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Regional Conferences

2015 Regional Conference Prospectus Available

Boston Regional Conference
September 11, 2015
Boston, MA

Minneapolis Regional Conference
September 18, 2015
Minneapolis, MN

Overland Park Regional Conference
September 25, 2015
Overland Park, KS

Indianapolis Regional Conference
October 2, 2015
Indianapolis, IN

Pittsburgh Regional Conference
October 9, 2015
Pittsburgh, PA

Honolulu Regional Conference
October 15-16, 2015
Honolulu, HI

Denver Regional Conference
October 23, 2015
Denver, CO

View a Full List of 2015
Regional Conferences
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National Conferences

Clinical Practice Compliance Conference

October 11 – 13, 2015
Philadelphia, PA

Managed Care Compliance Conference
January 31 - February 3, 2016
Las Vegas, NV

20th Annual Compliance Institute
April 17 – 21, 2016
Las Vegas, NV

Research Academies

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

Compliance Academies

November Basic Compliance Academy
November 16 – 19, 2015
Lake Buena Vista, FL

December Basic Compliance Academy
November 30 – December 3, 2015
San Diego, CA

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HCCA HIPAA Training Guide

3rd edition

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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. Click here to buy now

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.

Covers everything you need to plan and execute a customized compliance program that meets federal standards. A quarterly update subscription keeps you current. Click here for a brochure and fax order form

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. Click here to buy now

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

Compliance and Managing the EMR Risks
August 27

Small Covered Entity and Business Associate Compliance – Simplifying the Complex
August 31

The Key Three: How collaboration, communication and culture solidify compliance
September 1

Risk Analysis Simplified - Meeting requirements while reducing stress
September 15

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Vol. XVII, No. 34
August 28, 2015

Health Care Compliance Association

Copyright © 2015 Health Care Compliance Association

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

This Week’s Headlines – August 28, 2015

Clinical lab chain pays $1.8 million to settle charges of double-billing

Medical director and three therapists convicted in $63 million health care fraud scheme

Former owner and operator of NYC health clinics sentenced for $30 million Medicare fraud scheme

Arrowhead Regional Medical center agrees to comply with federal law by improving access for people who are deaf or hard of hearing

Previously indicted Texas doctor charged again and ordered into custody

Five defendants pay over $8 million to resolve civil fraud allegations that they billed Medicare and Medicaid for unlicensed and unnecessary inpatient detoxification services

Brattleboro Retreat focus of state fraud probe

Feds get extra time to review pending Aetna-Humana merger

Hospital consolidation troubling, Hopkins doctors say

SCCE Blog Posts Update

This Week’s Links

Regulatory News

CMS Update

In the Federal Register

CMS Transmittals

From the OIG

Acronym Library


Clinical lab chain pays $1.8 million to settle charges of double-billing
On August 26, 2015, the Sacramento Business Journal reported, “Quest Diagnostics has paid the federal government $1.79 million to settle allegations that it submitted false claims to the Medicare program, U.S. Attorney Benjamin Wagner announced Tuesday.

Based in Madison, N.J., Quest Diagnostics has 10 clinical laboratory draw and testing stations in the Sacramento area. The company bought more than 50 testing centers in California and Nevada from Dignity Health in 2013.” For more | DOJ PR


Medical director and three therapists convicted in $63 million health care fraud scheme
On August 25, 2015, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced, “A federal jury in Miami late yesterday convicted the former medical director of, and three therapists employed by, a now-defunct health care provider of conspiracy to commit health care fraud and related charges for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.”

According to the government press release, “Roger Rousseau, 73, of Miami; Doris Crabtree, 62, of Miami; Angela Salafia, 68, of Miami Beach, Florida; and Liliana Marks, 48, of Homestead, Florida, were found guilty of conspiracy to commit health care fraud. In addition, Rousseau was convicted of two counts of health care fraud. Sentencing is scheduled for Nov. 6, 2015, before U.S. District Judge Robert N. Scola Jr. of the Southern District of Florida. Rousseau was the former medical director of Health Care Solutions Network Inc. (HCSN), a now-defunct partial hospitalization program (PHP) that purported to provide intensive treatment for mental illness. Crabtree, Salafia and Marks were therapists who worked for HCSN.” For more


