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Vol. VIII, No. 29 – September 19, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Fraud and Compliance Forum
Advanced Academy
Compliance Academy
Table of Contents
Headlines
Stamford University Ethics Policy Bans Gifts and Free Drugs
US Joins Suit Against Dey, Inc.
Florida Man Charged with Health Care Fraud
Ringleader of DME Fraud Scheme Sentenced
Georgia Wheelchair Supply Business Owner Convicted
Milwaukee Developer to Pay $90,000 in Fraud Case
Governor Pledges to Restore Tattered UMDNJ Reputation
US Corporations Conduct Examined
UW Settlement Requires Medical Costs Be Disclosed Upfront
Massachusetts Man Pleads Guilty to Fraud
JCAHO Partners with Infection Control Leaders to Identify Best Approaches to Measure Hand Hygiene Compliance
JCAHO Issues Sentinel Event Alert
Regulatory News
CMS Updates and Announcements
In the Federal Register
CMS Transmittals
From the OIG
Medicare Part D
This
Week’s Link
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
Stamford University Ethics Policy Bans Gifts and Free Drugs
On September 13 the Los Angeles Times reported that Stamford University ethics policy restricts medical staff from accepting gifts and free drugs. “They are common fixtures in many medical practices: free pens, mugs, stationery, stethoscopes and doctors' bags, all emblazoned with the logo of a new drug or a pharmaceutical firm. And those catered lunches staffers flock to? It may be courtesy of a major drug supplier.
“No more — at least for all staff and students at Stanford University's medical school, hospitals and clinics. Under a policy announced Tuesday, even free sticky notes violate ethics rules.” For more:
http://www.latimes.com/news/local/la-me-docs13sep13,0,6778894.story?coll=la-home-local
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US Joins Suit Against Dey, Inc.
On September 11, US Attorney for Massachusetts Michael Sullivan announced that the United States has intervened in a whistleblower suit filed in the District of Massachusetts against Dey, Inc. alleging that the company violated the False Claims Act, the Justice Department announced today. In its complaint, the government alleges that Dey engaged in a scheme to report fraudulent and inflated prices for several pharmaceutical products, knowing that federal healthcare programs established reimbursement rates based on those reported prices.
The government’s complaint alleges that the pharmaceutical manufacturer from at least on or before January 1, 1993 reported prices that were more than five times (500 percent) the actual sales prices on many of the drugs it manufactures. The United States alleges that Medicare and Medicaid have reimbursed Dey’s customers in excess of $500 million for the drugs which are the subject of the complaint. Dey sells generic drugs that are reimbursed by the two federal health care programs. For more:
http://www.usdoj.gov/usao/ma/Press%20Office%20-%20Press%20Release%20Files/Sept2006/Dey-CivilComplaint-Intervention.html
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Florida Man Charged with Health Care Fraud
On September 12, US Attorney for the Southern District of Florida R. Alexander Acosta announced the filing of an Indictment in connection with their investigation of a massive kickback network involving local assisted living facilities, medical equipment companies, pharmacies and physicians. To date, thirty-three persons have been convicted of kickback and Medicare fraud charges in connection with this investigation. For more: http://www.usdoj.gov/usao/fls/PressReleases/060912-01.html
In a related story, on August 25, US Attorney Alexander Acosta announced that defendant Zabdy Westerburger, a Miami physician, was sentenced in federal court on charges of conspiracy to violate the anti-kickback and false claims statutes and tax evasion, in connection with her participation in a massive kickback scheme involving pharmacies, medical equipment companies and Medicare beneficiaries. To date, more than thirty (30) people have been convicted of Medicare fraud charges in connection with this scheme. For more: http://www.usdoj.gov/usao/fls/PressReleases/060825-03.html
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Ringleader of DME Fraud Scheme Sentenced
On August 29 the US Attorny’s Office for the Central District of California announced that a California man who was one of the ringleaders of a large-scale durable medical equipment (DME) scheme that defrauded Medicare out of millions of dollars was sentenced to ten years in prison.
- Phu Luong, 51, of Huntington Beach, was sentenced by United States District Judge Cormac J. Carney in Santa Ana. In addition to the prison term, Judge Carney ordered Luong to pay $6,417,000 in restitution to Medicare.
