Vol. VIII, No. 22 – July 3, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Table of Contents

Headlines

Scrushy Found Guilty
Former CFO Pleads Guilty to Fraud
Settlement Announced by Tenet Healthcare and US Government
Clinic Owners Charged with Fraud
HCCB Approves Accreditation of George Washington University Graduate Certificate in Healthcare Corporate Compliance

Regulatory News

CMS Proposes Changes to Physician Fee Schedule

In the Federal Register

CMS Transmittals

From the OIG

This Week’s Link
Acronym Library

Visit HCCA's Web site
HCCA Headquarters - Contact Information

Headlines:

Scrushy Found Guilty
Richard Scrushy, former chief executive officer at HealthSouth Corp., Birmingham, Ala., was found guilty of bribery, conspiracy and mail fraud according to a June 29, 2006 Modern Healthcare report. “The jury, in U.S. District Court, Montgomery, Ala., returned the verdict after 11 days of deliberations. Scrushy was accused of paying former Alabama Gov. Don Siegelman $500,000 to obtain a seat on the state certificate-of-need board for a HealthSouth representative.”
US Department of Justice Press Release:
http://www.usdoj.gov/opa/pr/2006/June/06_crm_409.html

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Former CFO Pleads Guilty to Fraud
According to an Associated Press report aired on KRTV - Great Falls,MT, “In 2001, the state shut down a nursing home in Big Sandy. In closing the Prairie Vista Manor, the state cited unhealthy living conditions and lack of patient care.

" Now, the former chief financial officer for the nursing home has admitted filing false Medicaid claims to the government, and diverting money intended for patient care. Thirty-nine-year-old Jesse Marcel the Third of Spokane, Washington, yesterday pleaded guilty to one of eight felony counts of health care fraud, and filing false claims to the government."

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Settlement Announced by Tenet Healthcare and US Government
A June 28 Modern Healthcare Alert reported that Tenet Healthcare has “agreed to pay $900 million under a global settlement with the Justice Department resolving a number of Medicare fraud allegations. The company, which owns 68 hospitals, also agreed to divest nine hospitals in New Orleans, Philadelphia and Florida, sources said. Tenet and the government are expected to announce the settlement Thursday morning. Tenet will pay $450 million in cash upfront and an additional $275 million over three years beginning in November 2007. The remainding $175 million of the settlement will come from Medicare payments that Tenet has agreed not to collect. The settlement resolves numerous allegations, including manipulating the Medicare outlier system, upcoding DRGs and paying kickbacks to physicians.”
Tenet Healthcare Press Release: http://www.tenethealth.com/NR/rdonlyres/BE8B8557-A94B-4CDD-9B16-0E4ABE9EF525/97564/DOJSettlement.pdf
US Department of Justice Press Release: http://www.usdoj.gov/opa/pr/2006/June/06_civ_406.html

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Clinic Owners Charged with Fraud
On June 29, the SunHerald published an Associated Press report that “A husband and wife who owned a Mississippi rehabilitation clinic face charges that include health care fraud, making false statements, money laundering and Social
Security misuse, the FBI said Thursday.

“The FBI said in a statement that Dr. Jennifer Yvonne Berry, 33, was arrested in Bay City, Texas, and her husband, Johnnie Lee Winfield, 53, was taken into custody at the couple's residence in Houston.” For more: http://www.sunherald.com/mld/sunherald/14931949.htm

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HCCB Approves Accreditation of George Washington University Graduate Certificate in Healthcare Corporate Compliance
On June 15, 2006 The Healthcare Compliance Certification Board (HCCB) approved the accreditation of George Washington University Graduate Certificate in Healthcare Corporate Compliance. This accreditation by the HCCB is for the period of June 15, 2006 to June 15, 2007.  According to the letter sent to by HCCB President Debbie Troklus, “The Health Care Compliance Certification Board met on June 15, 2006 and approved the accreditation of the George Washington University Graduate Certificate in Healthcare Corporate Compliance.  The Compliance Certificate program has successfully met all criteria as established by the HCCB.”

