The Health Care Compliance Professional's Manual Used by the Health Care Compliance Association (HCCA) |
Vol. VIII, No. 42 – December 8, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
Please direct all comments to subscriptions@hcca-info.org.
Subscribe & unsubscribe information is at the bottom of this email click
here.
About HCCA | HCCB Certification | Shop Online | Events | Career Opportunities
NEW DATE - NEW HOTEL
CHC Exam Application, Deadline March 14, 2007
Improving Governance Practices February 26–28, 2007
The DRA: Now It's Here, What Have You Done? A two-part audio conference series from HCCA Part I. Recent Developments from the Perspective of a State Inspector General and Outside Counsel Part II. Practical Advice for Providers |
|
 Southwest Local
South East Local Conference Upper North East Local Conference Pacific Northwest Local Conference Upper North Central Local Conference West Coast Local Conference Alaska Local Conference New England Local Conference Upper Midwest Local Conference Midwest Local Conference North Central Local Conference East Central Local Conference Hawaii Local Conference Mountain Local Conference Tri State Local Conference South Central Local Conference November 9, 2007, Nashville, TN |
|
February
CHC Exam Application, Deadline December 29, 2006  Compliance Academy
March
CHC Exam Application, Deadline February 9, 2007 Compliance Academy
June
CHC Exam Application, Deadline April 27, 2007  Advanced Academy
June
|
|
| Products | |
NEW 
Here's an easy way to train your employees on some of the increasingly complex laws and regulations facing health care organizations today. |
|
The NEW Health Care Auditing & Monitoring Tools
The NEW Health Care Auditing & Monitoring Tools features dozens of tools, policies, and procedures used in auditing and monitoring programs. Includes CD-ROM. Preview the manual Compliance 101 |
|
| This Week's HCCA Corporate Members | |
|
|
Audit & Compliance
South Atlantic Local
Table of
Contents HeadlinesDefunct Psych Center Official Charged in Kickback Scheme
Texas Ambulance Firms Served Search Warrants
OIG Notes $2.4B in Savings
CBS News Reports on Health Care Fraud
Wheelchair Reimbursement Amounts Reduced
UMDNJ Responds to Whistleblower Suit
UnitedHealth CEO Steps DownRegulatory NewsCMS Updates
Special Open Door Forum
CMS Issues Final Rule
Diabetes Tip Sheet
Clarifications to Outpatient Therapy Cap Exceptions
Medicare Learning NetworkIn the Federal Register
From the GAO
From the OIG This Week’s Links
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:Defunct Psychiatric Center Official Charged in Kickback SchemeAssociated Press reported on December 8, that “the former operations director of a now defunct Lemont psychiatric center was charged Thursday with taking part in a scheme to pay $565,000 in bribes to doctors for patient referrals. “Mahmood Baig, 55, a licensed nutritionist who headed operations at the Rock Creek Center, was charged with one count of bribery conspiracy and six counts of paying bribes related to a federal health care program.“Prosecutors said Baig also pocketed $65,000 himself.“Baig became the second person charged in the federal government's ongoing investigation of the Rock Creek Center, which shut down in 2002.“Dr. Naseem Chaudry, who was medical director at Rock Creek, has pleaded not guilty to charges that he bilked Medicare out of $875,000 by billing for services not performed or more complex than performed.“Baig was charged in a criminal information rather than an indictment a procedure that usually signals the defendant plans to cooperate with federal investigators.“Defense attorney Jeffrey Steinback who represents Baig said he and his client would "evaluate the charges."
"’It is our ultimate intention to cooperate with the investigation,’ Steinback said in a brief telephone interview.“According to the charges, between 1999 and September 2002 Baig and three other unnamed individuals agreed to pay bribes to an unnamed Romeoville doctors group. In return, the group allegedly would send patients to Rock Creek Center for treatment.“Baig himself received payments under the deal, prosecutors alleged.”
