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Author Topic: Eleven charged with insurance frauds involving surgeries on addicts  (Read 348 times)

Krik

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Consumer Health Digest #18-42
October 21, 2018
Current # of subscribers: 10,640

Consumer Health Digest is a free weekly e-mail newsletter edited by William M. London, Ed.D., M.P.H
http://www.calstatela.edu/faculty/william-m-london
, with help from Stephen Barrett, M.D
http://www.quackwatch.org/10Bio/bio.html
It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making. Its primary focus is on health, but occasionally it includes non-health scams and practical tips.

###

Eleven charged with insurance frauds involving surgeries on addicts

The Orange County (California) district attorney's office has charged the alleged perpetrators of a scheme to fraudulently bill insurance companies millions of dollars for surgical implantations of naltrexone "pellets."
[Five doctors, two administrators, and four body brokers charged with insurance fraud for exploiting drug addicts to bill insurance for non-FDA approved and dangerous surgeries
http://orangecountyda.org/civica/press/display.asp?layout=2&Entry=5722
Orange County District Attorney News Release. Sept 26, 2018]

Naltrexone, which is used to help narcotic addicts deal with withdrawal symptoms, is FDA-approved for use in pill and injectable form but not for surgical implantation. The prosecutors have alleged:

* Fountain Valley-based SoberLife USA owner Thuy Rucks and employee Christianne Tiemann (a) hired "body brokers" who paid people up to $1,000 to receive the surgical implants and (b) fraudulently billed insurance companies an average of  $40,000 per operation.

* The "body brokers"—Dylan James Walker, Harrison Anthony Romanowski, John Kahal, and Jordan Tyler Hendrickson—attended sober-living homes and Alcoholics Anonymous meetings to entice people to have the surgery.

* David Michael Scarpino M.D. and Nabil Morcos M.D.
(a) misled patients about the safety and appropriateness of the surgery, which involved cutting open the patient's back or abdomen, and
(b) recommend the procedure without proper examinations to determine whether a patient was a suitable candidate for naltrexone therapy.

* Michael Henry Wong D.O., Gary Lamont Baker M.D., and Fritz John Baumgartner, M.D., performed the unnecessary operations.

No disciplinary actions against any of the doctors in the case are currently listed in public records made available by California's Department of Consumer Affairs.

###

Anti-fluoridation activities investigated

NBC News has examined some of the ways that opponents of community water fluoridation have misled people. Fluoridation's benefits and safety are well-established
https://www.cdc.gov/fluoridation/index.html
and nearly 75% of community water systems in the U.S. are fluoridated
https://www.cdc.gov/fluoridation/statistics/2014stats.htm
The NBC report notes:

Conspiracy theorizing about fluoridation began when the first U.S. Public Health Service launched the first community experiment of water fluoridation in 1945 without the consent of residents of Grand Rapids, Michigan.
Some anti-fluoridation activists argue 
https://www.reddit.com/r/conspiracy/comments/xov7o/fluoride_hitler_first_started_water_fluoridation/
that the government uses fluoride as a form of mind control; others believe it's designed to boost the sugar lobby by enabling people to eat more sweets without getting cavities; and still others believe that health officials are afraid to reverse course on fluoride after promoting it for decades.
The American Dental Association says that 74 cities in the past five years have voted to remove fluoride from their drinking water.
The New York State Coalition Opposed to Fluoridation
https://www.facebook.com/NYSFluoridation
, which blames fluoride for problems including thyroid damage, falsely claimed
https://www.scienceinmedicine.org/policy/papers/AntiFluoridationist.pdf
in 2012 that the federal government "recommends avoiding fluoridated water when making infant formula," when a federal agency merely warned 
https://www.cdc.gov/fluoridation/faqs/infant-formula.html
that exclusive formula feeding with fluoridated water may increase risk for mild dental fluorosis (spotting of teeth).
Social media are spreading false claims such as fluoride kills gut bacteria and is a cancer-causing neurotoxin.
The 2018 Republican Party of Texas platform
https://www.texasgop.org/platform/
calls for banning the fluoridation of all Texas water supplies.
Eighty percent of New Jersey residents do not have fluoridated water.
East Brunswick, New Jersey stopped fluoridating
https://www.mycentraljersey.com/story/news/local/middlesex-county/2015/03/02/east-brunswick-fluoride-drinking-water/24285689/
three years ago after Mayor David Stahl called it "mass medication of the public."
[Chuck E. Science says fluoride is good for kids. So why are these towns banning it?
https://www.nbcnews.com/news/us-news/science-says-fluoride-water-good-kids-so-why-are-these-n920851
NBC News. Oct 17, 2018]

###

“Creative" billing by chiropractors described

The Coalition Against Insurance Fraud has published an excellent summary of what the author calls "creative new ways" that chiropractors are using to scam the insurance system. They include:

* Ownership of multi-disciplinary clinics positioned as group medical practices that falsely bill chiropractic services as other services offered by other types of practitioners

* Miscoding noncovered services, such as low-level laser therapy, as services that can be reimbursed

* Using higher-paying codes to describe services such as "therapeutic" massage as manual therapy, neuromuscular stimulation, therapeutic exercise, and/or therapeutic activities

* Billing for phantom services by claiming that services such as massage, manual therapy, and therapeutic exercise performed by ineligible or nonclinical staff were performed by eligible practitioners

* Fraudulent entries into electronic medical records that utilize prepared blocks of text that do not accurately describe real findings

* Using hand-held automated devices with telemetry by untrained staff and then billing as if trained clinicians did full diagnoses

* Using pain-fiber nerve-conduction studies that require subjective reporting by patients and do not detail the source of the patient's problem

* Using elaborate treatment regimens on patients with minimal initial problems

[Bowerman D. Shady chiros manipulate patient joints, insurance claims
https://www.insurancefraud.org/jifa/feb-2018/shady-chiros-manipulate-patient-joi
Journal of Insurance Fraud in America. Feb 13, 2018]

=================================

Stephen Barrett, M.D.
Consumer Advocate
287 Fearrington Post
Pittsboro, NC 27312

Telephone: (919) 533-6009

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