HCCA's 19th Annual Compliance Institute, Lake Buena Vista, FL, April 19-22, 2015
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National Conferences

Managed Care Compliance Conference

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

Register by February 28, receive a free HCCA Web conference on CD*

April 19 – 22, 2015
Lake Buena Vista, FL


Research Compliance Conference

Save $250 before April 8

May 31 – June 3, 2015
Austin, TX


Clinical Practice Compliance Conference
October 11 – 13, 2015
Philadelphia, PA


Healthcare Enforcement Compliance Institute
October 25-28, 2015
Washington, DC

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

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This Week’s Headlines – January 30, 2015

St. Peter’s reports possible security breach

Kentucky ambulance services company to pay U.S. government $948,000 to settle False Claims Act violations

CMS plans pilot to better estimate home health agency fraud

Owner of Miami home health company sentenced to 106 months in prison for $30 million health care fraud scheme

United States settles False Claims Act allegations against Florida-based dermatology practice for $3 million

Hospital executive gets prison for health care fraud

Trial in medical research scandal at Duke postponed

FTC wants to know if divestitures are an adequate antitrust fix

This Week’s Links

Regulatory News

Dialysis Facility Compare (DFC) star ratings and data release

CMS Update

CMS Transmittals

From the OIG

Acronym Library


Headlines

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St. Peter’s reports possible security breach
On January 23, 2015, Fox23 reported, “St. Peter’s Hospital has reported a possible security breach after a manager’s cell phone was stolen.

“More than 5,100 patients may have been involved in the breach. St. Peter’s said the incident didn’t happen at the hospital, but rather at an off-site physician’s practice.
St. Peter’s officials said the manager used the cell phone to access the corporate e-mail system. Through that information, the thief could access patient health information. While it relates to mostly scheduling and appointments from August to November 2014, patients’ names, dates of birth and medical provider information is also included.” For more

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Kentucky ambulance services company to pay U.S. government $948,000 to settle False Claims Act violations
On January 26, 2015, the U.S. Attorney’s Office for the Eastern District of Kentucky announced, “An ambulance services company in Floyd County agreed to pay the U.S. Government $948,000 to settle civil allegations that it billed federal health care programs for medically unnecessary services over the course of several years.

“According to the settlement agreement, from February 1, 2006 until December 31, 2012, Lafferty Enterprises, LLC, doing business as Trans-Star Ambulance Services, transported Medicare patients to and from dialysis clinics by ambulance when an ambulance transport was not medically necessary. The government contends that Trans-Star violated the False Claims Act by billing Medicare for routine, non-emergency ambulance transports provided to patients who were able to safely travel to and from the dialysis clinics by other means. Medicare covers non-emergency ambulance transports only when all other forms of patient transportation are considered a medical risk.”

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

Regional Conferences

2015 Regional Conference Prospectus Available


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

Click Here

Compliance Academies

CMS plans pilot to better estimate home health agency fraud
On January 26, 2015, Modern Healthcare reported, “The CMS is developing a pilot program to determine just how many Medicare fraud cases are taking place in home health agencies. A contractor search is underway to help implement the initiative.” For more

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Owner of Miami home health company sentenced to 106 months in prison for $30 million health care fraud scheme
On January 26, 2015, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced, “The owner and operator of a Miami home health care agency was sentenced today to 106 months in prison for his participation in a $30 million Medicare fraud scheme.”

According to the government press release, “Ramon Regueira, 66, of Miami, pleaded guilty to one count of conspiracy to commit health care fraud on Nov. 13, 2014. In addition to the prison sentence, U.S. District Judge Cecilia M. Altonaga of the Southern District of Florida ordered Regueira to pay $21 million in restitution, both jointly and severally with his co-conspirator.

“According to his plea agreement, Regueira was an owner of Nation’s Best Care Home Health Corp. (Nation’s Best), a Miami home health care agency that purported to provide home health and therapy services to Medicare beneficiaries. Regueira admitted that he and his co-conspirators operated Nation’s Best for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary or not provided.” For more

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United States settles False Claims Act allegations against Florida-based dermatology practice for $3 million
On January 23, 2015, the Federal Bureau of Investigation announced, “The United States has settled a lawsuit brought by three whistleblowers that alleges a central Florida based dermatology practice knowingly billed the government millions of dollars for procedures that lacked basic indicia of medical necessity and, in some cases, had been performed by unlicensed, uncredentialed, and unsupervised employees. The qui tam complaint, filed by three former employees of the clinic, alleges that the defendants—a dermatology practice and its owner—violated the False Claims Act (FCA) by knowingly submitting false claims to the government for payment.”