- Luong was convicted in April 2006 of 35 counts of health care fraud and five counts of money laundering. Luong was the owner of a DME company called United Medical Supply ("United") that submitted fraudulent claims to Medicare for DME that was not medically necessary and, in many cases, never delivered. Three others also convicted at trial of 35 counts of health care fraud were:
- Sareth Tath, 56, of Long Beach, Luong's partner, who recruited physicians to provide fraudulent prescriptions for DME;
- Mo Thi Pham, 50, of Westminster, Tath's partner, who hired drivers and marketers to recruit Medicare beneficiaries to receive DME that was not medically necessary; and
- Peter Kim, 82, of Los Angeles (90022), who recruited and drove beneficiaries to the physicians.
For more: http://www.usdoj.gov/usao/cac/pr2006/113.html
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Georgia Wheelchair Supply Business Owner Convicted
On September 1, US Attorney for the of Georgia David E. Nahmias announced that the operator of a wheelchair supply business was convicted by a jury in Federal District Court on eleven counts of having engaged in a Medicare fraud scheme. For more: http://www.usdoj.gov/usao/gan/press/index.html
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Milwaukee developer to pay $90,000 in fraud case
On September 6, the Milwaukee Journal Sentinel reported that “A federal judge has ordered Milwaukee condominium and apartment developer Boris Gokhman to pay $90,000 as part of a civil lawsuit related to Gokhman's conviction in a Medicaid fraud case. U.S. District Judge Charles N. Clevert Jr. ordered Gokhman to pay civil forfeitures of $5,000 for each of 18 fraudulent claims submitted to Medicaid. Gokhman's attorney, Joshua Gimbel, declined to comment Tuesday because Clevert's order is not yet final.
“The $90,000 in forfeitures would be in addition to a $7,500 fine and one year of probation that Gokhman received in 2004 after he was convicted in the criminal portion of the case.
“The charges against Gokhman and 13 other area residents stemmed from an investigation into Cares R Us Home Health Care Agency Ltd., of Milwaukee. The company, now defunct, received more than $1 million in Medicaid reimbursements for nursing services and personal care that either never happened or were not necessary, prosecutors said.
“Gokhman admitted he filled out false time sheets indicating that he provided services to his parents, who were Cares R Us clients. As a result, Medicaid, which uses a combination of state and federal money to fund health care for low-income people, paid the company $29,000. Of that, Gokhman received $12,050, according to a 2004 plea agreement he reached with the U.S. attorney's office on the criminal portion of the case.”
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Governor Pledges to Restore Tattered UMDNJ Reputation
On September 6, The Philadelphia Inquirer reported that “While federal investigators continue probing allegations of Medicaid and Medicare fraud at the University of Medicine and Dentistry of New Jersey, Gov. Corzine told employees yesterday that the school was doing good work.
‘"We have our challenges, there's no question," he told those at the Newark campus. "But there are a lot of good things going on here." Corzine told the gathering that he would work to restore the school's reputation and praised health-care workers and researchers.
“University trustees agreed in December to appoint a federal monitor to oversee finances as a result of fraud allegations after U.S. Attorney Christopher Christie threatened to indict the university if it did not.”
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US Corporations Conduct Examined
An September 4, Agence France Presse report asked “What do AT&T, Boeing, Comverse Technology, Prudential Financial, Medtronic, Schering-Plough and Tenet Healthcare have in common?” The report went on “In recent months, they have all been charged with fraudulent conduct by the US Justice Department's Corporate Fraud Task Force or settled alleged fraud claims with the government. Among other charges, the companies were accused of deceptive stock trading, improper billing, falsification of drug prices, kickbacks to doctors and the creation of a "secret stock options slush fund."
“The total cost of their misconduct in fines and effective penalties to shareholders? A cool $2.6 billion dollars. Almost five years after the Enron scandal first came to light, corporate crime involving major American companies appears to show no sign of abating, despite a government crackdown on corporate malfeasance.
“Set up after Enron's collapse, the Corporate Fraud Task Force (CFTF) has taken the lead in prosecuting bad executive behavior. Critics concede it has notched up major victories, notably the convictions of Enron's two former top executives, but some securities lawyers and investor advocates say corporate fraud has become so endemic that harsher penalties are needed to defeat it.”
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UW Settlement Requires Medical Costs Be Disclosed Upfront
In a report published on September 2 in the Seattle Post-Intelligencer the reporter asked, “Sick of trying to figure out your medical bill?”
