidated the Corbett lawsuits and filed a Complaint in Suffolk Superior Court for Fraud, Civil Conspiracy, as well as violations of the Federal Racketeer Influenced Corrupt Organizations ("RICO") Act, and the Massachusetts' Unfair Business Practices Statute.

During the discovery phase of the case, Corbett admitted that he violated Massachusetts Chiropractic Regulations by paying individuals, known as referrers or runners, as much as $500.00 dollars per person to solicit patients for his clinics. Moreover, chiropractors employed by Corbett admitted that they knowingly provided excessive and unnecessary services to patients.
In reaching its decision, the Court found that, "Jason Corbett, and his clinics, were all responsible for the misrepresentations created by their employees." The Court concluded that "both as manager at the chiropractic clinics and of the chiropractors themselves, it is factually obvious that [Jason] Corbett had actual knowledge that the reports being prepared by the chiropractors contained false representations that the treatment rendered was reasonable and necessary." The Judge further observed that, "In addition, it is beyond dispute that Corbett possessed actual knowledge that the false reports would be relied upon by the Insurers' to their detriment." For these reasons, the Court awarded Judgment in favor of the insurer on all,". . . fraud claims stemming from chiropractic patients treated at the Corbett Clinics who were referred to the clinics by runners or who received unnecessary treatment . . ."

Norfolk & Dedham's $1.1 million dollar award against Jason Corbett follows closely behind another significant victory in its ongoing battle against insurance fraud. On September 9, 2011, in a separate fraud/racketeering lawsuit filed against former Massachusetts chiropractors, Alan Cohen and Marc Cohen, the Suffolk Superior Court entered a Final Judgment ordering the Cohens pay Norfolk & Dedham $693,961.67 dollars.

"These two awards from the Court demonstrate Norfolk & Dedham's resolve in combatting insurance fraud. Norfolk & Dedham will remain vigilant in rooting out insurance fraud in all forms," said James T. Harrington, Executive Director of the Massachusetts Insurance Federation. The Massachusetts Insurance Federation is an insurance company trade association comprised of 24 property/casualty insurers and is viewed as the leading advocacy voice of the property/casualty insurance industry in Massachusetts. The Norfolk & Dedham Group is a member of the Federation.
Norfolk & Dedham Mutual Fire Insurance Company, Dorchester Mutual Insurance Company, and Fitchburg Mutual Insurance Company, do business as The Norfolk & Dedham Group.

SOURCE: The Norfolk & Dedham Group
Atlanta Chiropractor Held for Fondling
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Written by TAC Staff: Yellow Pages   
Wednesday, 26 October 2011 22:36
Atlanta, GA: A Sandy Springs chiropractor was behind bars after being accused of fondling a male customer during a massage session. The 28-year-old customer said his chiropractor offered a free massage session after an initial visit to his office. The chiropractor’s office is at the same location as his home address. The chiropractor was taken into custody, and remained at the Fulton County Jail on $5,000 bond for four days.
Source: The Atlanta Journal-Constitution

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