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Table of Contents
Headlines
Schering-Plough Agreement with DOJ announced
Scrushy Loses Bonuses
California Medical Supply Owner Sentenced
DME Supplier Arrested on Fraud Charges
Regulatory News
In the Federal Register
CMS Transmittals
Court Cases and Administrative Actions
This
Week’s Link
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
Schering-Plough Agreement with DOJ announced
On August 29, Schering-Plough Corporation (NYSE: SGP) issued a press release announcing it had reached an agreement with the U.S. Attorney's Office for the District of Massachusetts and the U.S. Department of Justice to settle the previously disclosed investigation involving the company's sales, marketing and clinical trial practices and programs. The agreement resolves that investigation, which began prior to the arrival of the new management team.
The agreement provides for an aggregate settlement amount of $435 million and is subject to court approval. Under the agreement, Schering Sales Corporation, a subsidiary of Schering-Plough Corporation, will plead guilty to one count of conspiracy to make false statements to the government and pay a criminal fine of $180 million, and Schering-Plough Corporation will pay $255 million to resolve civil aspects of the investigation. For more:
http://www.schering-plough.com/schering_plough/ news/release.jsp?releaseID=900092
U.S. Attorney for MA:
The U.S. Attorney’s Office for the District of Massachusetts has made its press release, settlement agreement, information, addendum to CIA, agreement letter and side letter agreement available on its website at:
http://www.usdoj.gov/usao/ma/schering-plough.html
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Scrushy Loses Bonuses
On August 28, International Herald Tribune reported that “the Alabama Supreme Court has rejected as ''unconscionable'' a bid by the founder of HealthSouth, Richard Scrushy, to keep $47.8 million in bonuses from his former company.
“The ruling Friday came in a lawsuit brought by a shareholder, Wade Tucker, in 2002, before a $2.7 billion accounting fraud was revealed and 15 HealthSouth executives pleaded guilty.
“Scrushy was ordered by a trial court in January to return the bonuses to the struggling health care company and he appealed.
“The repayment was on hold during Scrushy's unrelated criminal trial in U.S. court in May, at which he was convicted of bribing Don Siegelman, a former Alabama governor. The latest ruling may dent Scrushy's fortune, once estimated by prosecutors at nearly $300 million. He still faces other charges in the same civil suit as well as from a U.S. Securities and Exchange Commission fraud complaint and other shareholder suits.
‘''It would be unconscionable to allow Scrushy to retain millions of dollars awarded to him in the form of bonuses at the expense of the corporation he served as chief executive officer and its shareholders,'' the court said in a 27-page ruling. The bonuses were paid because the company reported that it exceeded income targets. The books have since been restated.”
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California Medical Supply Owner Sentenced
On August 29, Associated Press reported that “An Orange County man who spent the proceeds of a Medicare fraud scheme on a Rolls-Royce, yacht and other luxury items was sentenced Monday to 10 years in prison. Phu Luong, 51, operated United Medical Supply in Huntington Beach as a front to fraudulently bill Medicare for wheelchairs and other items medically unnecessary or never provided, Assistant U.S. Attorney Jeannie Joseph said.Luong of Huntington Beach led a group of 10 people, including two doctors, prosecutors said. The group recruited patients from the local Vietnamese and Korean communities for medical examinations, then billed Medicare on their behalf, officials said.”
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DME Supplier Arrested on Fraud Charges
On August 24, US Attorney for the Central District of California Debra Wong Yang announced that a La Palma woman was arrested on federal mail fraud charges for allegedly orchestrating a scheme in which she sold durable medical equipment to sleep disorder patients that was actually inferior, disposable or used products.
Patricia Ann Wyatt-Chafe, 57, was arrested this afternoon without incident at her business in La Palma. Appearing in United States District Court in Santa Ana this afternoon, a United States Magistrate Judge ordered Wyatt-Chafe released on a $25,000 bond and ordered the defendant to appear for an arraignment on September 5.
Wyatt-Chafe was indicted by a federal grand jury on August 23 and charged with five counts of mail fraud. According to the indictment, Wyatt-Chafe owned and operated Phoenix CPAP Services, Inc., which supplied products and services to sleep disorder patients. The products sold by Phoenix included Continuous Positive Airway Pressure devices, face masks, hoses, filters and related durable medical equipment.
