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Vol. VIII, No. 34 – October 6, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Table of Contents

Headlines

Feds Recoup $1.47 Billion
Ex-Edgewater Medical Center Owner to Pay $64.2 Million
Home Health Care Agency To Pay $6 Million
Physician Sentenced
Miami Doctor Indicted
Indictments Issued in Health Care Kickback Scheme
Nursing Agency Head Indicted for Illegally Employing Unlicensed Nurses

Regulatory News

CMS: Most Hospitals Report Quality of Care Data
CMS Updates and Announcements
CMS has just released a new MLN Matters Special Edition Article

In the Federal Register
CMS Transmittals
From the GAO
From the OIG

This Week’s Link
Acronym Library

Visit HCCA's Web site
HCCA Headquarters - Contact Information

Headlines:

Feds Recoup $1.47 Billion
According to a report in the October 5 issue of The Hill, “An interdepartmental program designed to curb waste, fraud and abuse in federal healthcare programs will collect $1.47 billion as a result of criminal or civil cases brought in the most recent year reviewed, according to a federal report issued this week.

“The Department of Justice and the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS) also announced that they jointly have deposited $8.85 billion into the Medicare trust fund since their joint program began in 1997.

“Lawmakers, such as Sens. Chuck Grassley (R-Iowa) and Tom Coburn (R-Okla.), have repeatedly pressed federal agencies to do more to recover funds lost due to fraud and abuse.

“The defendants in the fraud and abuse cases outlined in the latest report range from individual schemers to some of the largest healthcare companies in the country.

“Among the companies appearing in the OIG-Justice report are the drug maker GlaxoSmithKline, the pharmacy-benefit manager AdvancePCS, the clinic and lab services firm HealthSouth Corp. and the kidney-dialysis provider Gambro Healthcare.” For more: http://www.thehill.com/thehill/export/ TheHill/News/TheExecutive/100506_fraud.html

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Ex-Edgewater Medical Center Owner to Pay $64.2 Million
On September 30, the Chicago Tribune reported that “a federal judge has ordered the former owner of a now-shuttered Chicago hospital to pay $64.2 million in damages and penalties for his role in a scheme to bilk government health programs.

“Peter Rogan was a key player in the fraud at Edgewater Medical Center on Chicago's North Side, U.S. District Judge John Darrah said in a 64-page opinion issued Friday.” For more: http://www.chicagotribune.com/news/local/illinois/chi-ap-il-diagnosisfraud,1,5076644.story?ctrack=1&cset=true

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Home Health Care Agency To Pay $6 Million
US Attorney for the Eastern District of New York Roslynn R. Mauskopf, , announced that Visiting Nurse Association of Brooklyn (VNAB) has agreed to pay nearly $3.8 million in damages and penalties in two civil health care fraud cases and more than $2.3 million in overpayments. For more:
http://www.usdoj.gov/usao/nye/pr/2006/2006Sep29.htm

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Physician Sentenced
US Attorney for the Northern District of Texas Richard B. Roper announced that Stephen P. Miller, who was convicted by a federal jury in July on one count of tax evasion, was sentenced to 46 months imprisonment and 3 years supervised release. United States District Judge Mary Lou Robinson also ordered that Miller pay $968,836.27 in restitution. Miller, age 68, is a physician who practiced medicine at Baptist Hospital in Amarillo in 1999 and 2000. Evidence at trial also showed that he practiced medicine in Wellington and Brownsville, Texas. Judge Robinson ordered that Dr. Miller surrender to the Bureau of Prisons on October 23, 2006.  For more: http://www.usdoj.gov/usao/txn/PressRel06/ miller_tax_sen_pr.html

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Miami Doctor Indicted
On October 2, US Attorney for the Southern District of Florida R. Alexander Acosta announced the September 26, 2006 Indictment of defendant, Pedro Cuni, a long time South Florida doctor, in a complex Medicare fraud scheme. For more:
http://www.usdoj.gov/usao/fls/PressReleases/061002-02.html

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Indictments Issued in Health Care Kickback Scheme
On September 29, US Attorney for the Southern District of Florida R. Alexander Acosta announced an Indictment in connection with a Medicare kickback scheme involving two Miami pharmacies and the owners of four durable medical equipment companies.

