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Vol. VIII, No. 37 – November 3, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Compliance Academy
Table of Contents
Headlines
Failure to Disclose and Return Overpayments Result in Million Dollar Settlement
Danbury Hospital Settlement Announced
$144 M Verdict Announced
Biopharmaceutical Company Settlement Announced
NY Nursing Home Indicted for Neglect and Falsifying Medical Records
Abandoned Building Was Once Thriving Nursing Home
Nursing Home Administrator Sentenced
Regulatory News
CMS:
Medicare Physician Fee Schedule
Hospital Outpatient Prospective Payment System and CY 2007 Payment Rates
Home Health PPS
In the Federal Register
CMS Transmittals
From the OIG
This Week’s Link
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
Failure to Disclose and Return Overpayments Result in Million Dollar Settlement
Nebraska Attorney General Jon Bruning and United States Attorney Debra Wong Yang of Los Angeles, Calif., announced on October 30, 2006 that St. Elizabeth Regional Medical Center has paid the State of Nebraska $1.2 million to settle allegations that it knowingly failed to disclose and failed to return overpayments made by the Nebraska Medicaid program.
This amount is part of a larger $4 million settlement in which St. Elizabeth will also pay the federal government $2.8 million for overpayments made by Medicare and Medicaid.
For more: http://www.ago.state.ne.us/
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Danbury Hospital Settlement Announced
On October 26, U.S. Attorney for Connecticut Kevin O’Connor announced that Danbury Hospital, Inc., located at 24 Hospital Avenue, Danbury, Connecticut has entered into a civil settlement agreement with the Government to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program. For more:
http://www.usdoj.gov/usao/ct/Press2006/20061026.html
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$144 M Verdict Against Medicaid HMO Announced
On October 31, The New York Times published a notice that “The Amerigroup Corporation, which manages government health plans for the poor, must pay at least $144 million in damages for wrongfully denying coverage to pregnant women eligible for Medicaid, a federal jury found yesterday.
“The jury, in Chicago, awarded the plaintiffs $48 million. That amount will be tripled under federal law.
“The company may also be liable for as much as $199 million in penalties for more than 18,000 instances of fraud found by jury.” For more: http://www.nytimes.com/2006/10/31/business/ 31fraud.html?_r=1&oref=slogin
Government Press Release: http://www.illinoisattorneygeneral.gov/pressroom /2006_10/20061031c.html
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Biopharmaceutical Company Settlement Announced
InterMune, Inc, a Brisbane, California biopharmaceutical company, has agreed to pay the United States more than $36.9 million to resolve criminal charges and civil liabilities in connection with its alleged illegal promotion and marketing of Actimmune, the Justice Department announced on October 26, 2006. For more:
http://www.usdoj.gov/opa/pr/2006/October/06_civ_728.html
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NY Nursing Home Indicted for Neglect and Falsifying Medical Records
On October 26, New York Attorney General Eliot Spitzer announced the indictment and arraignment of the corporation that operates a Cortland County Nursing Home on charges alleging patient neglect and falsifying medical records. The indictment was brought by the same grand jury that previously indicted employees of the home who were captured on surveillance cameras neglecting their patients.
The corporation, Highgate LTC Management LLC, the company that owns and operates the Northwoods Nursing Home, also has interests in five other facilities in Upstate New York. It has now been charged with six counts of Wilful Violation of Health Laws and three counts of Falsifying Business Records in the Second Degree. For more:
http://www.oag.state.ny.us/press/2006/oct/oct26c_06.html
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Abandoned Building Was Once Thriving Nursing Home
According to a report in the October 29 issue of Great Falls Tribune, all that remains of Prairie Vista Manor is the abandoned building rotting along Highway 87 in Big Sandy. “At one time the nursing home was the fourth-largest employer in this community of some 650. It was home to 27 elderly and mentally disabled residents.