Wyatt-Chafe allegedly supplied patients with inferior and inexpensive disposable medical equipment, claiming that the equipment was reusable. She also allegedly supplied patients with previously used medical equipment under the false pretense that such equipment was new and unused. For more:http://www.usdoj.gov/usao/cac/pr2006/111.html
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This week, MediRegs provided TWCC readers with the following Regulatory information: CMS Transmittals, In the Federal Register, and Court Cases and Administrative Actions.
Regulatory News
CMS Updates and Announcements
NPI Roundtable – September 26, 2006
- CMS will host a national NPI Roundtable, open to all health care professionals, on Tuesday, September 26th from 2:00-3:30PM ET.
- To participate, you may call 1-877-203-0044, pass code 4795739
- CMS will address common questions related to Medicare’s guidance on Subparts. While CMS will only address questions from a Medicare perspective, this information may be helpful to all providers. Medicare providers who have questions should select the appropriate email address below and send in questions by Friday, September 8th. Questions received after this date will not be considered.
Medicare providers who bill a Fiscal Intermediary should send questions to: NPIQuestionsfromFIBillers@cms.hhs.gov
Medicare providers who bill a Carrier should send questions to:
NPIQuestionsfromCarrierBillers@cms.hhs.gov
Medicare providers who bill a Durable Medical Equipment Regional Carrier (DMERC) should send questions to: NPIQuestionsfromDMERCBillers@cms.hhs.gov
Notice of Date Change for Acceptance of NPIs on Paper Claims
As mentioned in a previous announcement, Medicare will require the use of the NPI on paper claims. As such, CMS is implementing use of the revised CMS-1500 form to accommodate use of the NPI. Transition to the new form will begin on January 2, 2007. (A previous message from CMS indicated that the transition would begin on October 1, 2006.) For more details, and to learn more about the revised form, visit http://www.cms.hhs.gov/MLNMattersArticles/ downloads/MM5060.pdf
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Time Change Announced for Home Health, Hospice & DME Open Door Forum
The next Home Health, Hospice & DME Open Door Forum, scheduled for
Tuesday, September 26, 2006, will take place in a different time slot. Instead of the normal 2:00pm-3:00pm ET time, the call will be
1:00pm-2:00pm ET.
This is so Home Health, Hospice & DME providers can participate in the NPI Roundtable Meeting from 2:00pm-3:30pm ET.
***
CMS Announces Senior Risk Reduction Demonstration
On August 21, the Centers for Medicare and Medicaid Services (CMS) announced that as part of its efforts to increase prevention on the part of Medicare beneficiaries, that it has issued a solicitation to implement a health promotion and disease prevention program through the Medicare Senior Risk Reduction Demonstration. For more:
http://www.cms.hhs.gov/apps/media/ press/release.asp?Counter=1949
***
CMS Posts Ambulatory Surgery Centers Transparency Information
On August 21, CMS also announced that to help consumers, providers, and payers make more informed health care decisions, CMS is making available Medicare payment information for 61 procedures performed in Ambulatory Surgery Centers (ASCs). An ASC is an accredited, freestanding facility that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization. For more:
http://www.cms.hhs.gov/apps/media/ press/release.asp?Counter=1948
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In the Federal Register
September 1 – Proposed Rule
Medicare Program; Prohibition of Midyear Benefit Enhancements for
Medicare Advantage Organizations Offering Plans in Calendar Year 2007
and Subsequent Calendar Years
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/ edocket.access.gpo.gov/2006/06-7394.htm
Notice:
This notice announces the annual update to the hospice wage
index as required by statute. This fiscal year 2007 update is effective
from October 1, 2006 through September 30, 2007.
