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Vol. IX, No. 9 – March 2, 2007 | Contact: Margaret Dragon, Editor, (781) 593-4924
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Table of Contents
Headlines
CEO & Three Local Nursing Homes Sentenced on Conspiracy Charges Involving Failure of Care
Six arrested on Medicaid Fraud Charges
Fed Probe to Cost Medical Center Millions
Therapist Pleads Not Guilty
Two Nurses Arrested for Medicaid Fraud
State Prepares to Battle Medicaid Fraud
Florida Assisted Living Owner Pays $640,000 for Medicaid Fraud
Regulatory News
In the Federal Register
CMS Transmittals
From the OIG
This Week’s Links
Acronym Library
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
CEO & Three Local Nursing Homes Sentenced on Conspiracy Charges Involving Failure of Care
On February 28, U.S. Attorney for the Eastern District of Missouri Catherine L. Hanaway announced that American Healthcare Management Inc., its Chief Executive Officer and three nursing homes were sentenced on charges of conspiracy to defraud the Medicare and Medicaid Programs by providing inadequate staff at the nursing homes and thereby failing to provide proper care to elderly and disabled residents. For more:
http://www.usdoj.gov/usao/moe/press%20releases/ archived%20press%20releases/2007_press_releases/ february/american_healthcare.html
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Six arrested on Medicaid Fraud Charges
On February 27, Florida Attorney General Bill McCollum announced the arrest of six Manatee County women on charges of Medicaid fraud and organized fraud. The women, all employees of Acute Care Team, Inc., allegedly defrauded the state Medicaid program out of more than $2.6 million in counterfeit billing claims. The case was investigated by authorities with the Attorney General's Medicaid Fraud Control Unit. For more:
http://myfloridalegal.com/newsrel.nsf/newsreleases/ F285C962082264978525728B006020FA
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Fed Probe to Cost Medical Center Millions
On February 27, The Journal News reported that “Westchester Medical Center will likely spend millions in legal fees and other costs to comply with a federal investigation into possible health-care fraud at the hospital.
"This is a huge undertaking," Michael Israel, the president of the medical center, told a committee of the county Board of Legislators yesterday. "In fact, there will be a dedicated staff working on this, handling this."
Israel said the hospital had already retained an outside law firm to help it comply with a federal subpoena it received Jan. 31. For more:
http://www.nynews.com/apps/pbcs.dll/article?AID=/20070227/ NEWS02/702270337/1017
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Therapist Pleads Not Guilty
On February 28, KETV posted a report on its Web site that “An Omaha mental health therapist will face trial on charges of theft by deception.
“Christine Palermo has pleaded not guilty to Medicaid fraud.
“A Medicaid fraud auditor with the Nebraska Attorney General's Office took the stand on Wednesday and told the court how Palermo billed the state $4,000 for therapy services she did not render. The auditor said Palermo was billing the state for a client that she was no longer seeing.” For more: http://www.ketv.com/news/11137876/detail.html
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Two Nurses Arrested for Medicaid Fraud
On February 23, The Times-Dispatch reported that “Federal authorities yesterday arrested Yves Rommel Etienne and Lalita D. Etienne of Richmond on charges of cheating Medicaid out of about $1 million through a health-care business.
The two were indicted Feb. 20 by a U.S. District Court grand jury. Both are charged with conspiracy to defraud Medicaid. Yves Etienne, 35, also is charged with stealing personal-identity information from two registered nurses. For more:
http://www.timesdispatch.com/servlet/Satellite?pagename= RTD%2FMGArticle%2FRTD_BasicArticle&c=MGArticle&cid= 1149193366760&path=!news&s=1045855934842
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State Prepares to Battle Medicaid Fraud
On February 13, The Journal News reported that “Rockland County Executive C. Scott Vanderhoef announced that the county had selected four firms to help analyze Medicaid fraud data and take fraudulent providers to court.
“The county is one of 13 in the state, including New York City, that used IBM's VERIFY NY software program to find potential Medicaid overpayments to medical providers and pharmacies.