“In what is being called a victory for consumers, the University of Washington Medical Center has agreed to tell patients upfront what their costs for outpatient procedures are likely to be.The move, part of the settlement of a class-action lawsuit against the UW Medical Center, is designed to prevent the sticker shock that typically greets patients weeks or months after their treatment for minor outpatient procedures.
“John Phillips, the lawyer who filed suit on behalf of a patient who felt gouged by the UW's billing system, believes that the settlement is the first of its kind, but he hopes it will help set a precedent for better consumer information in medical care.
“Nationally, there has been a growing consumer backlash against medical bills and a call for more transparency in billing so that patients know what they're paying for, and how their costs might compare if they sought care elsewhere. ’"This (settlement) acknowledges the patients' rights as consumers," Phillips said.”
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Massachusetts Man Pleads Guilty to Fraud
On September 15, US Attorney for Massachusetts Michael Sullivan announced that a Westborough man and three Westborough companies, of which he was owner and officer, pleaded guilty today in federal court to health care fraud offenses.
James Taylor, age 67, of 77 Ruggles Street, Westborough, along with Westborough-based companies Vejay Oxygen, Inc. West Suburban Medical Rental, Inc. and Westborough Home Health, Inc., pleaded guilty before U.S. District Judge Patti B. Saris to a three-count Information charging them with knowingly and willfully committing health care fraud. For more: http://www.usdoj.gov/usao/ma/Press%20Office%20-%20Press%20Release%20Files/Sept2006/Taylor-James-plea.html
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JCAHO Partners with Infection Control Leaders to Identify Best Approaches to Measure Hand Hygiene Compliance
On September 7, the Joint Commission on Accreditation of Healthcare Organizations announced a partnership with major infection control leadership organizations in the United States and abroad to identify best approaches for measuring compliance with hand hygiene guidelines in health care organizations. The participating organizations include the Association for Professionals in Infection Control and Epidemiology (APIC), the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA), the World Health Organization (WHO) World Alliance for Patient Safety, the Institute for Healthcare Improvement (IHI), and the National Foundation for Infectious Diseases (NFID). For more:
http://www.jointcommission.org/NewsRoom/ NewsReleases/nr_09_07_06.htm
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JCAHO Issues Sentinel Event Alert
On September 6, the Joint Commission on Accreditation of Healthcare Organizations issued a Sentinel Event Alert that urges health care organizations to pay special attention to how emergency power systems can fail and recommends specific steps to keep patients safe in the event of a disaster or other major event that knocks out the organization’s electrical power supply. For more: http://www.jointcommission.org/ NewsRoom/NewsReleases/nr_sea37.htm
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This week, MediRegs provided TWCC readers with the following Regulatory information: CMS Transmittals, From the OIG and Medicare Part D.
Regulatory News
CMS Updates and Announcements
Change in Online Availability of NPI Application/Update Form (CMS-10114)
Beginning on September 20, 2006, the PDF version of the NPI Application/Update Form (CMS-10114) will no longer be available for download on the CMS forms website, and there will not be a link to that form from the NPPES page (https://nppes.cms.hhs.gov/NPPES/Welcome.do).
Health care providers can still, however, apply for National Provider Identifiers (NPI) in one of three ways:
- For the most efficient application processing and the fastest receipt of NPIs, health care providers should consider using the web-based NPI application process. They can log onto the National Plan and Provider Enumeration System (NPPES) and apply on line at https://nppes.cms.hhs.gov/NPPES/Welcome.doc; or
- Health care providers can agree to have an Electronic File Interchange (EFI) organization (EFIO) submit application data on their behalf (i.e., through a bulk enumeration process) if an EFIO requests their permission to do so; or,
- Health care providers may wish to obtain a copy of the paper NPI Application/Update Form (CMS-10114) and mail the completed, signed application to the NPI Enumerator located in Fargo, ND, whereby staff at the NPI Enumerator will enter the application data into NPPES. The form will be available only upon request through the NPI Enumerator. Health care providers who wish to obtain a copy of this form must contact the NPI Enumerator in any of these ways:
Phone: 1-800-465-3203 or TTY 1-800-692-2326
E-mail: customerservice@npienumerator.com
Mail: NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059
CMS 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.
