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Vol. IX, No. 7 – February 16, 2007 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Table of Contents
Headlines
Johnson and Johnson Voluntarily Discloses
Missing Hard Drive Could Result in Fraud
Federal Prosecutors Admit to Backlog of Health Care Fraud Cases
Four Charged with Operating Bogus Clinic
18 Indicted on Medicare Fraud Charges
Task Force Reports Health Care Fraud Recoveries
Operation Equity Excise nets $10.5 Million
Regulatory News
Medicare to Provide Beneficiaries with Physician Performance Information
From the GAO
CMS Update
This Week’s Links
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
Johnson and Johnson Voluntarily Discloses
On February 13, 2007 The Wall Street Journal reported that “Johnson and Johnson said it alerted federal officials to improper overseas payments and that one of its senior executives is resigning over the probe.
“The New Brunswick, N.J., health-care conglomerate voluntarily told the Department of Justice and the Securities and Exchange Commission that it believes its subsidiaries made improper payments in two countries regarding the sale of medical devices. Michael J. Dormer, world-wide chairman for Medical Devices & Diagnostics, stepped down as a result of the revelations. Mr. Dormer had been in charge of several medical-device divisions,
including Ethicon, Ethicon Endo-Surgery and DePuy.
“The company didn't name the countries involved. A J&J spokesman declined to comment beyond the press release, which said that Mr. Dormer told the company in a letter that he has "ultimate responsibility by virtue of my position" for the subsidiaries involved in the disclosure. The J&J spokesman said Mr. Dormer was not available. An SEC spokesman declined to comment.”
For Johnson and Johnson voluntary disclosure statement: http://www.jnj.com/news/jnj_news/20070212_192452.htm
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Missing Hard Drive Could Result in Fraud
According to a February 12, 2007 report on the GovExec.com Web site “The hard drive that went missing from a Birmingham, Ala., Veterans Affairs Department facility last month contained highly sensitive information on nearly all U.S. physicians and medical data for about 535,000 VA patients, agency officials announced over the weekend.
“The data for the 1.3 million physicians who have billed Medicaid and Medicare, both living and deceased, could result in widespread fraud, such as the creation of fake Medicare and Medicaid invoices. “ For more: http://www.govexec.com/dailyfed/0207/021207p1.htm
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Federal Prosecutors Admit to Backlog of Health Care Fraud Cases
According to a report published in the February 10, 2007 Star-Telegram “Federal prosecutors admitted having a backlog of more than 150 cases in which pharmaceutical companies are accused of defrauding federal and state healthcare programs, a Justice Department lawyer acknowledged to a congressional panel Friday.” For more: http://www.dfw.com/mld/dfw/news/16670092.htm
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Four Charged with Operating Bogus Clinic
On February 14, 2007, three people were arrested for their roles in a health care fraud scheme which involved transporting Medicare beneficiaries from across Southern California to a fraudulent clinic for unnecessary treatments and services. A fourth defendant, who was posing as a doctor at the clinic, is being sought by the FBI, announced J. Stephen Tidwell, Assistant Director in Charge of the FBI in Los Angeles and Gerald T. Roy, Special Agent in Charge for Health and Human Services; Office of the Inspector General. For more: http://www.usdoj.gov/usao/cac/pr2007/022.html
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18 Indicted on Medicare Fraud Charges
The U.S. Attorney’s Office for the Central District of California announced that two indictments returned on February 14, 2007 by a federal grand jury in Santa Ana charge a total of 18 defendants, half of whom are medical doctors, with fraudulently billing Medicare for more than $12 million worth of treatments that were not needed or were never performed.
The two indictments outline a scheme in which the doctors, "cappers" and administrators at board-and-care facilities worked together to provide respiratory treatments on elderly, infirm and mentally ill people that were unnecessary, not performed in accordance with Medicare's rules, or not performed at all. To facilitate the scheme, the doctors allegedly paid illegal kickbacks to cappers and board-and-care owners and administrators to make the elderly, infirm and mentally ill patients available for respiratory therapy.
http://www.usdoj.gov/usao/cac/pr2007/020.html
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Task Force Reports Health Care Fraud Recoveries
On February 15, 2007, Business First of Buffalo reported that “A task force made up of government agencies and area health insurers teamed to recover more than $7 million in fraudulent claims last year.