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Regulatory News

CMS Proposes Changes to Physician Fee Schedule
On June 21, the Centers for Medicare & Medicaid Services (CMS) issued a notice proposing changes to the Medicare Physician Fee Schedule (MPFS) that will improve the accuracy of payments to physicians for the services they furnish to Medicare beneficiaries.  The proposed notice includes substantial increases for “evaluation and management” services, that is, time and effort that physicians spend with patients in evaluating their condition, and advising and assisting them in managing their health.  The changes reflect the recommendations of the Relative Value Update Committee (RUC) of the American Medical Association. 
http://www.cms.hhs.gov/apps/media/press/ release.asp?Counter=188

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In the Federal Register
On June 28, 2006 the Centers for Medicare and Medicaid Services (CMS) issued a proposed notice - Physician fee schedule; work relative value units five-year review and practice expense methodology amendments.
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/ edocket.access.gpo.gov/2006/06-5665.htm

On June 30, CMS published a correcting amendment to the final rule regarding the Requirements for Providers and Suppliers To Establish and Maintain Medicare Enrollmenthttp://a257.g.akamaitech.net/7/257/2422/01jan20061800/ edocket.access.gpo.gov/2006/E6-10290.htm

CMS also published in the Federal Register on June 30, a correction related to the Inpatient Psychiatric Facilities Prospective Payment System Update for Rate Year Beginning July 1, 2006 (RY 2007) Final Rulehttp://a257.g.akamaitech.net/7/257/2422/01jan20061800/ edocket.access.gpo.gov/2006/E6-10277.htm

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CMS Transmittals – MLN Matters Articles
VMS Standard System Unavailability for Durable Medical Equipment Regional Carriers (DMERCs)
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/SE0640.pdf

Medicare Policy Regarding Collection of Fee-for-Service Payments Made During Periods of Managed Care Enrollment
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/SE0638.pdf

Use of the KX Modifier on Claims Submitted to the Fiscal Intermediary When Some Services Exceed the Therapy Caps
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/SE0637.pdf

Processing of Outpatient Prospective Payment System (OPPS) Claims with Certain Drug Administration Code Pairs
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/SE0635.pdf

Facilitating Your Medicare Enrollment
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/SE0634.pdf

Section 1011: Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens - An Update
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/SE0633.pdf

For more CMS Transmittals: http://www.cms.hhs.gov/Transmittals/2006Trans/list.asp

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From the OIG
Advisory Opinion 06-07 (concerning a proposal by a municipality, which provides emergency medical services through a municipally owned and operated ambulance service, to treat revenue received from local taxes as payment of otherwise applicable cost-sharing amounts due from municipal residents)
http://www.oig.hhs.gov/fraud/docs/advisoryopinions/ 2006/AdvOpn06-07.pdf

Recent Administrative Enforcement Actions
http://oig.hhs.gov/fraud/enforcement/ administrative/cmp/cmp.html
Audit of Illinois' Medicaid Payments for Skilled Professional Medical Personnel for the Period October 1, 2003 Through September 30, 2004
http://oig.hhs.gov/oas/reports/region5/50500051.htm

Review of Medicare Claims for Air Ambulance Services Paid to Allegheny General Hospital
http://oig.hhs.gov/oas/reports/region3/30400014.htm

A Comparison of Average Sales Price to Widely Available Market Prices: Fourth Quarter 2005
http://oig.hhs.gov/oei/reports/oei-03-05-00430.pdf***

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This Week’s Links:
List of settlements from 2004-2006 on the TAF Web site
http://www.taf.org/statistics.htm

Senator Grassley Wins Committee Approval of Non-Profit Improvements, Including Double Fines, Penalties for Non-profit Groups Engaged in Inappropriate Political Activity
http://finance.senate.gov/press/Gpress/2005/prg062806a.pdf

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Acronym Library

For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp

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Visit HCCA's Web site, http://www.hcca-info.org

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Email - info@hcca-info.org Contact: Margaret Dragon, Editor
This Week in Corporate Compliance (781) 593-4924

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