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Vol. IX, No. 3 –January 19, 2007 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Table of Contents

Headlines

UMDNJ Sets Policy to Encourage Reporting Abuses
Clinic Employee Admits Role in Identity Theft
President of HIV/AIDS Infusion Clinic Arrested
Florida Speech Therapy Business Owner Arrested
Massachusetts Physician Settles False Claims Allegations
Chiropractor, Doctor, and Clinic Owner Sentenced

Regulatory News

JCAHO Releases Statement on GAO Report

CMS Updates
From the GAO
In the Federal Register

CMS Transmittals
From the OIG

This Week’s Links
Acronym Library

Visit HCCA's Web site
HCCA Headquarters - Contact Information

Headlines:

UMDNJ Sets Policy to Encourage Reporting Abuses
On January 18, the Philadelphia Inquirer reported that “Trustees of the embattled University of Medicine and Dentistry of New Jersey have approved a new policy encouraging workers and students to report suspicious activity and to protect whistle-blowers from retaliation.

“The whistle-blower policy, approved Tuesday, reinforces the obligation of workers and students to report suspicions of possible misconduct to an appropriate authority. It sends an important message to our faculty and staff and students that wrongdoing will not be tolerated and we want them to come forward if they have any information," said Anna Farneski, a university spokeswoman.” For more: http://www.philly.com/mld/inquirer/news/local/states/ new_jersey/16486295.htm

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Clinic Employee Admits Role in Identity Theft
On January 11, R. Alexander Acosta, United States Attorney for the Southern District of Florida announced that defendant Isis Machado pled guilty to Superseding Indictment charging her with conspiracy to commit computer fraud, conspiracy to commit identity theft and conspiracy to wrongfully disclose individually identifiable health information, in violation of 18 U.S.C. § 371.
For more: http://www.usdoj.gov/usao/fls/PressReleases/ 070111-03.html

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President of HIV/AIDS Infusion Clinic Arrested
On January 12, Florida Attorney General Bill McCollum announced that the president of a Miami-Dade HIV/AIDS infusion clinic was arrested on charges of organized scheme to defraud. Sonia Rivera allegedly used her clinic to fraudulently bill the Florida Medicaid program more than $73,000 for an expensive prescription drug used to treat HIV and AIDS. She was arrested by investigators with the Attorney General’s Medicaid Fraud Control Unit.

The investigation into Rivera, 46, was initiated in 2004 when the Attorney General’s Office received information about her clinic from the Agency for Health Care Administration. Rivera owned and operated Medlife Services, Corp., an HIV/AIDS infusion clinic in Miami. Investigators believe Rivera solicited various physicians with Medicare and Medicaid provider numbers to work at her clinic, then abused their provider numbers to submit fraudulent claims for WinRho, an HIV/AIDS treatment medication. For more:
http://myfloridalegal.com/newsrel.nsf/newsreleases/ BE54A09DBE49057A852572610067952A

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Florida Speech Therapy Business Owner Arrested
On January 9, 2007 Florida Attorney General Bill McCollum announced that a Miami-Dade County woman was arrested for defrauding the Florida Medicaid program out of more than $119,000. Tracy L. Deskins was arrested this morning by law enforcement officers with the Attorney General’s Medicaid Fraud Control Unit after investigators discovered that she was using her speech therapy business to fraudulently bill Medicaid. For more:
http://myfloridalegal.com/newsrel.nsf/newsreleases/ 19698790CAF9EF428525725E004C3B6E

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Massachusetts Physician Settles False Claims Allegations
On January 12, 2007 U.S. Attorney for Massachusetts Michael Sullivan and Massachusetts Attorney General Thomas Reilly announced that Perry R. Hearn, M.D. a Norwell physician has agreed to pay $150,000, and Affiliated Professional Services Inc., a Wareham-based medical billing company has agreed to pay $100,000, to settle allegations that they submitted false claims to the Medicare and Medicaid programs for office and nursing home visits performed by nurse practitioners and physician assistants without any physician supervision. For more: http://www.usdoj.gov/usao/ma/Press%20Office%20-%20Press%20Release%20Files/Jan2007/Hearn-Perry-settmentagreement.html

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Chiropractor, Doctor, and Clinic Owner Sentenced
On January 11, U.S. Attorney for Massachusetts Michael J. Sullivan announced that three men from Gloucester, Newton, and Marblehead were sentenced late yesterday in federal court on charges of conspiracy to commit mail fraud, wire fraud, health care fraud, and money laundering.

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This week, MediRegs provided TWCC readers with the following Regulatory information: CMS Transmittals.

Regulatory News

JCAHO Releases Statement on GAO Report
On January 16, 2007, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released a statement regarding the recent GAO Report (See From the GAO below) titled “Hospital Accreditation:  Joint Commission on Accreditation of Healthcare Organizations' Relationship with Its Affiliate”.

