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Vol. VIII, No. 41 – December 1, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Audit & Compliance
Compliance Academy
Table of Contents
Headlines
Florida Hospital Settles, Pays $15.4 Million
33 Indicted in Texas on Medicaid Fraud Charges
Queens Nursing Home Surveillance Nets Nine
Physical Therapist Sentenced
UMDNJ Whistleblower Claims Retaliation
Physician Indicted on Health Care Fraud Charges
TX Medical Supply Company Owner Admits to Bilking Medicare
Regulatory News
Medicare Publishes New Hospital Requirements
Accreditation Organizations for DMEPOS Announced
CMS Updates
In the Federal Register
From the GAO
CMS Transmittals
From the OIG
This Week’s Links
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
Florida Hospital Settles, Pays $15.4 Million
On November 30, the U.S. Department of Justice announced that Larkin Community Hospital in Miami and its current and former owners, Dr. Jack Michel, Dr. James Desnick, Morris Esformes and Philip Esformes, have paid $15.4 million to settle federal and Florida civil health care fraud claims against them, the Justice Department announced today. Additionally, 34 related companies owned by the Esformes that were used to operate nine assisted living facilities are part of the settlement along with Claudia Pace, an employee of one of the Esformes-owned companies; and Frank Palacios, a long-time employee of the hospital.
The settlement resolves the civil case entitled United States v. Jack Jacobo Michel, M.D., et al., which the government filed in 2004, alleging violations of the False Claims Act. The state of Florida joined the suit later that year. For more:
http://www.usdoj.gov/opa/pr/2006/November/06_civ_803.html
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33 Indicted in Texas on Medicaid Fraud Charges
KLTV 7 reported on November 30 that “A Harris County grand jury has indicted 33 people for allegedly scheming to defraud the state Medicaid program. “The Texas attorney general's office said today an alleged Medicaid fraud scheme cost state taxpayers more than seven-point-seven (M) million dollars.
The A-G's investigation concentrated on 32 Harris County businesses that allegedly billed Medicaid for adult diapers, wheelchairs and other medical supplies. The indictments allege the suspects took reimbursements based on those billings for supplies that were never delivered to patients.” For more:
http://www.kltv.com/Global/story.asp?S=5751063
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Queens Nursing Home Surveillance Nets Nine
The New York Post reported on November 22, that “A doctor, two nurses and several aides from a Queens nursing home were arrested yesterday and face charges after a hidden-camera investigation revealed chronic patient neglect, authorities said.” For more:
http://www.nypost.com/seven/ 11222006/news/regionalnews/hidden_cam_nails_doctor _regionalnews_ikimulisa_livingston.htm
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Physical Therapist Sentenced
On December 29, the U.S. Attorney for Massachusetts Michael Sullivan announced that a physical therapist was sentenced in federal court Monday, November 27, 2006, on a charge of health care fraud in connection with her causing Medicare to be billed for at least $55,000 worth of physical therapy she either did not provide or provided incompletely to patients. For more:
http://www.usdoj.gov/usao/ma/Press%20Office%20-%20Press%20Release%20Files/Nov2006/Lai-Ho-sentencing.html
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UMDNJ Whistleblower Claims Retaliation
Newsday reported on November 29 that “A financial manager at the University of Medicine and Dentistry of New Jersey says in a lawsuit that his efforts as a whistleblower at the school got him harassed, demoted, less pay, an office in the lunchroom and an escort out by armed police.
“In the lawsuit, Michael Nappe, of Piscataway, said that for four years he repeatedly tried to report to university officials what he claims were the medical school's illegal and unethical billing and accounting practices.” For more:
http://www.newsday.com/news/local/wire/newjersey/ny-bc-nj--umdnjwhistleblowe1129nov29,0,4630280.story?coll=ny-region-apnewjersey
In a related story: The November 24 issue of the New York Times reported that “As New Jersey’s state medical school has been shaken in the past year by disclosures of widespread financial mismanagement, administrators there have repeatedly defended the institution, the University of Medicine and Dentistry of New Jersey, by insisting that the scandals have affected its treasury but not the quality of care for the more than two million patients it treats each year.
