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Vol. VIII, No. 24 – July 25, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Table of Contents
Headlines
UMDNJ Monitor Asks US Attorney to Intervene
Medtronic Settles, Will Pay $40 Million
Medical Center Agrees to Pay $3.75 Million
Hospice Provider Settles
Laurel Regional Hospital To Ensure Effective Communications
VT State Hospital Settlement Announced
Compliance Institute Issues Call For Speakers
Regulatory News
CMS Administrator Responds to IOM Report on Medical Errors
CMS Launches Medicaid Fraud and Abuse Detection and Prevention Effort
HHS Announces CCHIT Certification of Electronic Health Record Products
From the GAO
CMS Fact Sheets
CMS Transmittals
From the OIG
Court Cases and Administrative Actions
This
Week’s Link
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
UMDNJ Monitor Asks US Attorney to Intervene
On July 18, Associated Press reported that “Frustrated by its slow-starting search for a new president, a monitor hired to keep tabs on the University of Medicine and Dentistry of New Jersey has asked U.S. Attorney Christopher Christie to intervene.
"The absence of a permanent president at the troubled university is hampering executive recruitment, hurting employee morale and affecting its financial standing," former U.S. District Judge Herbert J. Stern told Christie in a letter Monday.
"It is absolutely crucial to create stability in the leadership of the institution," said Stern, who told Christie that the UMDNJ governing board's delays are hampering the university.
For more:
http://www.newsday.com/news/local/wire/newjersey/ny-bc-nj--umdnj-president0718jul18,0,4741759.story?coll=ny-region-apnewjersey
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Medtronic Settles, To Pay $40 Million
On July 18, MarketWatch reported that “The Minneapolis-based medical-products maker had faced charges filed by the Justice Department that it paid kickbacks between 1998 and 2003 involving sham consulting pacts and royalty agreements, as well as lavish trips for doctors who used the products.
The company “denied any wrongdoing in the cases, said it will record a one-time charge against results for the first quarter ending July 28. But the company also vowed to further strengthen its employee training and compliance systems regarding marketing practices.
"’We realize that any organization may be judged by the action of a few," Medtronic Chairman and Chief Executive Art Collins said in a news release. "We expect every Medtronic employee to adhere to high ethical standards at all times, and our compliance systems are designed to ensure compliance as our industry evolves.’
“The first civil suit was initiated in 2002 by an internal whistleblower who turned over the information to the government. A second lawsuit was filed in 2004.
“Medtronic spokesman Rob Clark said the first lawsuit is to be settled for $40 million and dismissed, while the second lawsuit simply is to be dismissed. U.S. Attorney spokesman Charles Miller said the government has filed motions for dismissal but neither case has formally been adjudicated.” For more:
http://www.marketwatch.com/news/story/ Story.aspx?guid=%7B40C932A5-A1A5-468F-BA45-4297B63A2DD6%7D&siteid=
U.S. Department of Justice press release: http://www.usdoj.gov/opa/pr/2006/July/06_civ_445.html
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Medical Center Agrees to Pay $3.75 Million
On July 18, the U.S. Department of Justice (DOJ) announced that Marion County Medical Center in Marion County, S.C. has agreed to pay the United States $3.75 million to resolve allegations of health care fraud against the government. The settlement resolves allegations that Marion County Medical Center submitted false claims to Medicare, Medicaid and TRICARE, the U.S. military’s health care program, by engaging in financial relationships with certain physicians that were prohibited under the Stark Law and/or the Anti-kickback Statute.
Specifically, the settlement focuses on the compensation Marion paid to two physicians which the United States contends far exceeded the fair market value of the services provided by those physicians and was not commercially reasonable. The settlement also resolves allegations that Marion submitted claims to Medicare for professional services for initial hospitalizations which were coded at a level higher than the services that were provided. For more:
http://www.usdoj.gov/opa/pr/2006/July/06_civ_447.html
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Hospice Provider Settles
On July 13, the DOJ announced that Odyssey HealthCare, a national hospice provider, has paid the United States $12.9 million to settle allegations that the company submitted false claims to Medicare. The Dallas-based company is alleged to have billed Medicare for services provided to hospice patients who were not terminally ill and therefore were ineligible for the Medicare hospice benefit. For more: http://www.usdoj.gov/opa/pr/2006/July/06_civ_430.html
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Laurel Regional Hospital To Ensure Effective Communications
On July 14, U.S. Department of Justice announced a comprehensive consent decree under the Americans with Disabilities Act (ADA) with Laurel Regional Hospital, a community hospital serving the Maryland suburbs of Washington. The hospital has agreed to ensure effective communication with patients or companions who are deaf or hard of hearing. For more: http://www.usdoj.gov/opa/pr/2006/July/06_crt_439.html
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VT State Hospital Settlement Announced
On July 21, the U.S. Department of Justice announced that it had reached a settlement agreement with the State of Vermont regarding civil rights violations in Vermont State Hospital, a hospital for persons with mental health problems, in Waterbury, Vermont. The four year agreement, filed in the United States District Court for the District of Vermont, requires the State to implement reforms to ensure that patients in the facility are adequately protected from harm and provided adequate services including mental health care. For more: http://www.usdoj.gov/opa/pr/2006/July/06_crt_458.html
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: CMS Fact Sheets, CMS Transmittals, From the OIG, Court Cases and Administrative Actions.