Former owner and operator of NYC health clinics sentenced for $30 million Medicare fraud scheme
On August 25, 2015, U.S. Attorney for the Southern District of New York Preet Bharara announced , “Oscar Huachillo, the former owner and operator of multiple HIV/AIDS clinics in New York City, was sentenced today in Manhattan federal court to 87 months in prison for orchestrating a scheme to defraud Medicare out of more than $31 million; he was also sentenced to 60 months in prison, to be served concurrently, for evading more than $3.4 million in federal income taxes by falsely underreporting his income. As part of the scheme, Huachillo submitted bills to Medicare for expensive treatments that were administered at highly diluted doses or never administered at all, and were often unnecessary. Huachillo previously pled guilty to conspiring to commit health care fraud and committing tax evasion before U.S. District Judge Katherine Polk Failla, who imposed today’s sentence.” For more


Arrowhead Regional Medical center agrees to comply with federal law by improving access for people who are deaf or hard of hearing
On August 26, 2015, the U.S. Department of Justice announced, “Arrowhead Regional Medical Center (ARMC) in Colton, California, has entered into an agreement with the United States to resolve allegations that the hospital violated the Americans with Disabilities Act (ADA) by failing to provide qualified interpreters and other services to persons who are deaf or hard of hearing. Under the voluntary compliance agreement, ARMC will provide equipment and services to ensure that people who are deaf or hard of hearing have equal access to medical services, which includes giving them the ability to effectively communicate with hospital staff.” For more


Previously indicted Texas doctor charged again and ordered into custody
On August 24, 2015, U.S. Attorney for the Southern District of Texas Kenneth Magidson announced, “A McAllen area doctor, previously indicted in an illegal kickback scheme, has been charged on new allegations of health care fraud for his scheme to defraud Medicare. Dr. Eduardo Carrillo, 42, of Edinburg, was previously released on bond on the initial charges in June 2015. Following the return of the superseding indictment on Tuesday, Aug. 18, 2015, the government filed a motion to revoke that bond, alleging he violated his previously imposed conditions and engaged in illegal conduct, to include health care fraud. At a hearing held today, U.S. District Judge Randy Crane ordered Carrillo surrender to authorities at the time of his initial appearance on the superseding indictment to be held tomorrow at 11:00 a.m. before U.S. Magistrate Judge Dorina Ramos.” For more


Five defendants pay over $8 million to resolve civil fraud allegations that they billed Medicare and Medicaid for unlicensed and unnecessary inpatient detoxification services
On August 24, 2015, Acting U.S. Attorney for the Eastern District of New York Kelly T. Currie announced, “three New York hospitals, Benedictine Hospital, Columbia Memorial Hospital, and St. Joseph’s Medical Center, together with SpecialCare Hospital Management Corporation (SpecialCare), a Missouri-based company, and SpecialCare’s chief executive officer, Robert McNutt, had agreed to pay over $8 million to resolve claims that they had defrauded the Medicare and Medicaid programs in connection with detoxification treatment provided to patients at the hospitals. For more


Brattleboro Retreat focus of state fraud probe
On August 24, 2015, The Bellingham Herald reported, “The Vermont attorney general's office is conducting a criminal investigation into the Brattleboro Retreat following a whistleblower's complaints about alleged Medicaid fraud at the private psychiatric hospital, The Associated Press has learned. Attorney General William Sorrell acknowledged that his office was investigating, and his comments coupled with documents provided to the AP in response to public records requests show the probe has gone beyond the concerns first raised by former hospital employee Thomas Joseph.” For more


Feds get extra time to review pending Aetna-Humana merger
On August 24, 2015, Bloomberg BNA reported, “Corporate mergers can be tricky things, especially when antitrust issues are factored in, and merging companies can expect a high degree of scrutiny from federal agencies. This is certainly the case in the pending $35 billion Aetna-Humana merger, which was announced in early July. In fact, the government will have an extra 30 days to review the merger, courtesy of Aetna’s refiling of a premerger notification. Under the Hart-Scott-Rodino Act of 1976, which amended antitrust laws, companies are required to file a premerger notification with both the DOJ and the FTC. A submitted notification starts a 30-day clock, during which the government agencies can review the transaction and request additional information.” For more


Hospital consolidation troubling, Hopkins doctors say
On August 19, 2015, The Baltimore Sun reported, “A group of Johns Hopkins doctors and professors have called on the Federal Trade Commission to act with more caution when considering hospital mergers.