***top***
Texas Ambulance Firms Served Search Warrants
On December 7, the Dallas Morning News reported that “Fraud investigators served 19 search warrants in Dallas and 11 other cities in a wide-ranging inquiry into allegations of fraudulent billing practices by ambulance companies, the Texas attorney general said Wednesday.” For more:
http://www.dallasnews.com/sharedcontent/dws/news/
localnews/stories/DN-raids_07met.ART.North.Edition1.3eae0f2.html
***top***
OIG Notes $2.4B in Savings
The Hill reported on December 6 that “The watchdog agency overseeing the Department of Health and Human Services (HHS) announced this week that its enforcement efforts have generated nearly $2.4 billion in savings for federal healthcare programs.” For more: http://www.thehill.com/thehill/export/TheHill/
News/TheExecutive/120706_young.html
***top***
CBS News Reports on Health Care Fraud
On December 5, CBS News reported that “When Beatrice Schiff died at the age of 98, she was laid to rest in peace — but her bill for prescription drugs lived on for nearly five months, CBS News chief investigative correspondent Armen Keteyian reports. An Omnicare subsidiary charged Medicaid for her drugs.” For more: http://www.cbsnews.com/stories/2006/12/05/
cbsnews_investigates/main2232021.shtml
***top***
Wheelchair Reimbursement Amounts Reduced
On December 5, the Orlando Sentinel reporter Harry Wessel wrote that “In an effort to reduce what it calls "numerous instances of fraud and abuse," the federal government recently reduced the amounts it reimburses companies and Medicare recipients for power wheelchairs.” For more: http://www.orlandosentinel.com/business/orl-wheelchair0506dec05,0,5664903.story?coll=orl-business-headlines
***top***
UMDNJ Responds to Whistleblower Suit
On December 2, the Asbury Park Press reported that “The University of Medicine and Dentistry of New Jersey said it did not retaliate against a whistle-blower who sued the school recently.“The lawsuit filed Thursday by Kathryn Gibbons says senior officials at the university concealed that the school overbilled the federal government by tens of millions of dollars and then retaliated against her because she wouldn't help in the cover-up.” For more: http://www.app.com/apps/pbcs.dll/
article?AID=/20061202/NEWS03/612020358/1007
***top***
UnitedHealth CEO Steps Down
Minnesota Public Radio reported on December 8 that “Amid investigations by federal prosecutors and securities regulators, William McGuire officially stepped down last week as UnitedHealth Group's CEO. His departure is part of a company effort to address a scandal involving hundreds of millions of dollars in stock options granted to McGuire and other executives.”“Unitedhealth has announced a broad range of measures designed to correct problems related to stock options. But the company is still under pressure from powerful and vocal critics who aren't satisfied; critics like Pat Macht of CalPERS, the California Public Employees' Retirement System. The country's largest pension fund is suing UnitedHealth.” For more:
http://minnesota.publicradio.org/display/web/
2006/11/30/unitedone/
***top***
Regulatory
NewsCMS Updates Special Open Door Forum:
Post-Acute Care -- Development of a Patient Assessment Instrument
Thursday, December 21, 2006
2:00 PM - 3:30 PM EST
Call in info: Dial: 1-800-837-1935 & Reference Conference ID: 2921982 (Persons participating by phone do not need to RSVP.)
Note:
TTY Communications Relay Services are available for the Hearing Impaired.
For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html .
A Relay Communications Assistant will help.Details: The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum to discuss the development of a post-acute care patient assessment instrument to be used in the payment reform demonstration mandated under Section 5008 of the Deficit Reduction Act (DRA) of 2005.More information on the CMS plan to implement the DRA demonstration is available at: http://www.cms.hhs.gov/SNFPPS/
11_post_acute_care_reform_plan.asp
***top***
CMS Issues Final Rule:
Notification of Hospital Discharge Appeal Rights
On November 27, 2006, the Centers for Medicare & Medicaid Services (CMS) issued a final rule, Notification of Hospital Discharge Appeal Rights, CMS-4105-F. This final rule responds to comments on the April 5, 2006 proposed rule and sets forth requirements for how hospitals must notify Medicare beneficiaries who are hospital inpatients about their hospital discharge appeal rights. Notice is required both for original Medicare beneficiaries and for beneficiaries enrolled in Medicare health plans. CMS-4105-F can be viewed on the Federal Register Online via GPO Access http://www.gpoaccess.gov/fr/index.html.
Questions may be directed to Eileen Zerhusen at Eileen.zerhusen@cms.hhs.gov
***top***
Diabetes Tip Sheet
CMS is providing a newly developed tip sheet that reviews some of the Medicare covered services related to diabetes, including some newly covered services.