Regulatory News
McClellan Responds to IOM Report on Medical Errors
On July 18, The Centers for Medicare & Medicaid Services (CMS) released the following statement from the agency’s administrator Mark McClellan, MD, PhD, in response to the Institute of Medicine’s report on medical errors “The Centers for Medicare & Medicaid Services appreciates the important findings of the Institute of Medicine’s (IOM) Committee on Identifying and Preventing Medication Errors.
The report issued today, funded by CMS, found that errors in prescriptions and failures to prescribe prescriptions result in pain, suffering, and deaths, as well as billions of dollars of unnecessary expenses. It is a problem that affects all healthcare settings and services, including hospitals, pharmacies, doctors offices, nursing homes, and home health – a problem that HHS is focusing much of its attention on resolving. For more: http://www.cms.hhs.gov/apps/media/press/ release.asp?Counter=1906
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CMS Launches Medicaid Fraud and Abuse Detection and Prevention Effort
On July 18, CMS Administrator Mark B. McClellan announced it is launching an unprecedented effort to detect and prevent fraud and abuse in the Medicaid program.
“A comprehensive and systematic approach to combating the misuse of taxpayer funds is key to helping lower health care costs for Medicaid beneficiaries,” Dr. McClellan said. “The program we are initiating today builds upon expanded activities to combat fraud in the Medicare program that have proven successful in the past few years, as well as recent congressional action on our request for additional funding to protect the Medicaid program. These strategies will yield significant Medicaid savings to help sustain the program.”
The new Medicaid Integrity Program (MIP) was created by the Deficit Reduction Act of 2005 with funds that will rise from $5 million in 2007to $75 million by fiscal year 2009 and each year thereafter. Congress specifically required the use of contractors to review the actions of those seeking payment from Medicaid, conduct audits, identify overpayments and educate providers and others on program integrity and quality of care. Congress also mandated that the agency devote at least 100 full-time staff to the project which will also be in collaboration with state Medicaid officials. For more: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1900
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HHS Announces CCHIT Certification of Electronic Health Record Products
On July 18, the US Department of Health and Human Services (HHS) announced that the first round of ambulatory electronic health record products (EHRs) have been certified by the Certification Commission for Healthcare Information Technology (CCHIT), HHS Secretary Mike Leavitt announced today. HHS awarded CCHIT a contract in fall 2005 to develop certification criteria and a certification process.
“This seal of certification removes a significant barrier to wide-spread adoption of electronic health records. It gives health care providers peace of mind to know they are purchasing a product that is functional, and interoperable and will bring higher quality, safer care to patients,” Secretary Leavitt said.
For more: http://www.hhs.gov/news/press/2006pres/20060718.html
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From the GAO
Medicare Physician Services: Use of Services Increasing Nationwide and Relatively Few Beneficiaries Report Major Access Problems. GAO-06-704, July 21.
