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Vol. IX, No. 5 – February 2, 2007 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Table of Contents

Headlines

Doctor Settles False Claims Charges

Former Medical Billing Employee Admits Stealing Patients’ Credit Information

Medical Biller Sentenced

Defendant in Medical Lab Fraud Scheme Pleads Guilty

Doctor and Equipment Company Owner Indicted in Medicare Fraud Scheme

Missouri Hospital Worker Pleads Guilty

RightCHOICE Managed Care Settles False Claims Allegations

NJ Podiatrist Charged with Health Care Fraud

Regulatory News

CMS Proposes Expanded Coverage of Angioplasty of the Carotid Artery Concurrent with Stenting

CMS Transmittals
From the OIG

This Week’s Links
Acronym Library

Visit HCCA's Web site
HCCA Headquarters - Contact Information

Headlines:

Doctor Settles False Claims Charges
On January 30, 2007, U.S. Attorney for the Eastern District of Pennsylvania Patrick L. Meehan announced that Dr. Irina Benaur has agreed to pay $210,000 to resolve civil claims under the Federal False Claims Act and other federal statutes and common law principles.

The United States contends that during 2000-2002, Dr. Benaur, a psychiatrist, billed Medicare for claimed psychotherapy provided by an unlicensed person. Additionally, Dr. Benaur maintained false medical records for the patients. For more: http://www.usdoj.gov/usao/pae/News/Pr/2007/jan/benaur.html

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Former Medical Billing Employee Admits Stealing Patients’ Credit Information
Lavon Lafaye Hennings, 47, of Seattle, Washington was sentenced January 26, 2007 in U.S. District Court in Seattle to four months in prison and four months of home detention, three years of supervised release, and $18,098 in restitution for Conspiracy to Commit Access Device Fraud and Wire Fraud. Hennings admitted that she stole credit card information from her employer, a medical billing firm. The credit card information was for patients who had recently seen doctors at a hospital emergency room. At sentencing U.S. District Judge Ricardo S. Martinez said Hennings victimized people who were already in physical pain, increasing their mental anguish and creating problems with their credit that took weeks to untangle. For more: http://www.usdoj.gov/usao/waw/press/2007/jan_2007.html

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Medical Biller Sentenced
U.S. Attorney for the Southern District of Florida R. Alexander Acosta announced February 1, 2007 that defendant Diana Sotto, an owner of All Medical Billing Solutions, Inc. (All Medical Billing), a medical billing company, was sentenced on January 31, 2007 by United States District Court Judge Cecilia M. Altonaga to 121 months’ imprisonment (10 yrs.), followed by 3 years of supervised release. Judge Altonaga also set a hearing to determine the amount of restitution to be ordered in the case. For more: http://www.usdoj.gov/usao/fls/PressReleases/070201-01.html

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Defendant in Medical Lab Fraud Scheme Pleads Guilty
On January 31, 2007, U.S. Attorney for the Southern District of Florida R. Alexander Acosta announced that defendant, Marcelo De Jesus Serrano, pleaded guilty before United States District Judge Marcia G. Cooke in Miami, Florida to one count of conspiracy to commit health care fraud.

At the plea, Serrano admitted to conspiring with others to submit fraudulent claims to Medicare for various services from 2003 to 2005. These services were allegedly performed by two local laboratories and resulted in the payment of approximately $2.5 million in false claims. Serrano controlled the two laboratories, Biocyte Laboratories, Inc and Washington Medical Laboratory, Inc., and used nominees to conceal his control of the labs. 
For more: http://www.usdoj.gov/usao/fls/
PressReleases/070131-04.html

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Doctor and Equipment Company Owner Indicted in Medicare Fraud Scheme
On January 31, U.S. Attorney for the Southern District of Florida R. Alexander Acosta announced the Indictment of defendants Julian Torres, a Florida-licensed physician, Elsa Dominguez and Marcos Martinez, the owners of a durable medical equipment company, in a Medicare fraud scheme.