“The consolidation of hospitals into large chains makes the market less competitive, gives patients fewer choices and could result in higher medical expenses, the researchers said in a commentary published in the Aug. 13 edition of the Journal of the American Medical Association.

“The authors of the article want the FTC to pay particular attention to mergers that could result in one dominant hospital system in a region.” For more


SCCE Blog Posts Update

Social media is big business for compliant organizations
Social media is paving the way for consumer consideration and education, but only a third of organizations have documented guidelines, fewer provide training to avoid violations. The Internet is only a few years older than HIPAA (enacted in 1996), but as social media has grown in popularity with healthcare professionals in recent years, HIPAA has begun cracking down on privacy concerns that have come up on social platforms. For more

What’s in the job description?
I keep on my desk a replica of Jackie Robinson’s plaque from the Baseball Hall of Fame. Like the plaques for the other players there are inspiring statistics about his on-field play. More impressive than any of the numbers listed, though, is the last sentence of the inscription. The words don’t address his hitting or fielding but his character:  “Displayed tremendous courage and poise in 1947 when he integrated the modern major leagues in the face of intense adversity.” I’ve seen a lot of job descriptions in my career, and none that I can recall had such a description. For more


This Week’s Links:

Becker’s Hospital Review:
- “Medicare fraud scheme abroad costs US $25M: 5 things to know” For more
-“OIG: St. Luke’s Hospital received $119,721 in Medicare overpayments” For more

News-Medical: “Pitt unveils research-based guidance to improve compliance while treating sepsis”
For more “Kyle Flood investigation: Rutgers compliance policy prohibits coach-initiated contact with faculty” For more

FBI: Medicare fraud - Hospice owner falsified numerous claims Medicare Fraud For more


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:

Thursday, September 3; 1:30-3pm ET - National Partnership to Improve Dementia Care and QAPI Call

Thursday, September 17, 2:30 PM ET - Overview of the 2014 Annual Quality and Resource Use Reports — Webcast

Thursday, September 24; 1:30-3pm ET - Medicare Quality Reporting Programs: 2017 Payment Adjustments

To register and 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.

PQRS Webinars: Public Reporting of 2014 Measures
Did you know that some 2014 Physician Quality Reporting System (PQRS) quality measures will be publicly reported on Physician Compare later this year? CMS will host a series of one-hour webinars about public reporting and the Physician Compare website. Each webinar will present the same information and provide stakeholders the opportunity to ask questions about public reporting on Physician Compare and this year’s measure preview period. See the announcement for more information and to register.

  • Tuesday, September 22 at 1pm ET
  • Wednesday, September 23 at 4pm ET
  • Thursday, September 24 at 11am ET


In the Federal Register
Proposed rule; correction: Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements; Correction

As stated by CMS:
"This document corrects technical errors in the proposed rule that appeared in the July 10, 2015 Federal Register entitled "Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value- Based Purchasing Model; and Home Health Quality Reporting Requirements." For more

Final rule; interim final rule with comment period: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals

As stated by CMS:
"We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform (SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post- Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation." For more


CMS Transmittals
2015 Transmittals and MLN Matters For more


From the OIG
Podcasts, Spotlight Articles, Videos and Related Materials

  • OIG Podcasts about Reports - Last Updated: 08/10/2015 For more
  • OIG Monthly Update Podcasts - Last Updated: 08/07/2015 For more

Evaluation and Inspection Reports

  • Overlap Between Physician-Owned Hospitals and Physician-Owned Distributors (OEI-01-14-00270) (08/2015) (PDF) For more
  • OIG Site Visits to Indian Health Service Hospitals in the Billings, Montana Area (OEI-09-13-00280; 08/2015) (PDF) For more


Acronym Library

MFSDB Medicare Fee Schedule Database
MFSR Medicare Focused Medical Review Status Report
MGA Medicaid Grant Awards
MGCRB Medical Geographical Classification Review Board

Click here for more from CMS Acronyms


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HCCA Phone: 888-580-8373
Fax: 952-988-0146
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Contact: Margaret Dragon, Editor, This Week in Corporate Compliance: 781-593-4924

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This Week’s HCCA Corporate Members

Reliant Rehabilitation is a leading provider of rehabilitation management services - providing programs to Acute Care Hospitals, Skilled Nursing Facilities, Subacute Facilities, LTACHs, Rehab Hospitals, and CCRCs across the United States. SAI Global Compliance

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