“When it closed five years ago, Prairie Vista Manor became what is believed to be the first nursing home in Montana shut down by the state for failing to provide adequate care to its residents.
“Theft and mismanagement led to a host of problems that eventually sank the 38-year-old, family-run business. The closure left some jobless, homeless or broke. Victims ranged from white-collar business partners, to nurses' aides, to mom-and-pop stores and other creditors.” For more: http://www.greatfallstribune.com/apps/pbcs.dll/ article?AID=/20061029/NEWS01/610290302/1002
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Nursing Home Administrator Sentenced
On October 28 The Daily News reported that “A former nursing home administrator from West Mifflin has been sentenced in federal district court on health care fraud and giving multiple false statements relating to health care matters.” For more: http://www.zwire.com/site/news.cfm?newsid=17390697& BRD=1282&PAG=461&dept_id=182121&rfi=6
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This week, MediRegs provided TWCC readers with the following Regulatory information: In the Federal Register, CMS Transmittals, and From the OIG.
Regulatory News
CMS: Medicare Physician Fee Schedule
On November 1, the Centers for Medicare and Medicaid Services announced that starting next year, the Medicare program will pay physicians more for the time they spend talking with Medicare beneficiaries about their health care and will pay for a broader range of preventive services. The changes, which will become effective January 1, 2007, are included in the Medicare Physician Fee Schedule (MPFS) final rule. For more: http://www.cms.hhs.gov/apps/media/press/ release.asp?Counter=2044
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Hospital Outpatient Prospective Payment System and CY 2007 Payment Rates; CY 2007 Update to the Ambulatory Surgical Center Covered Procedures List; Medicare Administrative Contractors; and Reporting Hospital Quality Data for FY 2008 Inpatient
On November 1, the Centers for Medicare & Medicaid Services (CMS) issued a final rule, in part, for Medicare payment for Ambulatory Surgical Center services in calendar year (CY) 2007 titled: Medicare Program; Hospital Outpatient Prospective Payment System and CY 2007 Payment Rates; CY 2007 Update to the Ambulatory Surgical Center Covered Procedures List; Medicare Administrative Contractors; and Reporting Hospital Quality Data for FY 2008 Inpatient Prospective Payment System Annual Payment Update Program--HCAHPS Survey, SCIP, and Mortality; CMS-1506-FC; CMS-4125-F
The link to CMS-1506-FC is available online in the “Spotlights” section at: http://www.cms.hhs.gov/center/asc.asp .
Or, you can go to http://www.cms.hhs.gov/ASCPayment/06a_CMS1506fc.asp .
To view the press release, go to http://www.cms.hhs.gov/apps/media/press/ release.asp?Counter=2042
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Home Health PPS
Also on November 1, the Centers for Medicare & Medicaid Services (CMS) announced a 3.3 percent market basket increase for Medicare payment rates for home health services for calendar year 2007. The home health prospective payment system (HH PPS) annual update will bring an estimated additional $410 million in wage adjusted payments to home health agencies next year. For More:
http://www.cms.hhs.gov/apps/media/press/ release.asp?Counter=2040
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In the Federal Register
SSA Issues Part B Monthly Adjustment Amount Rules
On October 27, 2006, SSA added a new set of rules for Medicare Part B income-related monthly adjustment amount determinations. The final rule describes the new subpart; the information that will be use to determine whether a beneficiary will pay an income-related monthly adjustment amount and the amount of the adjustment when applicable; when SSA will consider a major life-changing event that results in a significant reduction in modified adjusted gross income; and how to appeal income-related monthly adjustment amount determinations.
71 FR 62923:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_ssa&u= 0610272&h=top1.html&t=80&s=twcc
Also on October 27, 2006, the Centers for Medicare and Medicaid Services proposed a rule that would require all long term care facilities to be equipped with sprinkler systems. The proposed rule requests public comments on the duration of a phase-in period to allow long term care facilities to install such systems.