The Indictment, which was returned by the grand jury on September 26, 2006, charges defendants Ricardo Aguera, his brother, Ivan Aguera, their step-father, Carlos Berenguer, and Carlos’s brothers, Aristides Berenguer and Robert Berenguer, with conspiracy to solicit and receive kickbacks involving a federal health care program. Ricardo and Ivan Aguera, and Carlos and Robert Berenguer, are also charged with soliciting and receiving kickbacks involving a federal health care program. For more: http://www.usdoj.gov/usao/fls/PressReleases/060929-02.html

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Head of Nursing Agency Indicted for Illegally Employing Unlicensed Nurses
New York Attorney General Eliot Spitzer announced on September 8 the indictment of Hermine McFadden for running an agency that placed unlicensed and unregistered nurses at State and City facilities. New York law requires that anyone engaged in the practice of nursing be licensed and registered. For more:
http://www.oag.state.ny.us/press/2006/sep/sep8a_06.html

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

Regulatory News

CMS: Most Hospitals Report Quality of Care Data
The Centers for Medicare & Medicaid Services (CMS) announced September 29 that nearly all of the nation’s eligible hospitals reported data on the quality of care they deliver, providing transparency in information for consumers on quality performance measures linked to payments hospitals receive for treating Medicare beneficiaries.

Under the Medicare Modernization Act of 2003 (MMA), and later revised under the Deficit Reduction Act of 2005 (DRA), hospitals that submit quality information to CMS are eligible to receive the full Medicare payment update for inpatient services in 2007. For more: http://www.cms.hhs.gov/apps/media/ press/release.asp?Counter=2026

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CMS Updates and Announcements
FY 2007 Hospital Inpatient PPS Final Payment Rates – Fact Sheet
On September 29, 2006, the Centers for Medicare & Medicaid Services (CMS) announced final hospital inpatient prospective payment system (IPPS) rates for fiscal year (FY) 2007.  Although CMS completed its FY 2007 IPPS final rule on August 1, the rates announced at that time were tentative.  CMS could only make tentative IPPS rates available with the final rule because it was unable to calculate final occupational mix adjusted wage indices as a result of only recently completing the collection of new occupational mix survey data ordered by the 2nd Circuit Court of Appeals in Bellevue Hospital Center v. Leavitt on April 3.
Consistent with the Court’s order, the final rates announced for FY 2007 fully adjust the wage indices for occupational mix.  The revised wage indices affect other aspects of IPPS payments such as the DRG relative weights, the outlier threshold and geographic reclassification that, in turn, affect the calculation of the final IPPS rates. For more: http://www.cms.hhs.gov/apps/media/ press/release.asp?Counter=2028

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CMS has just released a new MLN Matters Special Edition Article  SE0672 –Clarification of the Requirements for the Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals.  This article provides clarification on some of the common problems CMS has identified with claims submitted by participating CAP physicians for the administration of drugs covered under the CAP.  The article can be accessed at http://www.cms.hhs.gov/ MLNMattersArticles/downloads/SE0672.pdf

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In the Federal Register
CMS Corrects IRF PPS Final Rule errors that appeared in the August 18, 2006 Federal Register
Medicare: Inpatient rehabilitation facility prospective payment system (2007 FY) Correction, 57447-57448:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_fr69_cms&u=0609297&h=top1.html&t=80&s=twcc
Medicare program: Inpatient rehabilitation facility prospective payment system (2007 FY), 48354-48434:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_fr69_cms&u=0608182&h=top1.html&t=80&s=twcc

September 29 – Final Rule
Occupational Safety and Health Review Commission amends Privacy Act
OSHRC is amending its regulations implementing the Privacy Act of 1974, Effective 09/29/2006
Rule: Privacy Act; implementation
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_fr69_osha&u=0609292&h=top1.html&t=80&s=twcc

SSA corrects Social Security and SSI final rule
Social security benefits and supplemental security income: Federal old age, survivors, and disability insurance; and aged, blind, and disabled - Initial disability claims adjudication; administrative review process; correction, 57415-57416:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_fr69_ssa&u=0609292&h=top1.html&t=80&s=twcc

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CMS Transmittals
Medicare Claims Processing (PUB. 100-04)
Transmittal #1066, October 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective October 1, 2006, and Revisions to April 2006 and July 2006 Quarterly ASP Medicare Part B Drug Pricing Files (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1066cp&h=top1.html&t=80&s=twcc
Transmittal #1065, Disabling the Revenue/HCPCS Consistency Edit Codes in the Fiscal Intermediary Shared System (FISS) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1065cp&h=top1.html&t=80&s=twcc
Transmittal #1063, Ending the Contingency Plan for Remittance Advice and Charging for PC Print, Medicare Remit Easy Print, and Duplicate Remittance Advice (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1063cp&h=top1.html&t=80&s=twcc
Transmittal #1062, Termination of Healthcare Common Procedure Coding System (HCPCS) Code G0107, Colorectal Cancer Screening, Fecal Occult Blood Test (FOBT), 1-3 Simultaneous Determinations (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100 _04&u=mrepm10004r1062cp&h=top1.html&t=80&s=twcc