In the prepared statement, The Joint Commission President Dennis S. O’Leary, M.D. states “The Joint Commission concurs with the GAO’s assertion that ensuring the independence of the Joint Commission’s accreditation process is vitally important to safeguarding the safety and quality of hospital services provided to Medicare beneficiaries and the public at large.” For the complete press release:
http://www.jointcommission.org/NewsRoom/NewsReleases/ gao_1_07.htm

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CMS Update
Important Update for Instructions for the Coordination of Medicare Secondary Payer (MSP) claims for the Competitive Acquisition Program (CAP)
In Change Request (CR) 5332 (Transmittal 1088) “Instructions for the Coordination of Medicare Secondary Payer (MSP) claims for the Competitive Acquisition Program (CAP)”, issued October 27, 2006, the Centers for Medicare & Medicaid Services (CMS) indicated that, under certain circumstances, a participating CAP physician may procure a CAP drug from a source other than the CAP vendor because of a mistake in identifying the patient’s primary insurer. Under these unusual circumstances, CR 5332 instructed CAP physicians to use the J3 modifier to receive payment for the drug at the non-CAP rate.  However, CR 5332 further indicated that a new modifier would be created in the near future for the situation described above.

Please take note that the new modifier—M2—has been created and effective January 1, 2007, participating CAP physicians must use the M2 modifier when billing for the unusual circumstances identified above.  Medicare will no longer accept the J3 modifier for this purpose. For more information, please see the related MLN Matters article at
http://www.cms.hhs.gov/MLNMattersArticles/Downloads/ SE0703.pdf

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From the GAO
Hospital Accreditation:  Joint Commission on Accreditation of Healthcare Organizations' Relationship with Its Affiliate.  GAO-07-79, December 15.
http://www.gao.gov/cgi-bin/getrpt?GAO-07-79
Highlights - http://www.gao.gov/highlights/d0779high.pdf

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In the Federal Register

Rules
January 19 – FDA/Medical Device
Medical Devices; Patient Examination and Surgeons' Gloves; Test
Procedures and Acceptance Criteria; Correction
http://a257.g.akamaitech.net/7/257/2422/01jan20071800/ edocket.access.gpo.gov/2007/E7-682.htm

Proposed Rules
January 18, 2007
Medicaid Program; Cost Limit for Providers Operated by Units of
Government and Provisions
http://a257.g.akamaitech.net/7/257/2422/01jan20071800/ edocket.access.gpo.gov/2007/07-195.htm

January 17, 2007 – FDA/Medical Device
Orthopedic Devices; Reclassification of Non-Invasive Bone Growth
Stimulator
http://a257.g.akamaitech.net/7/257/2422/01jan20071800/ edocket.access.gpo.gov/2007/E7-476.htm

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CMS Transmittals
Medicare National Coverage Determinations (National Coverage Decisions) (PUB. 100-03)
Transmittal #64, Intracranial Percutaneous Transluminal Angioplasty (PTA) with Stenting (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _03&u=mrepm10003r64ncd&h=top1.html&t=80&s=twcc
Medicare Claims Processing (PUB. 100-04)
Transmittal #1152, Emergency Update to the 2007 Medicare Physician Fee Schedule Database **Rescinds Transmittal #1143, dated December 22, 2006**(PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1152cp&h=top1.html&t=80&s=twcc
Transmittal #1151, Skilled Nursing Facility (SNF) Consolidated Billing (CB) Common Working File (CWF) Edit Bypass Instructions for Hospital Emergency Room Services Spanning Multiple Service Dates **Rescinds Transmittal #1109, dated November 9, 2006**(PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1151cp&h=top1.html&t=80&s=twcc
Transmittal #1150 January 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) Specifications Version 22.1 **Rescinds Transmittal #1128, dated December 15, 2006**(PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1150cp&h=top1.html&t=80&s=twcc
Transmittal #1133, Reporting of Taxonomy Codes to Identify Provider Subparts on Institutional Claims **Rescinds Transmittal #1114, dated November 22, 2006**(PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1133cp&h=top1.html&t=80&s=twcc
Transmittal #1149, Revision of Chapter 31 Eligibility Rules of Behavior (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1149cp&h=top1.html&t=80&s=twcc
Transmittal #1148, Tax Relief and Health Care Act of 2006 Changes to Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1148cp&h=top1.html&t=80&s=twcc
Transmittal #1147, Intracranial Percutaneous Transluminal Angioplasty (PTA) With Stenting (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1147cp&h=top1.html&t=80&s=twcc

Financial Management (PUB. 100-06)
Transmittal #113, Notice of New Interest Rate for Medicare Overpayments and Underpayments-2nd Qtr. FY 2007 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100 _6&u=mrpm10006r113fm&h=top1.html&t=80&s=twcc

Demonstrations (PUB. 100-19)
Transmittal #52, Chiropractic Demonstration 2007 Rate Change **Rescinds Transmittal #51, dated December 19, 2006** NOTE: Transmittal 51 is not accessible on the CMS site (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_mr_pm_100 _19&u=mremrpm10019r52demo&h=top1.html&t=80&s=twcc

CMS One-Time Special Notification (PUB. 100-20)
Transmittal #259, Additional Codes for Physician Voluntary Reporting Program (PVRP) **Rescinds Transmittal #252, dated December 8, 2006** (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_ 100_20&u=mrepm10020r259otn&h=top1.html&t=80&s=twcc

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From the OIG
Updated Corporate Integrity Agreements (CIAs), Certification of Compliance Agreements (CCAs) and Settlement Agreements with Integrity Provisions
http://oig.hhs.gov/w-new.html

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This Week’s Link:
OIG Criminal Actions
http://oig.hhs.gov/fraud/enforcement/criminal/criminal.html
OIG Administration Actions – False and Fraudulent Claims
http://oig.hhs.gov/fraud/enforcement/administrative/ cmp/cmpitems.html#2

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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 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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