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2015 Regional Conference Prospectus Available


San Juan Regional Conference
April 30 - May 1, 2015
San Juan, PR


Columbus Regional Conference
May 8, 2015
Columbus, OH


New York Regional Conference
May 15, 2015
New York, NY


Philadelphia Regional Conference
June 5, 2015
Philadelphia, PA


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National Conferences

Research Compliance Conference

May 31 – June 3, 2015
Austin, TX


Clinical Practice Compliance Conference

Save $300 before August 18

October 11 – 13, 2015
Philadelphia, PA

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This Week’s Headlines – April 24, 2015

IG announces release of governing board guidance at 2015 Compliance Institute

More whistleblowers say health plans are gouging Medicare

Loretta Lynch confirmed as attorney general after long delay

Louisiana doctor pleads guilty to health care fraud charges

Family Dermatology PC agrees to pay U.S. more than $3.2 million to settle alleged false Claims Act violations

Texas-based Citizens Medical Center agrees to pay United States $21.75 million to settle alleged False Claims Act violations

Operator of Detroit adult day care center and two home health care company owners sentenced in $29 million Medicare fraud conspiracy

Government sues skilled nursing chain HCR Manorcare for allegedly providing medically unnecessary therapy

This Week’s Links

Regulatory News

CMS Update

In the Federal Register

CMS Transmittals

From the OIG

Acronym Library


Headlines

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IG Announces release of governing board guidance at 2015 Compliance Institute
On April 20, 2015, Health and Human Services Inspector General speaking at the Compliance Institute in Lake Buena Vista, Florida announced the release of “Practical Guidance for Health Care Governing Boards on Compliance Oversight,” a collaboration between the Inspector General of the Department of Health and Human Services (HHS OIG), the American Health Lawyers Association (AHLA), the Association of Healthcare Internal Auditors (AHIA) and the Health Care Compliance Association (HCCA).  This guidance is a joint educational resource to assist governing boards of health care organizations carry out their compliance plan oversight obligations.

According to the April 20, 2015 Modern Healthcare report, “Evolving payment models along with increasing amounts of publicly available data could present new compliance challenges for healthcare governing boards, according to new guidelines released by the federal government and industry groups Monday.”

The report noted, “Roy Snell, CEO of the Health Care Compliance Association, said it's significant that the guidelines specifically emphasize the importance for boards of keeping compliance officers independent.” For more | View “Practical Guidance for Health Care Governing Boards on Compliance Oversight” (PDF) | View Joint Press Release

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Healthcare Enforcement Compliance Institute

Save $175 before August 18

October 25-28, 2015
Washington, DC

Research Academies

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

Privacy Academies

More whistleblowers say health plans are gouging Medicare
On April 23, 2015, NPR reported, “Federal court records show at least a half dozen whistleblower lawsuits alleging billing abuses in these Medicare Advantage plans have been filed under the False Claims Act since 2010, including two that just recently surfaced. The suits have named insurers from Columbia, S.C., to Salt Lake City to Seattle, and plans that have together enrolled millions of seniors. Lawyers predict more whistleblower cases will surface. The Justice Department also is investigating Medicare risk scores.” For more

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Loretta Lynch confirmed as attorney general after long delay
On April 23, 2015, the Chicago Tribune reported, “Loretta Lynch was confirmed on Thursday to serve as attorney general by a Senate that forced her to wait more than five months for the title and remained divided to the end.

“The 56-43 vote installs Lynch, now U.S. attorney for the Eastern District of New York, as the first black woman in the nation's top law enforcement post. She will replace Eric Holder, a perennial lightning rod for conservatives who was once held in contempt of Congress.” For more | Statement by the Attorney General on the Senate Confirmation of Loretta Lynch

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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

August Basic Compliance Academy
August 10 – 13, 2015
New York, NY


September Basic Compliance Academy
September 14 – 17, 2015
Chicago, IL


September Basic Compliance Academy
Sept 28 – Oct 1, 2015
Scottsdale, AZ


October Basic Compliance Academy
October 19 – 22, 2015
Las Vegas, NV

Louisiana doctor pleads guilty to health care fraud charges
On April 23, 2015, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced, “A Louisiana doctor pleaded guilty to federal health care fraud charges today, admitting that he wrote false home health care certifications that were used in a multi-million dollar Medicare fraud scheme.”

According to the government press release, “Winston Murray, M.D., 62, of Hammond, Louisiana, pleaded guilty before Chief U.S. District Judge Sarah S. Vance of the Eastern District of Louisiana to all three charges against him, including one count of conspiracy to commit health care fraud and two counts of health care fraud.  He is scheduled to be sentenced on Aug. 12, 2015. Murray is the ninth defendant to plead guilty in this case.  The trial for the remaining four defendants is scheduled to begin on May 6, 2015.

