HCCA's 19th Annual Compliance Institute, Lake Buena Vista, FL, April 19-22, 2015
This Week in Corporate Compliance

Regional Conferences

2015 Regional Conference Prospectus Available


Atlanta Regional Conference
January 23, 2015
Atlanta, GA


Orlando Regional Conference
February 6, 2015
Orlando, FL


Portland Regional Conference
February 13, 2015
Portland, OR


Dallas Regional Conference
February 20, 2015
Dallas, TX


Anchorage Regional Conference
February 26-27, 2015
Anchorage, AK


View a Full List of 2015
Regional Conferences

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National Conferences

Managed Care Compliance Conference

Save $175 before Dec 23

February 15 – 18, 2015
Las Vegas, NV


Audit & Compliance Committee Conference

Buy one registration for $795 and get one for $495

February 23 – 24, 2015
Scottsdale, AZ


2015 Compliance Institute

Save $575 before January 7

April 19 – 22, 2015
Lake Buena Vista, FL


Research Compliance Conference
May 31 – June 3, 2015
Austin, TX

Research Academies

March Research Basic Compliance Academy
March 2 – 5, 2015
San Diego, CA


November Research Basic Compliance Academy
November 2 – 5, 2015
Orlando, FL

Privacy Academies

March Health Care Privacy Basic Compliance Academy
March 2 – 5, 2015
San Diego, CA


June Health Care Privacy Basic Compliance Academy
June 15 – 18, 2015
Las Vegas, NV


November Health Care Privacy Basic Compliance Academy
November 2 – 5, 2015
Orlando, FL

Compliance Academies

January Basic Compliance Academy

SOLD OUT!

January 19 – 21, 2015
New York, NY


January Basic Compliance Academy- Puerto Rico
January 26 – 29, 2015
San Juan, PR


February Basic Compliance Academy
February 9 – 12, 2015
San Francisco, CA


March Health Care Privacy Basic Compliance Academy
March 2 – 5, 2015
San Diego, CA


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HCCA HIPAA Training Guide

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HIPAA Rules & Compliance

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Research Compliance Professional’s Handbook, Second Edition

This new edition of the handbook offers comprehensive, up-to-date guidance to get you on the right track.
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The Health Care Compliance Professional’s Manual

The Health Care Compliance Professional's Manual Covers everything you need to plan and execute a customized compliance program that meets federal standards.

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NEW!

The Health Care Privacy Compliance Handbook, Second Edition

This book helps privacy professionals sort through the complex regulatory framework and significant privacy issues that health care organizations face.
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Compliance and Ethics: An Introduction for Health Care Professionals

Compliance and Ethics: An Introduction for Health Care Professionals

HCCA’s 23-minute video and trainer’s guide provides everything you need to conduct training for new employee orientations and staff refreshers.
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Web Conferences

What it means to be a "chief" compliance officer: Today's challenges, tomorrow's opportunities
January 6, 2015


A Suspected Breach -How to Investigate, Document, and Respond
January 7, 2015


Finding Time for HIPAA Amid Deafening Administrative Noise
January 14, 2015


Fraud and Abuse - Year in Review
January 22, 2015


Proper Management of Medicare/Medicaid Overpayments to Limit Risk of False Claims Act Violations
January 28, 2015


View our List of remaining 2015 Web Conferences Click Here


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This Week’s HCCA Corporate Members

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Arent Fox

Atlas is best known for creating the ILLiad interlibrary loan management system now exclusively distributed by OCLC and used by more than 1,100 libraries worldwide. Focused on bringing the benefits of automation to library processes that have not been addressed by other software services, Atlas has introduced Ares, an electronic reserves solution, and Aeon, an online request and workflow management system specifically designed for special collections libraries and archives.


Vol. XVI, No. 52
December 23, 2014

 

About HCCA | Certification | Shop Online | Events | Career Opportunities | Read on Website


This Week’s Headlines – December 23, 2014

Owner of three home health care agencies indicted on new charges in investigation of Medicaid fraud

A medical practice, doctor in New York settle false and fraudulent claims case

Texas physician sentenced for health care fraud violation

Former Rite Aid vice president and New Jersey businessman charged in $14.6 million fraud & kickback scheme

Alabama man sentenced for stolen identity refund fraud using names stolen from nursing homes

Alabama medical clerk sentenced to prison for stolen identity tax refund fraud scheme that involved corrupt U.S. Postal Service employee

Dallas-based physician and home health agency nursing director sentenced in $3 million Medicare fraud conspiracy

Owner of dietary supplement company pleads guilty to multimillion-dollar scheme to adulterate dietary supplements

This Week’s Links

Regulatory News

CMS Update

CMS Transmittals

From the OIG

Acronym Library

Season’s Greetings and Best Wishes for the New Year!

Please note your next issue of This Week in Corporate Compliance
will be published January 9, 2015.