71 FR 62957:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69_cms&u= 0610277&h=top1.html&t=80&s=twcc
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CMS Transmittals
General Information, Eligibility and Entitlement (PUB. 100-01)
Transmittal #41, Update to Medicare Deductible, Coinsurance and Premium Rates for 2007:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_01&u= mrpm10001r41gi&h=top1.html&t=80&s=twcc
Medicare Claims Processing (PUB. 100-04)
Transmittal #1086, Annual Type of Service Update:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u= mrepm10004r1086cp&h=top1.html&t=80&s=twcc
Transmittal #1084, Line Item Billing Requirement for End Stage Renal Disease Claims:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u= mrepm10004r1084cp&h=top1.html&t=80&s=twcc
Transmittal #1082, Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1082cp&h=top1.html&t=80&s=twcc
Transmittal #1081, Electronic Data Interchange Media Changes:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u= mrepm10004r1081cp&h=top1.html&t=80&s=twcc
Transmittal #1080, The Supplemental Security Income/Medicare Beneficiary Data for Fiscal Year 2005 for Inpatient Prospective Payment System Hospitals:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u= mrepm10004r1080cp&h=top1.html&t=80&s=twcc
Transmittal #1079, Changes to the Process for Recovering Medicare Payments for Home Health Prospective Payment System Claims Failing to Report Prior Hospitalizations:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u= mrepm10004r1079cp&h=top1.html&t=80&s=twcc
Financial Management (PUB. 100-06)
Transmittal #110, Waiving Reporting Requirements on the CMS-2592 Report in Fiscal Year 2007 Due to Funding Constraints:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_6&u= mrepm10004r110fm&h=top1.html&t=80&s=twcc
Transmittal #109, Claims Accounts Receivable - Clarification to CR 3963:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_6&u= mrepm10004r109fm&h=top1.html&t=80&s=twcc
State Operations Manual (PUB. 100-07)
Transmittal #21, Revised Appendix P & Appendix PP-New Tag F334:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_07&u=mrpm10007r21som&h=top1.html&t=80&s=twcc
CMS One-Time Special Notification (PUB. 100-20)
Transmittal #243, Reporting the National Provider Identifier on Physician Claims for Diagnostic Services Purchased Outside of the Local Carrier's Jurisdiction:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_20&u= mrepm10020r243otn&h=top1.html&t=80&s=twcc
Transmittal #242, National Coverage Determination for Infusion Pump Exception Guidance Pub. 100-04, Chapter 1, Part 4, Section 280.14:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_20&u= mrepm10020r242otn&h=top1.html&t=80&s=twcc
National Coverage Analyses
Infrared Therapy Devices (CAG-00291N) - Expected Completion Date: 10/24/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u=CAG00291N5&h=top1.html&t=80&s=twcc
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From the OIG
Review of Medicaid Eligibility in New York State (A-02-05-01028; 10/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=20501028&h=top1.html&t=80&s=twcc
Contracting Practices for Tennessee Home and Community-Based Services for Mentally Retarded Persons (A-04-03-03025; 10/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=40303025&h=top1.html&t=80&s=twcc
Review of Organ Acquisition Costs Claimed by Certified Transplant Centers (A-09-05-000034; 09/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=90500034A&h=top1.html&t=80&s=twcc
Evaluation and Inspection Reports - Centers for Medicare and Medicaid Services
States' Provider Safeguards for Medicaid Personal Care Services (OEI-07-05-00250; 10/2006):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oei_cms&u=oei070500250&h=top1.html&t=80&s=twcc
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This Week’s Link:
TAF – State False Claims Act:
http://www.taf.org/statefca.htm
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Acronym Library
| PAHP | Prepaid Ambulatory Health Plan |
| PAL | Patient Accounting Language |
| PAL | Provider Audit List |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
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Email - info@hcca-info.org Contact: Margaret
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This Week in Corporate Compliance (781) 593-4924
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