“Hiring the firms to go after Rockland's fraudulent providers is the next step in recovering taxpayers' money, Vanderhoef said today, noting that the county also could get back millions through state investigations.” For more:
http://www.nynews.com/apps/pbcs.dll/article?AID=/ 20070213/UPDATE/702130406
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Florida Assisted Living Owner Pays $640,000 for Medicaid Fraud
On February 23, Florida Attorney General Bill McCollum announced that a Daytona woman was found liable for fraudulently billing Medicaid more than $210,000. A civil lawsuit filed by the Attorney General's Medicaid Fraud Control Unit determined that Vidya Bhoolai must pay more than $640,000 for numerous violations of Florida's False Claims Act. Bhoolai, the owner and operator of two Volusia County assisted living facilities, repeatedly billed the Medicaid program for services she never provided. For more: http://myfloridalegal.com/newsrel.nsf/newsreleases/ F7A803E70D1FEB748525728B00600403
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This week, MediRegs provided TWCC readers with the following Regulatory information: In the Federal Register, CMS Transmittals, and From the OIG.
Regulatory News
CMS Update
Upcoming CMS Open Door Forums
- 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
-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
- The next Skilled Nursing Facilities / Long-Term Care Open Door Forum is Wednesday, March 28, 2007.
http://www.cms.hhs.gov/OpenDoorForums/ 25_ODF_SNFLTC.asp
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In the Federal Register
CMS Grants COLA Deeming Authority
A notice published in the February 23, 2007 Federal Register by CMS announcing it granted COLA (formerly the Commission on Office Laboratory Accreditation) deeming authority as an accrediting organization for clinical laboratories under the Clinical Laboratory Improvement Amendments of 1988 program. CMS determined that the requirements of the COLA accreditation process are equal to or more stringent than the CLIA condition level requirements and that COLA has met the requirements of 42 CFR Part 493. Consequently, laboratories that are voluntarily accredited by COLA and continue to meet COLA requirements will be deemed to meet the CLIA condition-level requirements for laboratories and therefore are not subject to routine inspection by State survey agencies to determine their compliance with Federal requirements. They are, however, subject to Federal validation and complaint investigation surveys conducted by CMS or its designee.
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69 _cms&u=0702237&h=top1.html&t=80&s=twcc
Supplemental Election Period for Provider Participation in Competitive Acquisition Plan for Part B Drugs Announced
Also published in the February 23, 2007 Federal Register, CMS announced an additional physician election period for physicians who are not currently participating in the competitive acquisition program for Medicare Part B drugs for calendar year 2007. The additional physician election period begins on May 1, 2007 and ends on June 15, 2007. Physicians who elect to join the CAP during this additional election period will enter into a physician election agreement effective August 1, 2007 through December 31, 2007.
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_fr69 _cms&u=0702239&h=top1.html&t=80&s=twcc
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CMS Transmittals
Financial Management (PUB. 100-06)
Transmittal #117, Date: February 13, 2007 Chapter 7, Internal Control Requirements Update **Rescinds Transmittal #116, dated January 31, 2007** (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_ 6&u=mrpm10006r117fm&h=top1.html&t=80&s=twcc
National Coverage Analyses
Bariatric Surgery Facilities - 02/21/07:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u= bariatricsurglist2&h=top1.html&t=80&s=twcc
PET for Dementia Trials Facilities - 02/21/07:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_nca&u= dementialist2&h=top1.html&t=80&s=twcc
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From the OIG
Evaluation and Inspection Reports - Centers for Medicare and Medicaid Services
The Commissioned Corps’ Response to Hurricanes Katrina and Rita (OEI-09-06-00030; 02/2007) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oei _cms&u=oei090600030&h=top1.html&t=80&s=twcc
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This Week’s Link:
CMS Intermediary-Carrier Directory
http://www.cms.hhs.gov/apps/contacts/incardir.asp
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Acronym Library
| CHAMPUS | Civilian Health & Medical Programs of the Uniformed Services (Now TRI-CARE) |
| CHAMPVA | Civilian Health & Medical Program of the Veterans Administration |
| CHAP | Child Health Assurance Program |
| CHAP | Community Health Accreditation Program |
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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