More CMS News
CMS announced on September 12 that the standard Medicare Part B monthly premium will be $93.50 in 2007, an increase of $5.00 or 5.6 percent from the current $88.50 Part B premium, considerably lower than was earlier projected. This premium is the smallest percent increase in the Part B premium since 2001 and less than half of the dollar increase in the premium for 2006.
Together with an increase of 0.1 percent in the average Part D enrollee premium -- and less if beneficiaries choose lower-cost drug plan options, as they did for 2006 – Medicare beneficiaries are experiencing cost increases that are modest in comparison to recent health care cost trends. This is also less than the projected 6 percent increase in per capita national health spending for 2007 and the projected 7 percent increase for 2007 retail prescription drug spending. In addition, more than one-fourth of beneficiaries can receive assistance that pays for their entire Part B premium.
Link to Fact Sheet:
Link to Table:
9-Day Payment Hold
This message is a reminder for all providers and physicians who bill Medicare contractors for their services.
A brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005. No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments. All claims held during this time will be paid on October 2, 2006. Please note, however, that contractors handling large volumes of paper checks may have some difficulty putting all checks in the mail in a single day. Consequently, delivery of checks to providers may take a few extra days.
This policy only applies to claims subject to payment. It does not apply to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements.
Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold.
For more information, please view the MLN Matters Article at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf.
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CMS Fee-for-Service Provider Listservs
There are a multitude of listservs that you can subscribe to for up-to-the-minute, accurate news regarding CMS activities. Currently, you are subscribed to the Open Door Forums (ODF) listserv to find out when provider ODFs are scheduled. Did you know that other CMS Electronic Mailing Lists (listservs) can also help you with your business? To get the latest Medicare provider payment regulations and up-to-the minute fee-for-service (FFS) provider news, subscribe to any of the FFS provider-specific mailing lists from the CMS Mailing Lists web page at:
http://www.cms.hhs.gov/apps/mailinglists/default.asp?audience=3 .
For more details on other CMS Mailing Lists that may be helpful, click here for a Fact Sheet on the subject:
http://www.cms.hhs.gov/MLNProducts/downloads/MailingLists_FactSheet.pdf.
***
CMS Posts Data File on Web site That Can Be Used to Model the CMS Methodology for Calculating Proposed Payment Under the Revised Ambulatory Surgical Center (ASC) Payment System
The Centers for Medicare & Medicaid Services (CMS) recently posted a data file that can be used to model the CMS methodology for calculating facility payment amounts for services performed in ASCs under the revised payment system proposed for implementation in CY 2008. This file contains the proposed pricing data and historical utilization data that formed the basis for the proposed ASC conversion factor calculation and the alternative ASC conversion factor calculation described in the August 23, 2006 Federal Register ( 42 FR 49506).
The file is available online by clicking on the hyperlink titled “Supporting Data Files for CMS-1506-P” in the “Downloads” section at: http://www.cms.hhs.gov/ascpayment/06_cms1506P.asp
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In the Federal Register
September 18 - Notices
Medicare Program; Part A Premium for Calendar Year 2007 for the
Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted
Other Entitlement
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/06-7710.htm
Medicare Program; Inpatient Hospital Deductible and Hospital and
Extended Care Services Coinsurance Amounts for Calendar Year 2007
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/06-7711.htm
Medicare Program: Solicitation for Proposals To Participate in
the Medicare Hospital Gainsharing Demonstration Program Under Section
5007 of the Deficit Reduction Act
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/06-7738.htm
Medicare Program; Medicare Part B Monthly Actuarial Rates,
Premium Rates, and Annual Deductible for Calendar Year 2007
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/06-7709.htm
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CMS Transmittals
Medicare Claims Processing (PUB. 100-04)
Transmittal #1055, Competitive Acquisition Program - Creation of Automated Tables for Provider Information, Expansion of CAP Fee Schedule File Layout, and Additional Instructions for Claims Received from Railroad Retirement Board Beneficiaries:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1055cp&h=top1.html&t=80&s=twcc
Transmittal #1054, 2006 Reporting of Taxonomy Codes to Identify Provider Subparts on Institutional Claims:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1054cp&h=top1.html&t=80&s=twcc
.