“The health care fraud task force, originally coordinated by the FBI in 1998, is comprised of agents from the FBI, IRS, and other government agencies along with representatives from three local health insurers.” For more: http://www.bizjournals.com/ buffalo/stories/2007/02/12/daily36.html
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Operation Equity Excise nets $10.5 Million
On February 9, 2007, U.S. Attorney for the Southern District of Florida R. Alexander Acosta announced the results of Operation Equity Excise. Thus far, Operation Equity Excise has recovered approximately $10.5 million dollars in fraudulently obtained Medicare funds. Today, through the filing of civil False Claims Act complaints against twenty-three (23) clinics and durable medical equipment (DME) companies, the U.S. Attorney’s Office seeks an additional $30 million.
Fighting Medicare fraud is an ongoing priority of the United States Attorney’s Office for the South District of Florida. As part of this anti-fraud effort, the U.S. Attorney’s Office, the Department of Health and Human Services, and the FBI launched “Operation Equity Excise.” For more: http://www.usdoj.gov/usao/fls/PressReleases/070209-01.html
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This week, MediRegs provided TWCC readers with the following Regulatory information: CMS Transmittals.
Regulatory News
Medicare to Provide Beneficiaries with Physician Performance Information
On February 15, the Centers for Medicare & Medicaid Services (CMS) announced that the Delmarva Foundation for Medical Care (Delmarva), one of its quality improvement organizations, has entered into subcontracts with four regional collaboratives, as part of the Better Quality Information to Improve Care for Medicare Beneficiaries (BQI) Project.
These regional collabortives will combine Medicare data with data from other insurers to produce information on the performance of health care providers for the benefit of Medicare beneficiaries.
The following regional collaboratives have signed subcontracts: Indiana Health Information Exchange (IHIE), Massachusetts Health Quality Partners (MHQP), Minnesota Community Measurement (MNCM), and Wisconsin Collaborative for Healthcare Quality (WCHQ). For more: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter= 2082&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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From the GAO
Health Care Spending: Public Payers Face Burden of Entitlement Program Growth, While All Payers Face Rising Prices and Increasing Use of Services GAO-07-497T, February 15, 2007
Abstract PDF Accessible Text
Prescription Drugs: Oversight of Drug Pricing in Federal Programs GAO-07-481T, February 9, 2007
Abstract Highlights-PDF PDF Accessible Text
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CMS Update
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the 2007 Physician Quality Reporting Initiative (PQRI) webpage is now available.
On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the 2007 Physician Quality Reporting Initiative.
PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.
This newly established webpage will be updated regularly, so check it often for timely and reliable information from CMS.
For more information on 2007 PQRI, visit http://www.cms.hhs.gov/pqri/
on the CMS website.
Upcoming CMS Open Door Forums
-The next Ambulance Open Door Forum is Wednesday, February 21, 2007.
http://www.cms.hhs.gov/OpenDoorForums/ 10_ODF_Ambulance.asp#TopOfPage
- The next Rural Health Open Door Forum (ODF) is Wednesday, February 28, 2007
http://www.cms.hhs.gov/OpenDoorForums/ 24_ODF_RuralHealth.asp#TopOfPage
- The next Physicians, Nurses, and Allied Health Professionals Open Door Forum is Tuesday, March 6, 2007
http://www.cms.hhs.gov/OpenDoorForums/ 23_ODF_PNAHP.asp#TopOfPage
-The next Hospital Open Door Forum is scheduled for Thursday, March 8, 2007. For more:
http://www.cms.hhs.gov/OpenDoorForums/ 18_ODF_Hospitals.asp
-The next Home Health, Hospice, and DME Open Door Forum is scheduled for Wednesday, March 14, 2007
http://www.cms.hhs.gov/OpenDoorForums/ 17_ODF_HHHDME.asp#TopOfPage
The Understanding the Medicare Learning Network (MLN) Fact Sheet is now available in downloadable and print format from the Medicare Learning Network (MLN). This Fact Sheet explains the MLN web pages within the CMS website. It provides an overview of the MLN and where to access the information and education resources which are available through the MLN. To view, download, or print, select the title of the fact sheet from www.cms.hhs.gov/MLNProducts/MPUB/list.asp on the MLN Publications web page.
