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Vol. VIII, No. 43 – December 18, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Audit & Compliance
South Atlantic Local
Table of Contents Headlines
DOJ Revises Charging Guidelines for Prosecuting Corporate Fraud
SEC Proposes Revisions to SOX
Vladeck Won’t Seek UMDNJ Job
Myrtle Beach Man Pleads Guilty to Health Care Fraud
Lab Settles, Pays Government $510,000
Medicaid Fraud Charged
Regulatory NewsCMS Updates
Guidance Issued for Employee Education About False Claims Recovery
CMS Updates
2006 Fees for Power Mobility Device Codes Have Been Further Refined
CMS issues Inpatient Psych Facility PPS Fact Sheet
CMS Issues Hospice Payment Fact Sheet
This Week’s Links
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
DOJ Revises Charging Guidelines for Prosecuting Corporate Fraud
On December 12, U.S. Deputy Attorney General Paul J. McNulty announced during a speech at a meeting of the Lawyers for Civil Justice in New York that the Department of Justice is revising its corporate charging guidelines for federal prosecutors throughout the country.
The new guidance revises the Thompson Memorandum, which was issued in January 2003 by then-Deputy Attorney General Larry D. Thompson and titled the “Principles of Federal Prosecution of Business Organizations.” The memo provides useful guidance to prosecutors in the field through nine factors to use when deciding whether to charge a corporation with criminal offenses. For more:
http://www.usdoj.gov/opa/pr/2006/December/06_odag_828.html
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SEC Proposes Revisions to SOX
The December 15 issue of the Boston Globe reported that “Proposed revisions to a landmark 2002 anti-fraud law will include relaxing some rules for small public companies in a bid to curb what they say have been excessive costs related to audits, the Securities and Exchange Commission's accounting chief said yesterday.” For more: http://www.boston.com/business/globe/articles/2006/12/12/ changes_to_sarbanes_oxley_to_ease_costs_for_small_firms/
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Vladeck Won’t Seek UMDNJ Job
Newsday reported on December 14, that “the interim president of the embattled University of Medicine and Dentistry of New Jersey said he won't seek the permanent job.
“Bruce C. Vladeck took the $525,000-a-year job last February to lead the scandal-plagued medical school while a federal monitor investigated alleged Medicare and Medicaid fraud involving millions of dollars.” For more: http://www.newsday.com/news/local/wire/newjersey/ny-bc-nj--umdnjpresident1214dec14,0,6596318.story?coll=ny-region-apnewjersey
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Myrtle Beach Man Pleads Guilty to Health Care Fraud
On December 13, The Sun News reported that a “Myrtle Beach man pleaded guilty in federal court in Columbia Tuesday to one count of conspiracy to commit health care fraud.
The plea followed an investigation by the U.S. Department of Health and Human Services and the Columbia office of the U.S. District Attorney, according to the office U.S. district attorney Reginald I. Lloyd. For more: http://www.myrtlebeachonline.com/mld/myrtlebeachonline/ news/local/16230550.htm
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Lab Settles, Pays Government $510,000
KTVZ.com Eugene, Oregon reported on December 12 that “Oregon Imaging Center, a Eugene, radiology laboratory, has paid the United States $510,000 to settle claims that the laboratory improperly performed radiology tests not ordered by treating physicians and billed the federal Medicare and Medicaid programs for the tests, federal officials said Tuesday.” For more: http://www.ktvz.com/story.cfm?nav=oregon&storyID=17650
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Medicaid Fraud Charged
KRQE News reported on December 15, that “Two Bernalillo County residents have been indicted on charges of Medicaid fraud and conspiracy.
“Abrian Ortiz and Tami Menzel are accused of two counts of Medicaid fraud over $20,000 and a count of conspiracy.” For more: http://www.krqe.com/expanded.asp?RECORD_KEY%5B News%5D=ID&ID%5BNews%5D=18721
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This week, MediRegs provided TWCC readers with the following Regulatory information: CMS Transmittals, In the Federal Register, and From the GAO.
Regulatory News
Guidance Issued for Employee Education About False Claims Recovery
On December 14, the Centers for Medicare & Medicaid Services (CMS) released
guidance to State Medicaid agencies on the implementation of Section 6032 of the Deficit Reduction Act of 2005 (P.L. 109-171). Section 6032 of the
Deficit Reduction Act establishes section 1902(a)(68) of the Social Security
Act, which requires any entity (those that receive or make annual Medicaid
payments under the state plan of at least $5 million) to provide Federal
False Claims Act education to their employees. This provision must be
implemented no later than January 1, 2007, except as provided for in
section 6034(e) of the Deficit Reduction Act. To the extent a State determines
that it requires legislation to implement this provision and wishes to avail
itself of the section 6043(e) delayed effective date, it must request
through CMS that the Secretary concur with the determination that
legislation is required.
