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$67 million telemarketing Medicare fraud scheme; new ASD screening model for toddlers; single H5N1 mutation could enable transmission among humans – Morning Medical Update

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  • Jose Goyos defrauded Medicare by billing $67 million for unnecessary genetic tests, receiving over $53 million in payments.
  • The RITA-T model enhances early autism diagnosis in underserved communities, targeting toddlers aged 18 to 36 months.
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Physician telemarketing scheme © Jacob Lund - stock.adobe.com

© Jacob Lund - stock.adobe.com

Telemarketer sentenced in $67 million health care fraud scheme

Jose Goyos, 38, of West Palm Beach, Florida, was sentenced to 15 years in prison for his role in a conspiracy to defraud Medicare by billing more than $67 million for medically unnecessary genetic testing. Gotyos served as manager of the “doctor chase” sector of a call center, which contacted primary care physicians of Medicare beneficiaries—who were targeted by the call center—and tricked the physicians into ordering medically unnecessary genetic tests based on fake medical paperwork. Between May 2020 and June 2021, Goyos and co-conspirators submitted over $67 million in false and fraudulent claims to Medicare, for which they were paid over $53 million.

New interactive screening model for autism in toddlers

In response to a lack of valid screening measures for autism spectrum disorder (ASD), especially in communities that are under-resourced and culturally and linguistically diverse (CLD), researchers have developed a new, interactive screening model, referred to as the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T). The screening model, designed to help primary care and early intervention providers in the diagnosis of high-risk toddlers, offers precise and quick diagnosis for children between the age of 18 and 36 months. A study published in Pediatric Investigation, looked to identify RITA-T’s potential to improve early identification of high-risk toddlers in underserved communities, according to an organizational release.

A mutation in H5N1 influenza surface protein could result in easier human infection

A study, funded by the National Institutes of Health (NIH), and published in Science, found that a single modification in the protein found on the surface of the avian influenza (HPAI) H5N1 influenza virus, which is highly pathogenic and currently circulating in dairy cows in the U.S., could allow for easier transmission among humans. Influenza viruses attach to cells with hemagglutinin (HA), a surface viral protein, which latches on to cell’s glycan molecule receptors to cause infection. Avian influenza viruses have not infected humans because the human upper respiratory tract lacks the avian-type cell receptors, but scientists are now concerned that viruses could evolve to recognize human-type cell receptors, making them transmissible among humans.

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