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CMS Transmittals
Medicare Claims Processing (PUB. 100-04)
Transmittal #1184, Date: February 9, 2007 Consolidation of Data Processing for Part A (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_ 100_04&u=mrepm10004r1184cp&h=top1.html&t=80&s=twcc
Transmittal #1183, Date: February 9, 2007 Infrared Therapy Devices **Rescinds Transmittal #1183, dated December 15, 2007**(PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1183cp&h=top1.html&t=80&s=twcc
Transmittal #1182, Date: February 9, 2007 April Quarterly Update to 2007 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1182cp&h=top1.html&t=80&s=twcc
Transmittal #1180, Date: February 2, 2007 Outpatient Clinical Laboratory Tests Furnished by Hospitals With Fewer Than 50 Beds in Qualified Rural Areas (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1180cp&h=top1.html&t=80&s=twcc
Transmittal #1179, Date: February 2, 2007 From Other Types of Adjustments and Claims for Crossover Purposes and Revising the Detailed Error Report Special Provider Notification Letters (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1179cp&h=top1.html&t=80&s=twcc
Transmittal #1177, Date: February 2, 2007 DME - Changes in Maintenance and Servicing Due to Deficit Reduction Act Legislation for Capped Rentals and Oxygen Equipment (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1177cp&h=top1.html&t=80&s=twcc
Transmittal #1175, Date: February 2, 2007 Part C and D Plan Type Display on the Common Working File (CWF) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1175cp&h=top1.html&t=80&s=twcc
Transmittal #1173, Date: February 2, 2007 Timeliness Standards for Processing Other-Than-Clean Claims (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1173cp&h=top1.html&t=80&s=twcc
Transmittal #1172, Date: February 2, 2007 Payment of Same Day Transfer Claims Under the Long Term Care Hospital Prospective Payment System (LTCH PPS) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1172cp&h=top1.html&t=80&s=twcc
Transmittal #1171, Date: February 2, 2007 Revisions to the Medicare Physician Fee Schedule (MPFS) Disclosure Format (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1171cp&h=top1.html&t=80&s=twcc
Transmittal #1170, Date: February 2, 2007 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for Oncology Treatment Payment Adjustment (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1170cp&h=top1.html&t=80&s=twcc
Transmittal #1169, Date: February 2, 2007 Editing to Ensure Demand Bills Remain Identifiable in Claims History After Processing (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_ 04&u=mrepm10004r1169cp&h=top1.html&t=80&s=twcc
Financial Management (PUB. 100-06)
Transmittal #116, Date: January 31, 2007 Chapter 7, Internal Control Requirements Update **Rescinds Transmittal #112, dated December 29, 2006**(PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_ 6&u=mrpm10006r116fm&h=top1.html&t=80&s=twcc
National Coverage Analyses
Vagus Nerve Stimulation for Treatment of Resistant Depression (TRD) (CAG-00313R) - Expected Completion Date: 05/06/07:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u= CAG00313R2&h=top1.html&t=80&s=twcc
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From the OIG
Testimony of Lewis Morris, Chief Counsel to the Inspector General, before the U.S. House Oversight and Government Reform Committee, on Allegations of Waste, Fraud and Abuse in Pharmaceutical Pricing: Financial Impacts on Federal Health Programs
http://oig.hhs.gov/testimony/docs/2007/020907tmy.pdf
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This Week’s Link:
Questions Boards Should be Asking
http://www.deloitte.com/dtt/article/ 0,1002,sid%253D5601%2526cid%253D91205,00.html
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Acronym Library
| CCN | Correspondence Control Number |
| CCO | Claims Collection Officer |
| CCP | Comprehensive Care Provider |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
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