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Headlines

Owner of three home health care agencies indicted on new charges in investigation of Medicaid fraud
On December 19, 2014, the Federal Bureau of Investigation announced, “Florence Bikundi, the owner of three home care agencies, has been charged in a superseding indictment with six additional offenses related to a scheme to secure more than $75 million in District of Columbia Medicaid payments, even though she was barred from participating in any federal health care programs. The new charges include allegations that Bikundi and others conspired to bill the Medicaid program for services that were not provided.” For more

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A medical practice, doctor in New York settle false and fraudulent claims case
On December 18, 2014, the U.S. Department of Health and Human Services Office of Inspector General announced, “Jennan Comprehensive Medical, P.C. (Jennan) - a medical group practice in New York - and its owner, Henry Chen, M.D., entered into a $694,887.02 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective December 18, 2014. The settlement resolves allegations that from May 15, 2008 to December 31, 2013, Jennan and Dr. Chen knowingly submitted or caused to be submitted false and/or fraudulent claims to Medicare for physical therapy services.” For more

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Texas physician sentenced for health care fraud violation
On December 18, 2014, U.S. Attorney John M. Bales announced, “A 75-year-old Beaumont, Texas doctor has been sentenced to federal prison for health care fraud violations in the Eastern District of Texas.

“John Q. A. Webb, Jr., now living in Houston, pleaded guilty on July 23, 2014 to conspiracy to commit health care fraud and was sentenced to 15 months in federal prison today by U.S. District Judge Ron Clark.” For more

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Former Rite Aid vice president and New Jersey businessman charged in $14.6 million fraud & kickback scheme
On December 18, 2014, the U.S. Attorney’s Office for the Middle District of Pennsylvania announced, “a former Rite Aid Corporation Vice President and a New Jersey businessman have been charged in connection with a $14.6 million dollar, surplus inventory sales/kickback scheme.

“According to U. S. Attorney Peter Smith, Jay Findling, age 54, of Manalapan, New Jersey, is charged in a Criminal Information filed today in the United States District Court in Harrisburg with Conspiracy to commit Wire Fraud. Former Rite Aid Vice President Timothy P. Foster, age 65, of Portland Oregon, is charged in the same Criminal Information with making False Statements to Authorities.” For more

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Alabama man sentenced for stolen identity refund fraud using names stolen from nursing homes
On December 18, 2014, Acting Deputy Assistant Attorney General Larry J. Wszalek for the Justice Department’s Tax Division and U.S. Attorney George L. Beck Jr. for the Middle District of Alabama announced, “A Pike Road, Alabama, man was sentenced to serve 51 months in prison today for committing stolen identity refund fraud (SIRF) crimes.

“Charlie Jackson pleaded guilty to wire fraud and aggravated identity theft on May 5, and was also ordered to serve three years of supervised release following his prison term and to pay $98,177 in restitution. According to court documents, from October 2010 up until April 2013, Jackson was involved in SIRF crimes—the use of stolen identities to steal money from the Internal Revenue Service (IRS)—by filing fraudulent tax returns claiming refunds in the victims’ names. He admitted to obtaining stolen identities from various sources, including from nursing homes. Altogether, the false tax returns filed by Jackson fraudulently claimed more than $170,000 in refunds. Many of the returns were detected as fraudulent by the IRS and were not issued, however, Jackson was successful in defrauding the IRS of more than $90,000 in illegitimate refunds.” For more

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Alabama medical clerk sentenced to prison for stolen identity tax refund fraud scheme that involved corrupt U.S. Postal Service employee
On December 18, 2014, Acting Deputy Assistant Attorney General Larry J. Wszalek for the Justice Department's Tax Division and U.S. Attorney George L. Beck Jr. for the Middle District of Alabama announced, “An Alabama woman was sentenced today to serve 70 months in prison for her involvement in a stolen identity tax refund fraud (SIRF) scheme.

“Sasha Webb was also ordered to serve three years of supervised release following her prison sentence and to pay $528,823 in restitution.

“According to court documents and court proceedings in this and related cases, Webb worked as a medical records clerk at an Alabama Department of Corrections facility in Elmore County, Alabama, where she had access to the means of identification of inmates from databases maintained by the Alabama Department of Corrections. On several occasions in 2009 and 2010, Webb stole identities from those databases and sold them to Harvey James and his sister, Jacqueline Slaton, for the purpose of filing false tax returns.”
For more

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Dallas-based physician and home health agency nursing director sentenced in $3 million Medicare fraud conspiracy
On December 17, 2014, U.S. Attorney for the Northern District of Texas Sarah R. Saldaña announced, “Joseph Megwa, M.D., 60, of Arlington, Texas, and Ebolose Eghobor, R.N., 49, of Grand Prairie, Texas, were sentenced today by U.S. District Judge Ed Knikeade to 120 months and 48 months respectively, in federal prison. In May 2014, Megwa and Eghobor were each convicted on one count of conspiracy to commit health care fraud. In addition, Mega was convicted on three counts of health care fraud and four counts of making false statements related to a health care benefit program based on his submission of false claims to Medicare for home visits or house calls to patients that he never actually made.