http://www.gao.gov/cgi-bin/getrpt?GAO-06-704
Highlights - http://www.gao.gov/highlights/d06704high.pdf
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CMS Fact Sheet
July 17 CMS Fact Sheet: Just The Facts: More Accurate Hospital Payments to Improve Access to Quality Care:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_rrl_facts&u=release20060717&h=top1.html&t=80&s=twcc
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CMS Transmittals
Medicare Claims Processing (PUB. 100-04)
Transmittal #1000, Common Working File to the Medicare
Beneficiary Database Data Exchange Changes:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1000cp&h=top1.html&t=80&s=twcc
Transmittal #999, Non-Physician Practitioner Payment for Care Plan Oversight:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r999cp&h=top1.html&t=80&s=twcc
Financial Management (PUB. 100-06)
Transmittal #102, Notice of New Interest Rate for Medicare Overpayments and Underpayments:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_6&u=mrpm10006r102fm&h=top1.html&t=80&s=twcc
Transmittal #151, Provider Enrollment Appeals Process:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_08&u=mrpm10008r151pi&h=top1.html&t=80&s=twcc
Addition of ICD-9-CM 600.10, Nodular prostate without urinary obstruction and 600.11, with urinary obstruction, as covered indications for the PSA NCD (CAG-00331N) - Expected Completion Date: 08/31/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u=CAG00331N2&h=top1.html&t=80&s=twcc
Addition of ICD-9-CM 600.21, Benign localized hyperplasia of prostate with urinary obstruction as a covered indication for the PSA NCD (CAG-00332N) - Expected Completion Date: 07/31/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u=CAG00332N2&h=top1.html&t=80&s=twcc
Glycated Hemoglobin/Glycated Protein (Addition of ICD-9-CM 271.3, Intestinal disaccharidase deficiencies and disaccharide malabsorption) (CAG-00036N) - Expected Completion Date: 10/20/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u=CALCAG00036N&h=top1.html&t=80&s=twcc
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From the OIG
Corporate Integrity Agreements
Medtronic, Inc. and Medtronic Sofamor Danek U.S.A., Inc. - Corporate Integrity Agreement - Minneapolis, MN - 07/18/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=medtroniccia&h=top1.html&t=80&s=twcc
Odyssey Healthcare, Inc. - Corporate Integrity Agreement - Dallas, TX - 07/06/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=odysseyhccia&h=top1.html&t=80&s=twcc
List of Excluded Individuals/Entities (Cumulative Sanction Reports)
OIG 06/06 Cumulative Sanction Report-Reinstatements for June 2006 (Excel):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fed_gov_oig_csr&u=0606rein&h=top1.html&t=80&s=twcc
OIG 06/06 Cumulative Sanction Report-Update for June 2006 (Excel):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fed_gov_oig_csr&u=0606up&h=top1.html&t=80&s=twcc
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Court Cases and Administrative Actions
Provider Reimbursement Review Board Decisions
Osteopathic Founders Foundation - Tulsa,OK
The proper allocation of closing costs and sales proceeds for determining net gains and losses on sales was addressed by the PRRB in this case.
PRRB 06-D32 06/22/06: http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_pr&u=2006D32&h=top1.html&t=80&s=twcc
Olive View Medical Center - Sylmar, CA at the statute and regulation mandate that the rebasing of TEFRA rates only applies to cost reporting periods beginning on or after April 1, 1990 and that intermediary’s denial of rebasing for this provider was proper. PRRB 06-D31 06/16/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_pr&u=2006D31&h=top1.html&t=80&s=twcc
Greenbriar Nursing and Convalescent Center, Guest House of Slidell, Riverland Healthcare Center
Here, the PRRB found that the therapy services in question met the definition of outpatient physical therapy services as described in 42 U.S.C §1395 l(a)(8)(A) and therefore would be subject to the 10 percent reduction requirement of 42 U.S.C. §1395m(k). PRRB 06-D30 06/16/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_pr&u=2006D30&h=top1.html&t=80&s=twcc
CMS Departmental Appeals Board Appellate Division Decisions
DAB(APP) 06/13/06 - 2032 - Andrew D. Goddard vs. Inspector General - program exclusion for criminal offenses:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mms_dec_dabap&u=dab2032&h=top1.html&t=80&s=twcc
DAB(APP) 06/12/06 - 2031 - Liberty Commons Nursing and Rehab Center -- Johnston vs. Centers for Medicare & Medicaid Services - penalties for failure to comply substantially with program requirements:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mms_dec_dabap&u=dab2031&h=top1.html&t=80&s=twcc
DAB(APP) 05/25/06 - 2030 - Cal Turner Extended Care Pavilion vs. Centers for Medicare & Medicaid Services - calculation of civil monetary penalties:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mms_dec_dabap&u=dab2030&h=top1.html&t=80&s=twcc
DAB(APP) 05/03/06 - 2028 - Mashantucket Pequot Tribal Nation vs. Indian Health Services - validity of declination of proposals for provision of pharmacy services:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mms_dec_dabap&u=dab2028&h=top1.html&t=80&s=twcc
DAB(APP) 04/25/06 - 2027 - Hazem Garada, M.D. vs. Inspector General - opporunity for hearing to submit evidence of mitigation factors:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mms_dec_dabap&u=dab2027&h=top1.html&t=80&s=twcc
DAB(APP) 04/20/06 - 2026 - Golden Age Skilled Nursing & Rehabilitation Center vs. Centers for Medicare & Medicaid Services - adequacy of supervision of residents and imposition of civil monetary penalties:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mms_dec_dabap&u=dab2026&h=top1.html&t=80&s=twcc
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This Week’s Link:
Press Release HCA Going Private:
http://phx.corporate-ir.net/phoenix.zhtml?c=63489&p=irol-newsArticle&ID=885406&highlight=
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Acronym Library
| MDC | Medicare Data Center |
| MDCN | Medicare Data Communications Network |
| MDH | Medicare Dependent Hospital |
| MDRI | Medicaid Drug Rebate Initiative |
| MDS | Minimum Data Set |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
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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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