Julian Torres, Marcos Martinez, and Elsa Dominguez were arrested on January 30, 2007 after a Miami grand jury returned an Indictment against them earlier in the day. Torres and Dominguez were each released on a $100,000 bond. Martinez is scheduled to appear for a pre-trail detention hearing on February 9, 2007. For more: http://www.usdoj.gov/usao/fls/PressReleases/070131-03.html

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Missouri Hospital Worker Pleads Guilty
Tonya R. Long, St. Luke’s Hospital employee, pled guilty to embezzling more than $500,000 over a four- year period and filing a false tax return to conceal the receipt of the funds, U.S. Attorney for the Eastern District of Missouri Catherine L. Hanaway announced on January 31, 2007. For more: http://www.usdoj.gov/usao/moe/press%20
releases/archived%20press%20releases/2007_
press_releases/january/long_tonya.html

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RightCHOICE Managed Care Settles False Claims Allegations
RightCHOICE Managed Care, Inc. has agreed to pay the United States $975,000 to settle allegations that it violated the False Claims Act in connection with providing health care benefits to federal employees and their dependents in the state of Missouri, U.S. Attorney Catherine L. Hanaway and the Justice Department announced on January 31, 2007. The settlement resolves allegations that RightCHOICE overcharged the Federal Employees Health Benefits (FEHB) Program, which is administered by the U.S. Office of Personnel Management. For more:
http://www.usdoj.gov/usao/moe/press%20
releases/archived%20press%20releases/2007_
press_releases/january/rightchoice.html

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NJ Podiatrist Charged with Health Care Fraud
On January 29, 2007, U.S. Attorney for New Jersey Christopher J. Christie announced that a Mercer County podiatrist was arrested on a federal Indictment in connection with health care fraud schemes that cost more than $1 million in total losses. For more: http://www.usdoj.gov/usao/nj/press/2006releases.html

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This week, MediRegs provided TWCC readers with the following Regulatory information: CMS Transmittals and From the OIG.

Regulatory News

CMS Proposes Expanded Coverage of Angioplasty of the Carotid Artery Concurrent with Stenting
On February 1, 2007, the Centers for Medicare & Medicaid Services (CMS) announced that it is proposing to expand its coverage policy for carotid artery stenting (CAS).

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CMS Transmittals

Medicare Benefit Policy - Basic Coverage Rules (PUB. 100-02)
Transmittal #64, Date: January 19, 2007 2007 Guidelines for Payment of Diabetes Self-Management Training (DSMT (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_
100_02&u=mrepm10002r64bp&h=top1.html&t=80&s=twcc

Medicare Claims Processing (PUB. 100-04)
Transmittal #1161, Date: January 24, 2007 Additional Changes to the 2007 Medicare Physician Fee Schedule Database (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u
=mrepm10004r1161cp&h=top1.html&t=80&s=twcc
Transmittal #1160, Date: January 19, 2007 Colorectal Cancer Screening Flexible Sigmoidoscopy and Colonoscopy Coinsurance Payment Change (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=
mrepm10004r1160cp&h=top1.html&t=80&s=twcc
Transmittal #1158, Date: January 19, 2007 Guidelines for Payment of Diabetes Self-Management Training (DSMT) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=
mrepm10004r1158cp&h=top1.html&t=80&s=twcc
Transmittal #1157, Date: January 19, 2007 Processing All Diagnosis Codes Reported on Claims Submitted to Carriers (Final Phase) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=
mrepm10004r1157cp&h=top1.html&t=80&s=twcc

Program Integrity (PUB. 100-08)
Transmittal #183, Date: January 24, 2007 Update the MCS System to Validate National Provider Identifiers (NPIs) in Place of Unique Physician Identification Numbers (UPINs)**Rescinds Transmittal #183, dated November 3, 2006** (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_08&u=
mrpm10008r183pi&h=top1.html&t=80&s=twcc

CMS One-Time Special Notification (PUB. 100-20)Transmittal #261, Date: January 19, 2007 Institutional Value Code Changes (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_20&u=
mrepm10020r261otn&h=top1.html&t=80&s=twcc

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From the OIG

Audit Reports

Report on the Medicare Drug Discount Card Program Sponsor Computer Sciences Corporation PDF (A-06-06-00112; 12/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms
2005&u=60600112&h=top1.html&t=80&s=twcc

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This Week’s Link:

Suspected Medicaid Fraud Referrals
http://oig.hhs.gov/w-new.html

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Acronym Library

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

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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.

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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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