Financial Management (PUB. 100-06)
Transmittal #107, Instructions for Conducting In-House Audits and Revision to Part II Acceptability Checklist Requirements (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100 _6&u=mrepm10004r107fm&h=top1.html&t=80&s=twcc

Program Integrity (PUB. 100-08)
Transmittal #160, Complaint Screening (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100 _08&u=mrpm10008r160pi&h=top1.html&t=80&s=twcc
Transmittal #159, New DMEPOS Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFS) for Claims Processing (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100 _08&u=mrpm10008r159pi&h=top1.html&t=80&s=twcc

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From the GAO
Recent Reports
VA Health Care:  Budget Formulation and Reporting on Budget Execution Need Improvement.  GAO-06-958, September 20.
http://www.gao.gov/cgi-bin/getrpt?GAO-06-958

Consumer-Directed Health Plans:  Early Enrollee Experiences with Health Savings Accounts and Eligible Health Plans.  GAO-06-798, August 9.
http://www.gao.gov/cgi-bin/getrpt?GAO-06-798

Medicare Outpatient Payments:  Rates for Certain Radioactive Sources Used in Brachytherapy Could Be Set Prospectively.  GAO-06-635, July 24.
http://www.gao.gov/cgi-bin/getrpt?GAO-06-635

Recent Testimony
Global Health:  Spending Requirement Presents Challenges for Allocating Prevention Funding under the President's Emergency Plan for AIDS Relief, by David B. Gootnick, director, international affairs and trade, before the Subcommittee on National Security, Emerging Threats, and International Relations, House Committee on Government Reform.
GAO-06-1089T, September 6.
http://www.gao.gov/cgi-bin/getrpt?GAO-06-1089T

Health Information Technology:  HHS Is Continuing Efforts to Define Its National Strategy, by David A. Powner, director, information technology management issues, before the Subcommittee on Federal Workforce and Agency Organization, House Committee on Government Reform, in St. Louis, Missouri. GAO-06-1071T, September 1.
http://www.gao.gov/cgi-bin/getrpt?GAO-06-1071T

Medicare Physician Payments:  Trends in Service Utilization, Spending, and Fees Prompt Consideration of Alternative Payment Approaches, by A. Bruce Steinwald, director, health care, before the Subcommittee on Health, House Committee on Energy and Commerce.  GAO-06-1008T, July 25.
http://www.gao.gov/cgi-bin/getrpt?GAO-06-1008T

Recent Correspondence
TRICARE:  Enrollment of the Department of Defense's TRICARE Beneficiaries in Medicare Part B.  GAO-06-489R, June 30.http://www.gao.gov/cgi-bin/getrpt?GAO-06-489R

VA and DOD Health Care:  Efforts to Provide Seamless Transition of Care for OEF and OIF Servicemembers and Veterans.  GAO-06-794R, June 30.http://www.gao.gov/cgi-bin/getrpt?GAO-06-794R

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From the OIG
OIG Executes Tenet Corporate Integrity Agreement; Unprecedented Provisions Include Board of Directors Review
http://oig.hhs.gov/publications/pressmaterials.html

Recent Audit Reports:
Review of University of California, San Diego Medical Center’s Reported Fiscal Year 2004 Wage Data
http://oig.hhs.gov/oas/reports/region9/90600027.htm

Review of TriSpan Health Services’s Payments to Synergy Behavioral Health for Partial Hospitalization Services for the Period August 1, 2000, Through June 20, 2003
http://oig.hhs.gov/oas/reports/region6/60400032.htm

Review of TriSpan Health Services’s Payments to Community Mental Health Centers for Partial Hospitalization Services for the Period August 1, 2000, Through June 30, 2003
http://oig.hhs.gov/oas/reports/region6/60400065.htm

Review of University of California, Los Angeles Medical Center’s Reported Fiscal Year 2004 Wage Data
http://oig.hhs.gov/oas/reports/region9/90600026.htm

Review of University of California, Davis Medical Center’s Reported Fiscal Year 2004 Wage Data
http://oig.hhs.gov/oas/reports/region9/90600024.htm

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This Week’s Link:
Health Care Fraud and Abuse Control (HCFAC) Program annual report for FY 2005.  To get to the full document:
http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2005.pdf

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Acronym Library

For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp

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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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Fax number - (952) 988-0146
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Email - info@hcca-info.org Contact: Margaret Dragon, Editor
This Week in Corporate Compliance (781) 593-4924

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