CMS asks that you take a few minutes to review this tip sheet and send it on to your network including people at the community level who may be interested. We want to make sure that this information reaches people with diabetes as well as people who provide care or services to people with diabetes.
http://www.hcca-info.org/Content/NavigationMenu/
ComplianceResources/ComplianceNews/11274-PdiabetesUpdates_11-22-06.pdf
***top***
Clarifications to Outpatient Therapy Cap Exceptions
For information regarding Outpatient Therapy Cap Exceptions Clarifications, please see the MLN Matters provider education article located at the following url: http://www.cms.hhs.gov/MLNMattersArticles/
downloads/MM5271.pdfThis article also serves as a reminder that therapy caps continue to apply but the exception process ends after December 31, 2006. We will provide any updates to the status of the exceptions process by issuing a new MLN Matters article.
***top***
New from Medicare Learning Network:
The Second Edition – October 2006 of the “Reference Guide for Medicare Physician & Supplier Billers -- Helping Front Office Personnel Navigate Medicare Rules for Part B Claims Processing,” is now available in downloadable format. This guide contains a variety of information to help providers submit accurate and timely Medicare claims. While providing historical information on Medicare Part A, Medicare Advantage, and Medicare Part D drug and coverage benefits, this guide is focused on providing information and procedures for physicians and suppliers that provide Part B services. Topics include how to enroll as a Medicare provider; claims submission; medical review; appeals; troubleshooting denials and claim rejections; and much more! You can access this downloadable publication at http://www.cms.hhs.gov/MLNProducts/MPUB/
itemdetail.asp?filterType=none&filterByDID
=0&sortByDID=4&sortOrder=ascending&itemID
=CMS061385&intNumPerPage=10
***top***
In the Federal Register
December 8, 2006 – Final Rules
-Medicare and Medicaid Programs; Hospital Conditions of
Participation: Patients' Rights
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/
edocket.access.gpo.gov/2006/06-9559.htm-Physician fee schedule (CY 2007) Payment policies and relative value units-Correction
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/
edocket.access.gpo.gov/2006/06-9550.htmNotice – December 8
Revisions to OIG's Privacy Act System of
Records--Criminal Investigative Files
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/
edocket.access.gpo.gov/2006/E6-20848.htmDecember 1 - Final Rule
Physician fee schedule (CY 2007); payment policies and relative value units
http://www.access.gpo.gov/su_docs/fedreg/a061201c.html
***top***
From the GAO
End-Stage Renal Disease: Bundling Medicare's Payment for Drugs with Payment for All ESRD Services Would Promote Efficiency and Clinical Flexibility. GAO-07-77, November 13.
http://www.gao.gov/cgi-bin/getrpt?GAO-07-77
Highlights - http://www.gao.gov/highlights/d0777high.pdfTestimonies
End-Stage Renal Disease: Medicare Payments for All ESRD Services, Including Injectable Drugs, Should Be Bundled, by David M. Walker, comptroller general of the United States, before the House Committee on Ways and Means. GAO-07-266T, December 6.
http://www.gao.gov/cgi-bin/getrpt?GAO-07-266T
***top***
From the OIG
Audit Reports
Review of Corrective Actions Concerning the Human Subject Research Program
http://oig.hhs.gov/oas/reports/region6/60600042.htmReview of Royalty Payments for Intramural Inventions Received by the National Institutes of Health in Fiscal Year 2004
http://oig.hhs.gov/oas/reports/region3/30403000.htmReview of Medicaid Outpatient Drug Expenditures in Nebraska for the Period October 1, 1997, Through September 30, 2004
http://oig.hhs.gov/oas/reports/region7/70504056.htm
***top***
This Week’s Link:
OIG Semiannual Report to Congress
http://www.hcca-info.org/Content/NavigationMenu/ ComplianceResources/ComplianceNews/Semiannual06.pdf
***top***
Acronym Library
| ABS | Annual Beneficiary Summary |
| AC | Actual Charge |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
***top***
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 NPIIf 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: * March Issue – January 2, 2007
* April Issue – February 1, 2007
* May Issue – March 1, 2007
* June Issue – April 2, 2007
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.
***top***
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
To subscribe to TWCC click here