Compliance 101 |
Vol. VIII, No. 32 – September 29, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Advanced Academy
Compliance Academy
Table of Contents
Headlines
Both Sides Rests in Corruption Trial of Health Care Executives
Two Men Plead Guilty to Mail Fraud
Oregon Physicians Attempt Settlement
Vladeck: UMDNJ Becoming Top Model for Conduct
CA Physician Sentenced to 15 Year Prison Term
TX Doctor Sued by Government
Regulatory News
CMS Awards $7.5 Million to Expand PACE
CMS Update
From the OIG
In the Federal Register
From the GAO
This
Week’s Link
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
Both Sides Rests in Corruption Trial of Health Care Executives
On September 28, Associated Press reported that "Both sides have rested their cases in the federal corruption trial of a former Roger Williams Medical Center president and two other health care executives.
"Jurors have tomorrow off, and closing arguments will take place Monday morning.
"Former Roger Williams C-E-O Robert Urciuoli and the other two defendants are accused of paying former state Senator John Celona to promote their legislative agenda at the Statehouse. " For more:
http://www.abc6.com/engine.pl?station=wlne&id=22111 &template=breakout_story_local_news.shtml&dateformat =%25M+%25e,%25Y
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Two Men Plead Guilty to Mail Fraud
On September 26, US Attorney for Massachusetts Michale J. Sullivan announced that two men from Gloucester and Newton pleaded guilty today in federal court to conspiracy to commit mail fraud, wire fraud, health care fraud, and money laundering.
Sullivan announced that John Montoni, age 53, of 193 Washington Street, Gloucester, Massachusetts, and Igor Moyseyev, age 47, of 20 Keefe Avenue, Newtonville, Massachusetts, pleaded guilty before U.S. District Judge Nathaniel M. Gorton to conspiracy to commit mail fraud, wire fraud and health care fraud. Mosyeyev also pleaded guilty to a charge of money laundering. For more: http://www.usdoj.gov/usao/ma/Press%20Office%20-%20Press%20Release%20Files/Sept2006/Moyseyev-Igor-plea.html
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Oregon Physicians Attempt Settlement
On September 14, The Register-Guard reported that "The professional lives of three Eugene heart surgeons are at stake in a long-running investigation into whether they allegedly defrauded Medicare and Medicaid.
The doctors, plus a fourth member of their practice who has retired, are trying to reach a settlement with state and federal investigators that would allow them to continue practicing medicine, according to federal court documents. For more:
http://www.registerguard.com/news/2006/09/14/ c1.bz.heartsurgeons.0914.p1.php?section=business
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Vladeck: UMDNJ Becoming Top Model for Conduct
On September 20, The Star-Ledger reported that "Recent reforms at the scandal- ridden University of Medicine and Dentistry of New Jersey will usher the university out of "institutional trauma" and make it a "model for institutional conduct," the school's interim president said yesterday.
"During the annual University Day address, Bruce C. Vladeck said one of his top goals is a university- wide ethics education program that will begin later this year. He also wants to bolster research, improve medical services on the Newark campus, strengthen the school's infrastructure and foster more collaboration and cooperation among UMDNJ's five campuses." For more:
http://www.nj.com/news/ledger/jersey/index.ssf?/base/news-4/115872858484860.xml&coll=1
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CA Physician Sentenced to 15 Year Prison Term
On September 26, The Pasadena Star-News reported that “A Pasadena physician who collaborated on a scheme to bribe the mentally ill with candy, doughnuts and even cigarettes to undergo unnecessary respiratory treatments was sentenced to 15 years in federal prison Monday for fraudulently billing $3.1 million to Medicare and Medi-Cal.
“Aziz F. Awad, 43, was also ordered to pay $2.5 million in restitution by Judge James V. Selna. The judge called Awad's conduct in targeting the mentally ill in board and care facilities throughout the Southland "egregious" and a violation of his duty as a physician.” For more: http://www.pasadenastarnews.com/news/ci_4396649
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TX Doctor Sued by Government
KGBT 4 reported on September 8 that “More than two years after federal agents raid a McAllen doctor's office, he's facing a five-million dollar lawsuit filed by the U.S. government.
“The U.S. Attorney's Office has filed a false claims act lawsuit against Dr. Raul Marquez and two hospitals that Marquez is affiliated with and owns - Cornerstone Regional Hospital and Cornerstone Rehabilitation Hospital.” For more:
http://www.team4news.com/Global/ story.asp?S=5379839&nav=0w0v
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This week MediRegs provided TWCC with the following information: From the OIG.
Regulatory News
CMS Awards $7.5 Million to Expand PACE
On September 28, The Centers for Medicare & Medicaid Services (CMS) announced the award of $7.5 million to organizations developing Programs of All-Inclusive Care for the Elderly (PACE) in rural service areas. This grant program was initiated through the Deficit Reduction Act of 2005 (DRA) and follows the New Freedom Initiative to develop and provide additional care options in the community while providing more efficient and coordinated care through Medicare and Medicaid. for more http://www.cms.hhs.gov/apps/media/ press/release.asp?Counter=1973
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CMS Update
The updated Medicare/Medicaid Relationship Brochure is now available in downloadable format on the Centers for Medicare & Medicaid Services MLN Publications Page located at http://www.cms.hhs.gov/MLNProducts/downloads/ Relationship_Brochure.pdf on the CMS website.