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/ edocket.access.gpo.gov/2006/06-7293.htm
August 28 – Interim Final Rule
Medicaid Program and State Children's Health Insurance Program
(SCHIP) Payment Error Rate Measurement
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/ edocket.access.gpo.gov/2006/06-7133.htm
August 25 –Rule:
CHAMPUS: TRICARE Prime Remote; medical care coverage for active duty family members; enrollment period, 50347-50349:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_dod& u=0608252&h=top1.html&t=80&s=twcc
August 23 – Proposed Rule:
Proposed Rule: Medicare: Hospital outpatient prospective payment system and 2007 CY payment rates, 49506-49977:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms& u=0608233&h=top1.html&t=80&s=twcc
August 22 – Proposed Rule:
CHAMPUS: TRICARE program - Reserve and Guard family member benefits, 48864-48866:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_dod &u=0608222&h=top1.html&t=80&s=twcc
Proposed Rule:
Medicare: Physician fee schedule (CY 2007); payment policies and relative value units, 48982-49252:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms &u=0608222&h=top1.html&t=80&s=twcc
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CMS Transmittals
CMS One-Time Special Notification (PUB. 100-20)
Transmittal #234, Modification of NPI Editing Requirements in CR 4023 and of an Attachment to CR 4320 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_20 &u=mrepm10020r234otn&h=top1.html&t=80&s=twcc
National Coverage Analyses
Clinical Trial Policy (CAG-00071R) - Expected Completion Date: 04/10/07:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca &u=CAG00071R2&h=top1.html&t=80&s=twcc
Electrical Bioimpedance for Cardiac Output Monitoring (CAG-00001R2) - Expected Completion Date: 11/21/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca &u=CAG00001R22&h=top1.html&t=80&s=twcc
Cavernous Nerves Electrical Stimulation with Penile Plethysmography (CAG-00311N) - Expected Completion Date: 09/07/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca &u=CAG00311N4&h=top1.html&t=80&s=twcc
Missouri Medicaid Payments for Skilled Professional Medical Personnel (A-07-05-03066; 08/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005 &u=70503066&h=top1.html&t=80&s=twcc
Review of Blue Cross Blue Shield of Maine's Postretirement Benefit Plan (A-07-05-00196; 08/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005 &u=70500196&h=top1.html&t=80&s=twcc
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Court Cases and Administrative Actions
CMS Administrator Decisions - PRRB Appeals
ADMR(PRRB) 07/21/06 06-D29 Montefiore Medical Center (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_ad&u=2006D29&h=top1.html&t=80&s=twcc
ADMR(PRRB) 07/11/06 06-D25 MGH Home Health (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_ad&u=2006D25&h=top1.html&t=80&s=twcc
ADMR(PRRB) 07/25/06 06-D23 UPMC - St. Margaret Hospital (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_ad&u=2006D23&h=top1.html&t=80&s=twcc
ADMR(PRRB) 07/19/06 06-D22 Saint Anthony's Hospital Center (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_ad&u=2006D22&h=top1.html&t=80&s=twcc
ADMR(PRRB) 07/17/06 06-D21 HCT 94-95 Physical Therapy AHSEA Exception Group (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_ad&u=2006D21&h=top1.html&t=80&s=twcc
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From the OIG
Advisory Opinion 06-09
This advisory option concerns a nonprofit, tax-exempt, charitable organization’s proposals to subsidize Medicare Part D premium and cost-sharing obligations owed by financially needy patients with end-stage renal disease and chronic kidney disease. For Advisory Opinion click here: http://www.hcca-info.org/Content/NavigationMenu/ComplianceResources/ComplianceNews/AdvOpn06-091.pdf
Audit Reports
Posted August 31
Review of Skilled Services at Regent Care Center of Laredo, Texas
http://oig.hhs.gov/oas/reports/region6/60600047.htm
Review of Kansas's Mental Health Center Medicaid Administrative Cost for the Quarters Ended December 31, 2002, and March 31, 2003
http://oig.hhs.gov/oas/reports/region7/70503063.htm
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This Week’s Links:
OIG CIA Addendum entered into with Schering-Plough
Corporation. http://tinyurl.com/pkjbx
A listing of all current CIAs is here:
http://oig.hhs.gov/fraud/cia/index.html
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Acronym Library
| MMIS | Medicaid Management Information System |
| MMORP | Medicare Management & Open Review Program |
| MMP | Mixed Model Plan (GPP/IPP combination) |
| MMPS | Medicare Mortality Predictor System |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
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