Transmittal #1053, 2006 Inpatient Rehabilitation Facility Annual Update: Prospective Payment System Pricer Changes for FY 2007:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1053cp&h=top1.html&t=80&s=twcc
Transmittal #1052, Maintenance and Update of the Temporary Hook Created to Hold OPPS Claims that Include Certain Drug HCPCS Codes:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1052cp&h=top1.html&t=80&s=twcc
Transmittal #1051, Claims Submission Instructions for Institutional Providers Billing Vaccine Claims In Cases Where a National Provider Identifier is Not Available:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1051cp&h=top1.html&t=80&s=twcc
Medicare Contractor Beneficiary and Provider Communications (PUB. 100-09)
Transmittal #18, Provider Customer Service Program:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mr_pm_100_09&u=mremrpm10009r18com&h=top1.html&t=80&s=twcc
CMS One-Time Special Notification (PUB. 100-20)
Transmittal #236, New Contractor Numbers for Jurisdiction 3 Part AB Medicare Administrative Services Workload:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_20&u=mrepm10020r236otn&h=top1.html&t=80&s=twcc
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From the OIG
Corporate Integrity Agreements
Athena Health Care Associates, Inc. - Southington, CT - 07/10/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=athenahc&h=top1.html&t=80&s=twcc
Crocker, Thomas - Columbia, SC - 05/24/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=crocker&h=top1.html&t=80&s=twcc
Harris, John Joel, Jr., M.D. - Bladenboro, NC - 07/13/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=harris&h=top1.html&t=80&s=twcc
Kidd, Michael G., M.D. - Lumberton, NC - 07/13/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=kidd&h=top1.html&t=80&s=twcc
LifeCare Holdings, Inc. - Plano, TX - 06/12/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=lifecarehold&h=top1.html&t=80&s=twcc
Lochearn Nursing Home, LLC - Baltimore, MD - 08/04/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=lochearn&h=top1.html&t=80&s=twcc
Lumberton Anesthesia Consultants, P.A. - Lumberton, NC - 07/13/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=lumberton&h=top1.html&t=80&s=twcc
Malis, Charles D. - Concord, MA - 01/31/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=malis&h=top1.html&t=80&s=twcc
Maynor, Jayne P., M.D. - Lumberton, NC - 07/13/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=maynor&h=top1.html&t=80&s=twcc
Miller, Mark - Fenton, MI - 07/11/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=millerm&h=top1.html&t=80&s=twcc
Moresco-Goniu, Carol - Pewaukee, WI - 06/13/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=moresco&h=top1.html&t=80&s=twcc
National Direct Diabetic Supply - Columbia, SC - 05/24/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=ndds&h=top1.html&t=80&s=twcc
National Direct Home Pharmacy - Columbia, SC - 05/24/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=ndhp&h=top1.html&t=80&s=twcc
Wright, Lancelot - Columbia, SC - 05/24/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=wright&h=top1.html&t=80&s=twcc
Family Health Group, Cesar Vargas, M.D., Ricardo Cardona, M.D., and Ricardo Ruiz, M.D. - San Juan, PR - 01/10/2003 - CLOSED: 08/14/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=1164&h=top1.html&t=80&s=twcc
HealthTexas Medical Group of San Antonio - San Antonio, TX - 03/19/03 - CLOSED: 08/15/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=1204&h=top1.html&t=80&s=twcc
Poudre Valley Health Care, Inc. - Fort Collins, CO - 04/18/03 - CLOSED: 08/22/06 (not yet available):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=1368&h=top1.html&t=80&s=twcc
Quincy Physicians and Surgeons S.C. d/b/a Quincy Medical Center - Quincy, IL - 12/31/02 - CLOSED: 07/31/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=1378&h=top1.html&t=80&s=twcc
Riffel, Hugo, M.D. (d/b/a Perinatal Medical Group) - Long Beach, CA - 1/25/01 - CLOSED: 08/07/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=1393&h=top1.html&t=80&s=twcc
West Georgia Medical Center - Lagrange, GA - 06/12/03 - CLOSED: 08/17/06 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_cia&u=1501&h=top1.html&t=80&s=twcc
List of Excluded Individuals/Entities
OIG 08/06 Cumulative Sanction Report-Reinstatements for August 2006 (Excel):
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_fed_gov_oig_csr&u=0608rein&h=top1.html&t=80&s=twcc
OIG 08/06 Cumulative Sanction Report-Update for August 2006 (Excel):
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_fed_gov_oig_csr&u=0608up&h=top1.html&t=80&s=twcc
Audit Reports - Centers for Medicare and Medicaid Services