“At his plea hearing, Murray admitted that he operated a clinic in Hammond, Louisiana, from which he wrote home health care referrals for Medicare beneficiaries he knew were not confined to their homes.  Murray further admitted that his referrals were used by home health companies Interlink Health Care Services Inc. (Interlink) and Lakeland Health Care Services Inc. (Lakeland), among others, to fraudulently bill Medicare for home health services supposedly rendered to hundreds of Medicare beneficiaries living in and around Hammond and New Orleans.” For more

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Family Dermatology PC agrees to pay U.S. more than $3.2 million to settle alleged false Claims Act violations
On April 21, 2015, U.S. Department of Justice announced, “Family Dermatology P.C. which owns and operates a dermatopathology laboratory in Georgia and a number of dermatology practices throughout the Eastern United States, has agreed to pay the United States $3,247,835 plus interest to settle allegations that it violated the False Claims Act by engaging in improper financial relationships with a number of its employed physicians.”

According to the government press release, “The settlement announced today resolved allegations that financial relationships that Family Dermatology and its affiliates had with a number of their employed physicians violated the Stark Statute and the False Claims Act.  The Stark Statute restricts the financial relationships that health care providers may have with doctors who refer patients to them.  Family Dermatology employs a number of dermatologists as independent contractors and it has routinely required them to use Family Dermatology’s in-house pathology lab, which operated under the name Nelson Dermatopathology, for their pathology services.  The government alleged that Family Dermatology’s financial relationships with a number of these physicians did not comply with the requirements of the Stark Statute, and that Family Dermatology improperly billed Medicare for dermatopathology analyses performed by Nelson Dermatopathology on specimens that were sent to the laboratory by these employed physicians.” For more

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Texas-based Citizens Medical Center agrees to pay United States $21.75 million to settle alleged False Claims Act violations
On April 21, 2015, the U.S. Department of Justice announced, “Citizens Medical Center, a county-owned hospital in Victoria, Texas, has agreed to pay the United States $21,750,000 to settle allegations that it violated the False Claims Act by engaging in improper financial relationships with referring physicians.”

According to the government press release, “The settlement announced today resolved allegations that the hospital provided compensation to several cardiologists that exceeded the fair market value of their services. The settlement also resolved allegations that the hospital paid bonuses to emergency room physicians that improperly took into account the value of their cardiology referrals. The United States contended that these agreements violated the Stark Statute and the False Claims Act. The Stark Statute restricts the financial relationships that hospitals may have with doctors who refer patients to them.

“The allegations settled today arose from a lawsuit filed by three whistleblowers, Dakshesh ‘Kumar’ Parikh, Harish Chandna and Ajay Gaalla, under the qui tam provisions of the False Claims Act.  Under the act, private citizens can bring suit on behalf of the government for false claims and share in any recovery. The whistleblowers will collectively receive $5,981,250 from the recoveries announced today.” For more

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Operator of Detroit adult day care center and two home health care company owners sentenced in $29 million Medicare fraud conspiracy
On April 21, 2015, the U.S. Department of Justice announced, “The former operator of a Detroit adult day care center and two former owners of Detroit-area home health care companies were sentenced to prison today for their roles in a $29 million Medicare fraud scheme.”

According to the government press release, “Felicar Williams, 51, of Dearborn, Michigan, was sentenced to five years in prison and ordered to pay $2,431,018 in restitution, representing the amount paid by Medicare for Williams’ fraudulent claims.  Abdul Malik Al-Jumail, 54, and Jamella Al-Jumail, 25, both of Brownstown, Michigan, were sentenced to 10 years in prison and four years in prison respectively.  Both were also ordered to pay $8,389,541 and $589,516 in restitution, respectively, the amounts paid by Medicare for their fraudulent claims.  The sentences were imposed by U.S. District Judge Denise Page Hood of the Eastern District of Michigan in Detroit.

“All three defendants were convicted on Sept. 30, 2014, after a 12-week jury trial in the Eastern District of Michigan.” For more

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Government sues skilled nursing chain HCR Manorcare for allegedly providing medically unnecessary therapy
On April 21, 2015, the U.S. Department of Justice announced, “The government has intervened in three False Claims Act lawsuits and filed a consolidated complaint against HCR ManorCare alleging that ManorCare knowingly and routinely submitted false claims to Medicare and Tricare for rehabilitation therapy services that were not medically reasonable and necessary, the Department of Justice announced today.  ManorCare is one of the nation’s largest healthcare providers, operating approximately 281 skilled nursing facilities (SNFs) in 30 states.”

