 Bridging the Gap Between Medicare Compliance and Medicine |
Vol. VIII, No. 23 –July 17, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Medicare Prescription Drug Part D Compliance Conference
Research Compliance Conference
Fraud and Compliance Forum
Compliance Academy
Table of Contents
Headlines
Doctor Sentenced to One Year and One Day
Three Indicted in Health Care Fraud and Identity Theft Conspiracy
Physician Receives Life Sentence
Couple Settle Health Care Fraud Charges
Doctor Pleads Guilty
Kickback Scheme Uncovered
Former Medical Director Indicted
Baxter Healthcare Agrees To Comply
Owner of Home Health Agency Pleads Guilty
Compliance Institute Issues Call For Speakers
Regulatory News
National Provider Identifier Education Available From CMS
National Coverage Determinations Guidance Revised
Medicare Modernization Act – Part D
This
Week’s Link
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
Doctor Sentenced One Year and One Day
On July 14 the Jackson Sun reported that “A federal judge sentenced former medical doctor Sheran Yeates Friday in U.S. District Court in Jackson to 12 months and a day in prison on a health care fraud charge.
“Yeates will serve 85 percent of that time or a little more than 10 months, his attorney, Mark Donahoe said.“Yeates will get a letter from the Federal Bureau of Prisons telling him when and where to report to serve his sentence, Donahoe added. Judge James Todd said that usually happens within five to six weeks after sentencing.” For more: http://www.jacksonsun.com/apps/pbcs.dll/article? AID=/20060714/NEWS01/60714001
On July 7, US Attorney for the Southern District of Florida R. Alexander Acosta, announced that three (3) defendants who were indicted by a Federal Grand Jury in a multi-million dollar health care fraud were arrested. The Indictment charges Ramon Avila, Yvette Aguilera, and Noemy Ruiz, with conspiracy to defraud a health care benefits program (Medicare), and defrauding a health care benefits program (Medicare) in violation of Title 18 U.S.C. §1347. It also charges Yvette Aguilera and Ramon Avila with Identity Theft for fraudulently utilizing Unique Physician Identification Numbers (UPIN) without the physician's approval or knowledge in violation of Title 18 U.S.C. § 1028(a)(7) and §1028 (b)(1)(A). It also charges Noemy Ruiz with paying kickbacks and bribes to induce the referral of Medicare beneficiaries in violation of Title 42 U.S.C. § 1320a-7b(b)(2)(a). The case has been assigned to United States District Court Judge Kenneth A. Marra. For more: http://www.usdoj.gov/usao/fls/060707-02.html
Physician Receives Life Sentence
On July 12, the North Country Gazette reported that “A former Apalachicola osteopathic physician, convicted of prescribing quantities of drugs that resulted in the deaths of five individuals, has been sentenced to life imprisonment on 98 counts of wire fraud, health care fraud, and distribution of controlled substances.
For more: http://www.northcountrygazette.org/ articles/071206DrugDeaths.html
In a related story…on June 9, the US Attorney for the Northern District of Ohio Gregory A. White announced that Dr. Jorge A. Martinez, age 54, formerly of Bath, Ohio, was sentenced to life imprisonment by United States District Court Judge Donald C. Nugent. This is the first conviction under the “health care fraud resulting in death” statute in the country and the first life sentence. For more:
http://www.usdoj.gov/usao/ohn/news/09June2006_2.html
On July 11, Associated Press reported that “A Haleyville couple have agreed to pay $3.14 million to the federal government to settle health care fraud claims.
Gerald M. "Max" Burleson and his wife, Frances R. Burleson, agreed to settle the civil charges, the U.S. Attorney's office announced Tuesday.