“But a federal monitor’s recent accusations that the cardiology unit at the university’s main hospital has been paying kickbacks to doctors for referring heart patients have undercut that argument at a time when the school’s future remains in doubt.” For more: http://www.nytimes.com/2006/11/24/ nyregion/24hosp.html?_r=1&ref=nyregion&oref=slogin
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Physician Indicted on Health Care Fraud Charges
On November 29, U.S. Attorney for the Northern District of Alabama Alice Martin announced that Thomas Richard Martin, Jr. of Boaz, Alabama was indicted in U.S. District Court and charged with one count of Health Care Fraud against the Medicare Program, and one count of Health Care Fraud against Blue Cross and Blue Shield of Alabama. The indictment seeks criminal forfeiture of property, both real and personal, derived from any proceed traceable to the charged activity. For more:
http://www.usdoj.gov/usao/aln/Docs/November%202006/
NOVEMBER%2029,%202006%20BOAZ%20PHYSICIAN
%20INDICTED%20FOR%20HEALTH%20CARE%20FRAUD.html
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TX Medical Supply Company Owner Admits to Bilking Medicare
The Express-News reported on November 28, that “The owner of a San Antonio medical supply company pleaded guilty Tuesday to charges that she bilked Medicare and Medicaid out of more than $4.4 million.
“Mary Lou Hernandez, who does business as Angel Care Medical Supply Inc., billed the government $10 million for power wheelchairs or motorized scooters, and accessories, between Sept. 3, 2000, and Sept. 30, 2004, court records state. She admitted the benefits programs paid Angel Care $4.6 million, of which $4.4 million was overpayment induced through fraudulent means.” For more:
http://www.mysanantonio.com/news/metro/ stories/MYSA112906.02B.healthcare_fraud.29349b7.html
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This week, MediRegs provided TWCC readers with the following Regulatory information: In the Federal Register, From the GAO, CMS Transmittals, and From the OIG.
Regulatory News
Medicare Publishes New Hospital Requirements
On November 28, 2006 the Centers for Medicare & Medicaid Services (CMS) published a final rule revising requirements in the hospital conditions of participation (CoPs) for completion of history and physical examinations, authentication of verbal orders, securing medications, and completion of post anesthesia evaluations. The new rule addresses concerns of the health care community that the old regulations were outdated and unduly burdensome.
For more: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter =2050&intNumPerPage=10&checkDate=&checkKey =&srchType=&numDays=3500&srchOpt=0&srchData =&keywordType=All&chkNewsType=1%2C+2%2C +3%2C+4%2C+5&intPage=&showAll=&pYear =&year=&desc=&cboOrder=date
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Accreditation Organizations for DMEPOS Announced
On November 22, 2006 the Centers for Medicare & Medicaid Services (CMS) announced the names of eleven national accreditation organizations that will accredit suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) as meeting new quality standards under Medicare Part B.
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter =2049&intNumPerPage=10&checkDate=&checkKey=&srchType =&numDays=3500&srchOpt=0&srchData=&keywordType =All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage =&showAll=&pYear=&year=&desc=&cboOrder=date
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CMS Updates
IPPS New Technology Applications
CMS is extending the deadline for FY 2008 inpatient prospective payment system (IPPS) New Technology Applications to December 30, 2006. Complete information (criteria to qualify, application information, etc…) on the IPPS new medical services and technology add on payment process is available at http://www.cms.hhs.gov/AcuteInpatientPPS/08_newtech.asp on the CMS Website.
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National Influenza Vaccination Week
November 27 to December 3 is National Influenza Vaccination Week. The Centers for Disease Control and Prevention has designated the week after Thanksgiving as National Influenza Vaccination Week. This week long event is designed to raise awareness of the importance of continuing influenza (flu) vaccination, as well as foster greater use of flu vaccine through the months of November, December and beyond. Since flu activity typically does not peak until February or later, November and December still provide good opportunities to get vaccinated. The Centers for Medicare & Medicaid Services (CMS) invites you to join in this event as an opportunity to ensure that people with Medicare get their flu shot. The flu vaccine is the best way to protect your patients from the flu. Though Medicare provides coverage for the flu vaccine and its administration, there are still many beneficiaries who don’t take advantage of this benefit. If you have Medicare patients who have not yet received their flu shot, we ask that you encourage these patients to protect themselves from the risk and severity of the flu virus. – And don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot. Remember - Influenza vaccination is a covered Part B benefit. Note that influenza vaccine is NOT a Part D covered drug. For more information about Medicare’s coverage of adult immunizations and educational resources, go to CMS’s website: http://www.cms.hhs.gov/MLNMattersArticles/ downloads/SE0667.pdf.