According to the government press release, “The government’s complaint alleges that ManorCare, which is owned by The Carlyle Group, exerted pressure on SNF administrators and rehabilitation therapists to meet unrealistic financial goals that resulted in the provision of medically unreasonable and unnecessary services to Medicare and Tricare patients.  ManorCare allegedly set prospective billing goals designed to significantly increase revenues without regard to patients’ actual clinical needs and threatened to terminate SNF managers and therapists if they did not administer the additional treatments necessary to qualify for the highest Medicare payments.  ManorCare also allegedly increased its Medicare payments by keeping patients in its facilities even though they were medically ready to be discharged.” For more

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This Week’s Links:

McKnight’s Long-Term Care News: “Self-reporting False Claims Act violation averts litigation” For more

OIG: Medicaid Fraud Control Units Fiscal Year 2014 Annual Report 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: In the Federal Register, 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, May 12; 1:30-3 pm ET - Medicare Acute Care Quality and Reporting Programs

Tuesday, June 16 from 1:30-3 pm ET - National Partnership to Improve Dementia Care in Nursing Homes and QAPI

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

Special Open Door Forum: Tuesday, April 28; 1:30-2:30 pm ET - Home Health Electronic and Paper Clinical Templates Details: For more

Proposed FY 2016 Skilled Nursing Facility Payment and Policy Changes
On April 15, CMS issued a proposed rule (CMS-1622-P) outlining proposed FY 2016 Medicare payment rates for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). Based on proposed changes contained within this rule, CMS projects that aggregate payments to SNFs will increase by $500 million, or 1.4 percent, from payments in FY 2015. This estimated increase is attributable to a 2.6 percent market basket increase, reduced by a 0.6 percentage point forecast error adjustment and further reduced by 0.6 percentage point, in accordance with the multifactor productivity adjustment required by law.
For further information, see the SNF PPS website. Public comments on the proposal will be accepted until June 15, 2015.

Proposed FY 2016 Inpatient and Long-Term Care Hospital Payment and Policy Changes
On April 17, CMS issued a proposed rule (CMS-1632-P) to update FY 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed rule, which would apply to approximately 3,400 acute care hospitals and approximately 435 LTCHs, would affect discharges occurring on or after October 1, 2015.
Full text of this excerpted CMS fact sheet (issued April 17).

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In the Federal Register
Proposed rule: Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems (90/10)
As stated by CMS:
"This proposed rule would extend enhanced funding for Medicaid eligibility systems as part of a state's mechanized claims processing system, and would update conditions and standards for such systems, including adding to and updating current Medicaid Management Information Systems (MMIS) conditions and standards. These changes would allow states to improve customer service and support the dynamic nature of Medicaid eligibility, enrollment, and delivery systems." For more

Proposed rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Modifications to Meaningful Use in 2015 Through 2017
As stated by CMS:
"This proposed rule would change the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program EHR reporting period in 2015 to a 90-day period aligned with the calendar year, and also would align the EHR reporting period in 2016 with the calendar year. In addition, this proposed rule would modify the patient action measures in the Stage 2 objectives related to patient engagement." For more

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Web Conferences

OCR HIPAA Audit Program 2015 and Beyond - What We Know So Far
April 27, 2015


Is anything secure? (Compliance with Information Security Requirements in the Healthcare Industry)
April 29, 2015


Transforming Your RAC Program: It Happens Through Centralization
May 5, 2015


Security Incident Response - Spend a little now and save a lot later
May 6, 2015


The Role of HIPAA in Your Social Media Guidelines
May 13, 2015


Log Management as an Early Warning System: The Edge for Compliance
May 14, 2015


Beyond Simply Compliant: Incorporating Data Analytics to Become Effective
May 19, 2015


View our List of remaining 2015 Web Conferences Click Here


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Vol. XVII, No. 16
April 24, 2015

Health Care Compliance Association

Copyright © 2015 Health Care Compliance Association

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CMS Transmittals   
2015 Transmittals and MLN Matters For more
2014 Transmittals For more

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From the OIG
Audit Reports
Medicare Compliance Review of Florida Hospital Orlando for the Period January 1, 2011, Through June 30, 2012 (A-04-13-07043) (04/14/2015) (PDF) For more
Colorado Paid Over 800 Thousand Medicaid Claims With Missing or Invalid National Provider Identifiers During 2011 (A-07-13-06042) (04/07/2015) (PDF) For more
Missouri Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-07-14-06051) (04/13/2015) (PDF) For more

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Acronym Library

MECT Multiple Electroconvulsive Therapy
MED Medicare Enrollment Data (System)
MED Medicare Exclusion Database

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 Headquarters Contact Information
Your HCCA Office is located at:
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HCCA Phone: 888-580-8373
Fax: 952-988-0146
Minnesota Phone: 952-988-0141
Email: service@hcca-info.org
Contact: Margaret Dragon, Editor, This Week in Corporate Compliance: 781-593-4924

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Providing innovative reimbursement and compliance solutions for the healthcare community. SumaCare Inc.

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