“The Burlesons, who own five pharmacy and medical equipment businesses, were accused in a lawsuit of paying kickbacks to people who improperly referred patients to the couple for medical equipment and respiratory medication. Gerald Burleson was also accused of defrauding Medicare by improperly dispensing prescribed medication.” For more: http://www.ledger-enquirer.com/mld/ledgerenquirer/news/local/15016608.htm
US Attorney press release: http://www.usdoj.gov/usao/aln/Docs/July%202006/JULY%2011, 2006%20HALEYVILLE%20DEFENDANTS%20AGREE%20TO PAY%20$3.14%20MILLION%20TO%20RESOLVE MEDICARE%20FRAUD%20CASE.htm
On July 10, US Attorney for the Northern District of Michigan reported that Skin and Vein Center Dr. Eric Seiger pleaded guilty to importation of non-FDA approved medical devices. For more:
http://www.usdoj.gov/usao/mie/press/2006/2006-07-10_eseiger.pdf
On June 27, The Office of US Attorney for Minnesota announced that a former director, officer, and co-owner of AGA Medical in Golden Valley, Minnesota, and the president of Foremost Machining, of Hugo, Minnesota, were indicted for orchestrating a kickback scheme. For more: http://www.usdoj.gov/usao/mn/press/econ/econ0094.htm
On June 30, US Attorney for the Northern District of Illinois reported that a former medical director at Rock Creek psychiatric facility was indicted in alleged $875,000 health care fraud scheme. For more:
http://www.usdoj.gov/usao/iln/pr/chicago/2006/pr0630_01.pdf
On June 29, US Attorney for the Northern District of Illinois announced that Baxter Healthcare agreed to a U.S. Court Order to remedy infusion pump defects and to comply with FDA requirements. For more
http://www.usdoj.gov/usao/iln/pr/chicago/2006/pr0629_01.pdf
On July 15, The Detroit News reported that “the former owner of one of Michigan's largest home health care companies has pleaded guilty to defrauding Medicare, the U.S. Attorney's Office said Friday.
“Elena Szilvagyi, 55, of Clarkston, the former president of Southfield-based Prime Care Services, pleaded guilty Thursday to forming two spin-off companies in a fraudulent scheme to avoid paying a $7 million debt to Medicare, U.S. Attorney Stephen Murphy said in a news release.
“Szilvagyi also pleaded guilty to conspiring to obstruct a criminal health care fraud investigation, Murphy said.” For more: http://www.detnews.com/apps/pbcs.dll/article?AID=/ 20060715/BIZ/607150383/1001
2007 Compliance Institute – Call for Speakers
August 2, 2006 is the deadline for those interested in speaking at the 2007 Compliance Institute. HCCA’s 11th Annual Compliance Institute will be held on
April 22-25, at the Sheraton Chicago Hotel & Towers.
The program is designed for compliance professionals from a variety of health
care backgrounds, including compliance officers, billing and coding professionals, auditors, nurses, risk managers, ethics officers, privacy officers, health information professionals.
The objectives of this conference include:
- To present practical approaches for enhancing compliance programs
- To examine the impact of legislative and regulatory changes
- To provide a comprehensive compliance curriculum
- To provide networking opportunities
- To assist participants with identifying key compliance strategies
The program will cover topics focusing on General Compliance, HIPAA, Auditing & Monitoring, Hot Topics, Quality of Care, Research/IRB, SOX, Tax Exemption/Charity Care, and Physician Transaction. If you would like to be considered as a speaker for the program, please complete the online form by clicking here.
Each 1-hour session should include a case study, interactive discussion of the topic, practical tools and 10 - 15 minutes of question and answer. A description and/or examples of how you will incorporate these items into your session will be required with your submission.
Click here to complete the form
The following information will be required to complete the online form:
- Session Title
- Co-Presenter(s)/Name, Title, Company & Email
- Describe the session
- A short paragraph describing the audience for whom your session is intended and why the subject area is important. Along with a description and/or examples of how you will incorporate a case study, and practical tools
- A short paragraph of how you will interact with your audience
- Three Marketing Bullet points, which if your session is selected will be used in the conference brochure to market your session
- A Bio (No longer than 1 page)
If selected as a speaker, the information you provide will be used in the program brochure. Please be sure the spelling is correct and all relevant titles, information about degrees, and credentials are included.
All forms and supporting documentation should be submitted by Wednesday, August 2, 2006:
Contact with questions:
Jennifer Hultberg at jennifer.hultberg@hcca-info.org or by telephone at 952-405-7916.
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This week, MediRegs provided TWCC readers with the following Regulatory News: In the Federal Register, CMS Transmittals, and From the OIG.