Review of Selected Ohio Skilled Nursing Facilities' Minimum Data Set Reporting for Purposes of Medicare Payments to Managed Care Organizations (A-05-06-00022; 08/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=50600022&h=top1.html&t=80&s=twcc
Medicare Part B Payments for Radiology Services Provided During Inpatient Stays: 2001 Through 2003 (A-01-04-00528; 08/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=10400528&h=top1.html&t=80&s=twcc
Evaluation and Inspection Reports - Administration on Aging
Cost Sharing for Older Americans Act Services (OEI-02-04-00290; 09/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oei_aoa&u=oei020400290&h=top1.html&t=80&s=twcc
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Medicare Part D
Prescription Drug Information
2006.09.01: Changes in Qualifying for Extra Help in 2007:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_mpdim_rx&u=07LISchanges&h=top1.html&t=80&s=twcc
2006.08.01: Introduction to the Re-deeming Notice: Change in (Extra Help) Copayment Level Version:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mpdim_rx&u=11199&h=top1.html&t=80&s=twcc
2006.08.01: Introduction to the Re-deeming Notice: Loss of (Extra Help) Status Version:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mpdim_rx&u=11198&h=top1.html&t=80&s=twcc
2006.09.01: You might still Save on your Medicare Prescription Drug Coverage Costs even if you don’t Automatically Qualify for Extra Help:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mpdim_rx&u=11215&h=top1.html&t=80&s=twcc
Prescription Drug Plan Contractors
Part D Enrollment and Appeals Guidance - Updated 09/2006:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=06RxCEA&h=top1.html&t=80&s=twcc
Marketing Guidance - Updated 09/2006:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=07RxContractingMarketing&h=top1.html&t=80&s=twcc
Plan Reporting and Oversight - Updated 09/2006:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=08RxCRO&h=top1.html&t=80&s=twcc
Prescription Drug Benefit Manuals - New 09/2006:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=12partdmanuals&h=top1.html&t=80&s=twcc
HPMS Systems/Data Notice History - Updated 09/2006:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=mhpmsghlist&h=top1.html&t=80&s=twcc
DRAFT - Chapter 5: Benefits and Beneficiary Protections [PDF, 361KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=PartDManualChapter5&h=top1.html&t=80&s=twcc
DRAFT - Chapter 6: Part D Drugs and Formulary Requirements [PDF, 1MB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=PartDManualChapter6&h=top1.html&t=80&s=twcc
Summary - Update to PDP Enrollment and Disenrollment Guidance (v09.08.06) [PDF, 51KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=09082006enroll&h=top1.html&t=80&s=twcc
PDP Enrollment and Disenrollment Guidance (v09.08.06) [PDF, 656KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=CurrentPDPEnrollmentGuidance&h=top1.html&t=80&s=twcc
ANOC - Final Rolling into Another Plan [DOC, 59KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=FINALMODELANOC2PDP0090606&h=top1.html&t=80&s=twcc
ANOC - Final Renewing Plan-Sent to all Members [DOC, 67KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=FINALMODELANOCPDP090606&h=top1.html&t=80&s=twcc
MTM Contact List (v06.15.06) [PDF, 385KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=MTMContactList&h=top1.html&t=80&s=twcc
CY07 Part D Reporting Requirements (v04.14.06) [PDF, 283KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=pdrep04142006&h=top1.html&t=80&s=twcc
Response to Industry Comments on Draft Medicare Part D Audit Guide (v05.09.06) [PDF, 92KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=PartDAuditGuideComments&h=top1.html&t=80&s=twcc
Draft Part D Audit Guide (v11.23.05) [PDF, 355KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=PartDAuditGuide&h=top1.html&t=80&s=twcc
FAQ: 2006 Part D Reporting Requirements (v08.18.06) [PDF, 131KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=PartDReportingRequirementsFAQ&h=top1.html&t=80&s=twcc
Changes to Part D Sponsors' Medication Therapy Management Program (MTMP) (v08.29.06) [PDF,96KB]:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_cms_pdccontractors&u=MemoMTMChanges08292006&h=top1.html&t=80&s=twcc
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This Week’s Link:
JCAHO Sentinel Event Statistics
http://www.jointcommission.org/SentinelEvents/Statistics/
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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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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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