For more:
The State Medicaid Director letter
http://www.hcca-info.org/Content/NavigationMenu/ ComplianceResources/ComplianceNews/SMDL06-025.pdf
State Plan Preprint
http://www.hcca-info.org/Content/NavigationMenu/ ComplianceResources/ComplianceNews/SMD121306att1.pdf
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CMS Updates
2006 Fees for Power Mobility Device Codes Have Been Further Refined
The Centers for Medicare & Medicaid Services (CMS) made additional refinements to the new power mobility device (PMD) fee schedule issued on October 2, 2006 and first refined on November 11, 2006. Product data has been verified and technical errors made in the calculation of base fee schedule amounts have been corrected.
The revised fee schedule amounts are to be effective for claims with dates of service on or after November 15, 2006. Suppliers may resubmit previously paid claims for adjustment.
For additional information regarding the fee schedule refinements, go to:
http://www.cms.hhs.gov/DMEPOSFeeSched/ 01a_Power_Mobility_Devices.asp
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CMS issues Inpatient Psych Facility PPS Fact Sheet
The Inpatient Psychiatric Facility Prospective Payment System Fact Sheet, which provides general information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS), how payment rates are set, and the Rate Year 2007 update to the IPF PPS, is now available in downloadable format from the Centers for Medicare & Medicaid Services MLN Publications Page located at www.cms.hhs.gov/MLNProducts/downloads/ InpatientPsychFac.pdf. Print versions of the fact sheet will be available in summer 2007.
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CMS Issues Hospice Payment Fact Sheet
The Hospice Payment System Fact Sheet, which provides general information about the Medicare hospice benefit, certification requirements, election periods, and payment rates, is now available in print format from the Medicare Learning Network. To place your order, visit www.cms.hhs.gov/mlngeninfo, scroll down to “Related Links Inside CMS,” and select “MLN Product Ordering Page.”
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 .
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In the Federal Register
CMS Changes Conditions of Participation on Patients' Rights
On December 8, 2006, CMS issued a final rule changing the Patients' Rights Condition of Participation which is applicable to all Medicare and Medicaid participating hospitals and contains standards that ensure minimum protections of each patient's physical and emotional health and safety. The rule, among other things, revises the standards regarding restraint and seclusion and sets forth standards regarding staff training and death reporting
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_fr69_cms&u=0612087&h=top1.html&t=80&s=twcc
PACE Program Interim Rule Finalized
Also on December 8, 2006, CMS finalized an interim final rule published on November 24, 1999 (64 FR 66234) and the interim final rule published on October 1, 2002 (67 FR 61496).
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_fr69_cms&u=0612088&h=top1.html&t=80&s=twcc
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From the GAO
VA Health Care: Spending for Mental Health Strategic Plan Initiatives Was Substantially Less Than Planned GAO-07-66, November 21, 2006:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mre_gao_cms&u=d0766&h=top1.html&t=80&s=twcc
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CMS Transmittals
Medicare Claims Processing (PUB. 100-04)
Transmittal #1013, Update of HCPCS Codes and Payments for Ambulatory Surgical Centers and File Names, Descriptions and Instructions for Retrieving the 2007 ASC HCPCS Additions, Deletions and Master Listing:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u= mrepm10004r1013cp&h=top1.html&t=80&s=twcc
Program Integrity (PUB. 100-08)
Transmittal #177, Update the VMS System to Validate National Provider Identifiers in Place of Unique Physician Identification Numbers:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=mr_pm_100_08&u= mrpm10008r177pi&h=top1.html&t=80&s=twcc
DMERC - Region C - Palmetto DMEPOS Supplier Manual
Winter Supplier Manual:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_d_palm_sm&u= winter2006&h=top1.html&t=80&s=twcc
Revised Pages:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_d_palm_sm&u= winter2006revised&h=top1.html&t=80&s=twcc
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From the OIG
Audit Reports
Review of Comprehensive Outpatient Rehabilitation Facility Therapy Services Provided by Absolute Therapy, Inc.
http://oig.hhs.gov/oas/reports/region4/40402010.htm
Other OIG News
OIG: Solicitation of New Safe Harbors and Special Fraud Alerts
http://oig.hhs.gov/w-new.html
Updated Corporate Integrity Agreements (CIAs), Certification of Compliance Agreements (CCAs) and Settlement Agreements with Integrity Provisions
http://oig.hhs.gov/fraud/cia/index.html
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This Week’s Link:
SEC Press Release on SOX
http://www.sec.gov/news/press.shtml
http://www.sec.gov/news/press/2006/2006-210.htm
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Acronym Library
| ABS | Annual Beneficiary Summary |
| AC | Actual Charge |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
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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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