Regulatory News
National Provider Identifier Education Available From CMS
Centers for Medicare and Medicaid Services (CMS) and the Workgroup for Electronic Data Interchange (WEDI) are working together to ensure that all healthcare providers are educated and informed on the new National Provider Identifier (NPI). As such there are a few upcoming outreach events, sponsored by WEDI, that health care providers may find helpful:
- Taxi-ing to the Taxonomy Code Audiocast July 26th from 2 - 3:30PM Eastern Time
- WEDI NPI Industry Forum IV: NPI Is Knocking At Your Door—Will You Let It In?
Please note that there is a cost to participate in these events. To learn more about the events, as well as the latest news on WEDI NPI outreach, visit http://www.wedi.org/npioi/index.shtml on the web.
On July 12, CMS released revised guidance for national coverage determinations
(NCDs) that include, as a condition of payment, the development and capture of additional patient data to supplement standard claims data and help ensure that patients receive appropriate care. For more: http://www.cms.hhs.gov/ apps/media/press/release.asp?Counter=1897
Medicare Part B Drugs: CMS Data Source for Setting Payments Is Practical but Concerns Remain, GAO-06-971T, July 13, 2006
http://www.gao.gov/new.items/d06971t.pdf
Medicare Part D: Prescription Drug Plan Sponsor Call Center Responses Were Prompt, but Not Consistently Accurate and Complete, GAO-06-710, June 30, 2006
http://www.gao.gov/new.items/d06710.pdf
In the Federal Register
Medicaid Rules Regarding Evidence of Citizenship Requirements Amended
On July 12, 2006, CMS published an interim final rule in the Federal Register that amends the Medicaid regulations to implement the provision of the Deficit Reduction Act that requires States to obtain satisfactory documentary evidence of an applicant's or recipient's citizenship and identity in order to receive Federal financial participation. The regulation provides States with guidance on the types of documentary evidence that may be accepted, including alternative forms of documentary evidence in addition to those described in the statute and the conditions under which the documentary evidence can be accepted to establish the applicant's declaration of citizenship. It also gives States guidance on the processes that may be used to help minimize the administrative burden on both States and applicants and recipients.
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u=0607122&h=top1.html&t=80&s=twcc
Medicare Benefit Policy - Basic Coverage Rules (PUB. 100-02)
Transmittal #53, Date: July 7, 2006 Medicare Telehealth Services Update:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_02&u=mrepm10002r53bp&h=top1.html&t=80&s=twcc
Medicare Claims Processing (PUB. 100-04)
Transmittal #997, Date: July 7, 2006 Medicare Telehealth Services Update:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r997cp&h=top1.html&t=80&s=twcc
Financial Management (PUB. 100-06)
Transmittal #101, Date: July 12, 2006 Notice of New Interest Rate for Medicare Overpayments and Underpayments:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_6&u=mrpm10006r101fm&h=top1.html&t=80&s=twcc
Transmittal #149, Date: June 30, 2006 Notification to Provider(s) or Supplier(s) Regarding Postpayment Review Results:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_08&u=mrpm10008r149pi&h=top1.html&t=80&s=twcc
National Coverage Analyses
Blood Brain Barrier Disruption Chemotherapy (CAG-00333N) - Expected Completion Date: 04/11/07:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u=CAG00333N&h=top1.html&t=80&s=twcc
Clinical Trial Policy (CAG-00071R) - Expected Completion Date: 04/10/07:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u=CAG00071R&h=top1.html&t=80&s=twcc
Ventricular Assist Devices as Destination Therapy (CAG-00119R) - Expected Completion Date: 04/10/07:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u=CAG00119R&h=top1.html&t=80&s=twcc
For more CMS Transmittals: http://www.cms.hhs.gov/Transmittals/2006Trans/list.asp#TopOfPage
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Medicare Modernization Act – Part D
Calculating the Late Enrollment Penalty:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mpdim_rx&u=lateenrollment&h=top1.html&t=80&s=twcc
Extra Help/LIS Outreach Toolkit:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mpdim_rx&u=LISOutreachToolkitFINAL&h=top1.html&t=80&s=twcc
Extra Help/LIS Outreach Toolkit Publications Links:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mpdim_rx&u=lispublications&h=top1.html&t=80&s=twcc