The brochure discusses the relationship between Medicare beneficiaries who have limited income and resources might be getting help paying for their out-of-pocket medical and prescription expenses from their State Medicaid Program. For such persons who are eligible for full Medicaid coverage, the Medicaid program supplements Medicare coverage by providing services and supplies that is available under their State's Medicaid Program. Hard copies of the brochure will be available for ordering through the Medicare Learning Network in approximately six weeks.
Encore Presentation of the 9/26 NPI Roundtable Now Available
The National Provider Identifier (NPI) Roundtable that occurred on September 26th drew a record-breaking number of participants -the likes of which CMS had not previously seen during the HIPAA Roundtable series. As a result, this overwhelming response exceeded logistical expectations and therefore many callers were unable to join the call. An encore presentation is now available for access at your convenience, 24 hours/day, until midnight on Wednesday, October 4th (including the weekend). Interested participants can access the encore with the following information:
Encore Dial In #: (800) 642-1687
Conference ID #: 4795739
A transcript of this call will also be available shortly at www.cms.hhs.gov/NationalProvIdentStand/ on the CMS website.
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Message to Medicare Providers, Billers, Clearinghouses, and Vendors
As noted in previous announcements by the agency and our contractors, CMS plans to begin testing the new software that has been developed to use the National Provider Identifier (NPI) in the existing Medicare fee-for-service claims processing systems. Providers have until May 23, 2007, before you are required to submit claims with only an NPI.
Until testing is complete within the Medicare processing systems, CMS urges providers to continue submitting Medicare fee-for-service claims in one of two ways:
* Use your legacy number, such as your Provider Identification Number (PIN), NSC number, OSCAR number or UPIN; or
* Use both your NPI and your legacy number.
Until testing of the new software that uses the NPI in the Medicare systems is complete and until further notice from CMS, the following may occur if you submit Medicare claims with only an NPI:
* Claims may be processed and paid, or
* Claims for which Medicare systems are unable to properly match the incoming NPI with a legacy number (e.g., PIN, OSCAR number) may be rejected to the provider, and then you will need to resubmit the claim with the appropriate legacy number.
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From the OIG
Advisory Opinion 06-14 PDF concerning a pharmaceutical manufacturer’s proposal to establish a patient assistance program to provide the company’s drugs to financially-needy Medicare Part D enrollees outside of the Part D benefit; http://oig.hhs.gov/fraud/docs/advisoryopinions/2006/Adv-Opn06-14.pdf
Review of Medicare Contractor's Pension Segmentation Requirements at Blue Cross Blue Shield of Arizona for the Period January 1, 1991, to January 1, 2005 (A-07-06-00207; 08/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005 &u=70600207&h=top1.html&t=80&s=twcc
Review of Arkansas’s Reporting of Medicaid Overpayments Collected by Contractors (A-06-06-00023; 09/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005 &u=60600023&h=top1.html&t=80&s=twcc
Medicaid Payments for Beneficiaries with Concurrent Eligibility in Michigan and Ohio - Michigan Department of Community Health (A-05-06-00020; 08/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005 &u=50600020&h=top1.html&t=80&s=twcc
Review of Pension Costs Claimed for Medicare Reimbursement by Blue Cross Blue Shield of Arizona for Fiscal Years 1991 Through 2005 (A-07-06-00216; 08/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005 &u=70600216&h=top1.html&t=80&s=twcc
Review of The Maine Claims Management System (A-01-05-00007; 08/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=10500007&h=top1.html&t=80&s=twcc
Audit Reports - Administration for Children and Families
State Agency Use of Contracted Services in Hamilton County - Ohio Department of Job and Family Services (A-05-05-00058; 08/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_acf&u=50500058&h=top1.html&t=80&s=twcc
Evaluation and Inspection Reports - Centers for Medicare and Medicaid Services
Home Oxygen Equipment: Cost and Servicing PDF (OEI-09-04-00420; 09/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oei_cms&u=oei090400420&h=top1.html&t=80&s=twcc
Hospital Reporting of Deaths Related to Restraint and Seclusion PDF (OEI-09-04-00350; 09/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oei_cms&u=oei090400350&h=top1.html&t=80&s=twcc
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In the Federal Register
Rule: Medicare:
Inpatient rehabilitation facility prospective payment system (2007 FY) Correction, 57447–57448 [E6–15980]
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-15980.pdf
Notices
Agency information collection activities; proposals, submissions, and approvals, 57513 [E6–15982]
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-15982.pdf
Medicare:
Intermediary and carrier performance; evaluation criteria and standards, 57513–57519 [E6–15991]
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-15991.pdf
Skilled nursing facilities; prospective payment system and consolidated billing; update Correction, 57519–57543 [E6–15979]
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-15979.pdf
Medicare and medicaid:
Program issuances and coverage decisions; quarterly listing, 57604–57642 [06–8266]
for more: http://www.access.gpo.gov/su_docs/aces/fr-cont.html
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From the GAO
VA Health Care: Preliminary Information on Resources Allocated for Mental Health Strategic Plan Initiatives http://www.gao.gov/new.items/d061119t.pdf
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This Weeks Link
Tenet CIA document http://oig.hhs.gov/fraud/cia/agreements/TenetCIAFinal.pdf
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Acronym Library
| MN | Medical Necessity |
| MN | Medically Needy |
| MNIL | Medically Needy Income Levels |
| MO | Management Office |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
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