“The home health care convictions related to a scheme involving PTM Healthcare Services Inc. (PTM), which was owned and operated by Ferguson Ikhile, R.N. Ikhile, 56, of Irving, Texas, pleaded guilty in 2013 to conspiracy to commit health care fraud and is scheduled to be sentenced on January 14 2015.” For more

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Owner of dietary supplement company pleads guilty to multimillion-dollar scheme to adulterate dietary supplements
On December 17, 2014, U.S. Attorney for New Jersey Paul J. Fishman announced, “The owner and president of a dietary supplement manufacturing company in Flanders, New Jersey, pleaded guilty today to conspiracy to commit wire fraud in relation to a scheme in which he directed the sale of diluted and adulterated dietary ingredients and supplements sold by his company.

“Barry Steinlight, 69, of Hackettstown, New Jersey, pleaded guilty to a one-count information charging him with conspiring to commit wire fraud. As part of his plea agreement, Steinlight admitted that Raw Deal’s gross sales during the scheme were between $7 million and $20 million. Steinlight has agreed to forfeit more than $1 million in profits from the scheme.” For more

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This Week’s Links

Becker’s Hospital Review: “5 of the biggest False Claims Act developments in 2014” For more

Bloomberg: “Alstom to Pay Record $772 Million in U.S. Bribery Settlement” For more

Bloomberg: “Wal-Mart Accused of Ignoring Order to Give Up Bribe Files” For more

Courthouse News Service: “$44.5 Million Settlement for Overcharging USA” For more

GAO:
- DODD-FRANK REGULATIONS: Regulators' Analytical and Coordination Efforts For more
- TAX-EXEMPT ORGANIZATIONS: Better Compliance Indicators and Data, and More Collaboration with State Regulators Would Strengthen Oversight of Charitable Organizations For more
- VA HEALTH CARE: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data For more

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MediRegs is a pioneer in Ethics, Compliance and Regulatory Information Management. With more than 500 organizations using MediRegs already, you can confidently empower your team with our ADVantage ArchitectureSM.This week, MediRegs provided TWCC readers with the following: CMS Transmittals and From the OIG.

Regulatory News

CMS Update

Dates & Times of Upcoming National Provider Calls
Registration is now open for the following CMS Calls:

  • Tuesday, January 13; 1:30-3pm ET - Medicare Quality Reporting Programs: Data Submission Process
  • Thursday, January 15; 1:30-3pm ET - IRF PPS: New IRF-PAI Items Effective October 1, 2015
  • Wednesday, January 21; 2-3:30 pm ET - ESRD QIP Payment Years 2017 and 2018 Final Rule — Registration Opening Soon

To register- To receive call-in information, you must register for calls on the CMS Upcoming National Provider Calls registration website. Space may be limited, register early. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.

The presentation for calls will be posted on the FFS National Provider Calls web page. A link to the slide presentation will be emailed to all registrants on the day of the call.

Visit the Continuing Education Credit Notification web page for continuing education information

Open Payments: Final Rule Changes Related to Continuing Education Events
On October 31, CMS published four revisions as a final rule in the Federal Register as part of the 2015 Medicare Physician Fee Schedule publication. The Law and Policy web page includes details about the four revisions made to the Open Payments final rule.

The most significant change affects the Open Payments reporting requirements for payments or other transfers of value provided at continuing education events; these requirements will change starting for data collected in 2016.

Learn more about the final rule changes, review:

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CMS Transmittals
2014 Transmittals and MLN MattersFor more
 
Program Integrity (PUB. 100-08)
Transmittal #561 Date: December 12, 2014 - Incorporation of Certain Provider Enrollment Policies in CMS-4159-F into Pub. 100-08,. (PDF)For more

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From the OIG
Audit Reports - Centers for Medicare and Medicaid Services

  • Blue Cross Blue Shield of South Carolina Overstated Its Allocable Medicare Excess Plan Costs for Calendar Years 2006 Through 2011 (A-07-14-00445) (12/12/2014) (PDF) For more
  • TrailBlazer Health Enterprises, LLC, Claimed Some Unallowable Medicare Excess Plan Costs for Fiscal Years 2005 Through 2011 (A-07-14-00444) (12/12/2014) (PDF) For more
  • Medicare Compliance Review of Stormont-Vail Regional Health Center for 2011 and 2012 (A-07-13-05051) (12/11/2014) (PDF) For more
  • Medicare Compliance Review of Boone Hospital for 2010 and 2011 (A-07-13-05043) (12/10/2014) (PDF) For more
  • Medicare Compliance Review of University of Missouri Health Center for 2010 and 2011 (A-07-13-05050) (12/05/2014) (PDF) For more

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Acronym Library

MCI Medicare Claims Inquiry
MCO Managed Care Organization  
MCOB Medicare Contractor Oversight Board    

Click here for more from CMS Acronyms

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HCCA’s website gives members and visitors secure, online access to register for conferences, order products, join HCCA, update membership information, post and follow discussions on HCCAnet, the premier social network for compliance professionals, and search compliance news and resources, and much more. Visit www.hcca-info.org to check out HCCA’s full array of online services.

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HCCA Phone: 888-580-8373
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Email: service@hcca-info.org
Contact: Margaret Dragon, Editor, This Week in Corporate Compliance: 781-593-4924

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