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In the Federal Register
CMS Issues Final Rule for Hospital Outpatient Prospective Payment System and CY 2007 Payment Rates
On November 24, 2006, CMS issued a final rule that revised the Medicare hospital outpatient prospective payment system to implement statutory requirements and certain related provisions of the MMA and the DRA. The final rule (with comment period) describes changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007. The rule also: (1) implements future CY 2009 required reporting on quality measures for hospital outpatient services paid under the prospective payment system; (2) revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center; and (3) revises the emergency medical screening requirements for critical access hospitals.71 FR 67960:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c =mre_fr69_cms&u=0611247&h=top1.html&t=80&s=twcc
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From the GAO
Social Security Administration: Short Time Frame and Workload Challenges Could Affect Timely Implementation of Income-Based Medicare Part B Premiums GAO-07-228R, November 17, 2006 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c =mre_gao_cms&u=d07228r&h=top1.html&t=80&s=twcc
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CMS Transmittals
National Coverage Analyses
Electrical Bioimpedance for Cardiac Output Monitoring (CAG-00001R2) - Expected Completion Date: 11/21/06:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u =CAG00001R23&h=top1.html&t=80&s=twcc
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From the OIG
Audit Report
Medical Review of Touro Rehabilitation Center’s Services for Medicare Outlier Claims for 2002 (A-04-04-00010; 11/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=40400010&h=top1.html&t=80&s=twcc
Evaluation and Inspection Reports - Centers for Medicare and Medicaid Services
Identifying Beneficiaries Eligible for the Medicare Part D Low-Income Subsidy PDF (OEI-03-06-00120; 11/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oei_cms&u=oei030600120&h=top1.html&t=80&s=twcc
Availability of Quality of Care Data in the Medicare End Stage Renal Disease Program PDF (OEI-05-05-00300; 11/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oei_cms&u=oei050500300&h=top1.html&t=80&s=twcc
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This Week’s Links:
JCAHO Granted Deeming Authority to Accredit DMEPOS
http://www.jointcommission.org/NewsRoom/NewsReleases/nr_11_30_06.htm
NCQA Report Cards:
http://hprc.ncqa.org/menu.asp
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Acronym Library
| T10 | Title X of the Social Security Act (Aid to the Blind) |
| T14 | Title XIV of the Social Security Act (Grants to States for Aid to the Disabled |
| T16 | Title XVI of the Social Security Act (SSI) |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
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Compliance Today Call for Authors
If you would like to submit an article on one or more of the following topics for publication in HCCA's monthly magazine - Compliance Today - please contact Margaret Dragon margaret.dragon@hcca-info.org – Tel: 781/593-4924):
* Compliance Program Basics (articles should be geared to the new compliance officer)
* Identifying and addressing conflicts of interest
* Long-Term Care, Home Health, and Hospice compliance issues
* Developing effective compliance program education programs
* Research Compliance
* Conducting a risk assessment
* Clinical trials and the FDA
* Human Subjects Protections
* Clinical trial billing compliance
* How to audit Compliance with Federal Grant Requirements
* Issues involved with Medicare Part D Compliance
* Deficit Reduction Act Compliance
* Compliance with the NPI
If you have other topics you'd like to explore, please send them along to Margaret.
In addition, we would like to receive news on the ways you celebrated 2006 National Corporate Compliance and Ethics Week. The information you submit will be published in the March issue of Compliance Today, so please e-mail margaret.dragon@hcca-info.org with your news by January 2, 2007.
Upcoming Compliance Today Deadlines:
* February Issue - December 1, 2006
* March Issue – January 2, 2007
* April Issue – February 1, 2007
* May Issue – March 1, 2007
* June Issue – April 2, 2007
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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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