Low-Income Subsidy Outreach Targeting Information: County Level Estimates of the Number of Unenrolled People who may be Eligible for the Low-Income Subsidy:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mpdim_rx&u=listargetingdata&h=top1.html&t=80&s=twcc
Understanding When People Who Qualify for Extra Help Can Enroll in a Medicare Drug Plan:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mpdim_rx&u=extrahelpenroll&h=top1.html&t=80&s=twcc
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From the OIG
Audit Reports - Centers for Medicare and Medicaid Services
Medicaid Hospital Outlier Payments in New York for State Fiscal Years 1998 through 2002 (A-02-04-01022; 06/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=20401022&h=top1.html&t=80&s=twcc
Medicaid Payments for Beneficiaries with Concurrent Eligibility in Ohio and Michigan, Ohio Department of Job and Family Services(A-05-06-00021; 06/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=50600021&h=top1.html&t=80&s=twcc
Some Recent Corporate Integrity Agreements from the OIG
Atlas Care Enterprises, Inc. - La Canada, GA - 03/06/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=atlascare&h=top1.html&t=80&s=twcc
Beebe Medical Center - Lewes, DE - 03/15/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=beebemedctr&h=top1.html&t=80&s=twcc
Caruso, Richard, M.D. - Lewes, DE - 03/16/06 (not yet available):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=carusorich&h=top1.html&t=80&s=twcc
Ember Care Corporation - La Canada, CA - 03/06/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=embercareco&h=top1.html&t=80&s=twcc
Guthrie Clinic, L.L.P. - Sayre, PA - 03/01/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=guthrieclinicllp&h=top1.html&t=80&s=twcc
Guthrie Clinic, Ltd. - Sayre, PA - 03/01/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=guthrieclinicltd&h=top1.html&t=80&s=twcc
Guthrie Clinic, P.C. - Sayre, PA - 03/01/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=guthrieclinicpc&h=top1.html&t=80&s=twcc
Guthrie Group Practice Partnership, L.L.P. - Sayre, PA - 03/01/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=guthriegrpprac&h=top1.html&t=80&s=twcc
Mobility Products Unlimited, Inc. - South Daytona, FL - 05/24/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=mobilityprod&h=top1.html&t=80&s=twcc
Parasher, Vinod, M.D. - Lewes, DE - 03/16/06 (not yet available):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=parashervinod&h=top1.html&t=80&s=twcc
PCC Health Services, Inc. - La Canada, CA - 03/06/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=pcchs&h=top1.html&t=80&s=twcc
Piedmont Hospital - Atlanta, GA - 06/09/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=piedmonthosp&h=top1.html&t=80&s=twcc
Pleasant Care Corporation - La Canada, CA - 03/06/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=pleasantcareco&h=top1.html&t=80&s=twcc
SNF Properties - La Canada, CA - 03/06/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=snfprop&h=top1.html&t=80&s=twcc
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This Week’s Links:
NHCAA Anti-Fraud Management Survey for Calendar Year 2005
http://www.nhcaa-institute.org/home/index.cfm
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Acronym Library
| M&M | Medicare & Medicaid |
| M+C | Medicare + Choice |
| M+C NSF | Medicare + Choice National Standard Format |
| M+CO | Medicare + Choice Organization |
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
NOTE: HCCA Members please contact April Kiel at april.kiel@hcca-info.org
if you have not received your password. This new
Web site allows members and visitors to register for conferences, order
products, or join HCCA online. HCCA Members can
update membership information and search for compliance resources
online in a secure environment, without faxing, emailing and other time-consuming
activities.HCCA's Web site
also offers E-Communities, which allow regional and
industry specific information to be shared through a discussion forum
and list-serve. Members can view and respond to documents,
tools, forms, policies and other information posted by Regional and Compliance
Focus Group leaders!
Visit http://www.hcca-info.org
and see for yourself.
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HCCA Headquarters
- Contact Information Your HCCA Office
is located at:
6500 Barrie Road, Suite 250
Minneapolis, MN 55435
The HCCA Toll-Free
888/580-8373,
Fax number - (952)
988-0146
MN telephone number-
(952) 988-0141
Email - info@hcca-info.org Contact: Margaret
Dragon, Editor
This Week in Corporate Compliance (781) 593-4924
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