According to the government press release, “it has reached a settlement with the defendant, Associates in Dermatology, and the physician who owned the practice, Dr. Michael Steppie. In reaching this settlement, the parties resolved allegations that, from January 1, 2009, until October 2013, Dr. Steppie operated a dermatology practice that had an unlicensed medical assistant performing radiation therapy without proper supervision. The whistleblowers, in many instances, alleged that the medical assistant lacked the basic knowledge to perform the tests she was performing. In addition, the allegations included that the clinic performed unnecessary destructions of skin lesions and that these destructions lacked proper documentation. Associates in Dermatology and Dr. Steppie agreed to pay the United States $3 million dollars to resolve these allegations.” For more

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February Basic Compliance Academy

SOLD OUT!

February 9 – 12, 2015
San Francisco, CA


March Basic Compliance Academy
March 9 – 12, 2015
Las Vegas, NV


April Basic Compliance Academy
April 27 – 30, 2015
Lake Buena Vista, FL


June Basic Compliance Academy
June 8 – 11, 2015
Scottsdale, AZ

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Research Compliance Professional’s Handbook, Second Edition

Hospital executive gets prison for health care fraud
On January 26, 2015, the Sun Sentinel (FLA) reported, “The former chief operating officer of the Hollywood Pavilion psychiatric hospital was sentenced Monday for his role in a $67 million health care fraud scheme, records show.”

According to the report, “Christopher Gabel, 62, of Davie, was sentenced to six years in federal prison and ordered to pay more than $39.3 million in restitution.” For more

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Trial in medical research scandal at Duke postponed
On January 26, 2015, newsobserver.com reported, “A judge in Durham County Superior Court has postponed the first civil trial against Duke University by the estate of a patient who had enrolled in one of a trio of clinical cancer studies that were based on bogus science.”

According to the report, “The postponement delayed resolution in the long-running case for the two patients still alive among the eight who filed suit. It also prolonged a lengthy public relations headache for Duke Medicine that has included retraction of research papers in major scientific journals, the embarrassing segment on “60 Minutes” and the revelation that the lead scientist had falsely claimed to be a Rhodes Scholar in grant applications and credentials.” For more

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FTC wants to know if divestitures are an adequate antitrust fix
On January 12, 2015, Modern Healthcare reported, “he Federal Trade Commission hopes to study the effectiveness of its orders for divestitures of hospitals, clinics and pharmaceutical companies, the agency said Friday. The commission wants to expand on a 1999 divestiture study to discover whether 92 orders made between 2006 and 2012 across a number of industries, including healthcare, met their goals.” For more

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This Week’s Links

Federal News Radio: “OSC fights whistleblower retaliation” For more

Modern Healthcare: “HHS cracks down on providers hiring prohibited employees” For more

NASDAQ: “Coordinating Care: Why Long-Term Care Must Make It a Priority For more

The Guardian: “Francis NHS whistleblower report: a new beginning?” For more

The Washington Post: “Some VA whistleblowers get relief from retaliation” 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

Dialysis Facility Compare (DFC) star ratings and data release
On January 22, 2015, the Centers for Medicare and Medicaid Services (CMS) announced, it “added star ratings to the Dialysis Facility Compare (DFC) website. These ratings summarize performance data, making it easier for consumers to use the information on the website. These ratings also spotlight excellence in health care quality. In addition to posting the star ratings, CMS updated data on individual DFC quality measures to reflect the most recent data for the existing measures.” For more

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CMS Update

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

  • Wednesday, February 18; 1:30-3pm ET - Payment of Chronic Care Management Services Under CY 2015 Medicare PFS
  • Thursday, February 26; 1:30-3pm ET - ICD-10 Implementation and Medicare Testing
  • Tuesday, March 10, 1:30 PM - 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

National Partnership to Improve Dementia Care in Nursing Homes and QAPI — Upcoming 2015 Calls
The National Partnership to Improve Dementia Care in Nursing Homes and Quality Assurance and Performance Improvement (QAPI) are partnering on future MLN Connects™ National Provider Calls to broaden discussions related to quality of life, quality of care, and safety issues. Register for the first call on March 10. Save the dates for upcoming calls in 2015:

  • Tuesday, March 10 from 1:30-3pm ET
  • Tuesday, June 16 from 1:30-3pm ET
  • Thursday, September 3 from 1:30-3pm ET
  • Tuesday, December 1 from 1:30-3pm ET

Webinars
Wednesday, February 4; 3-4pm ET - Comparative Billing Report on Modifier 59: Dermatology
How to Register and Event Replay:

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NEW!

The Health Care Privacy Compliance Handbook, Second Edition

New from MLN Matters
“Telehealth Services” Fact Sheet — Revised
The “Telehealth Services

New Medicare Learning Network® Provider Compliance Fast Fact

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CMS Transmittals

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

Financial Management (PUB. 100-06)

  • Transmittal #249 Date: January 14, 2014 - Notice of New Interest Rate for Medicare Overpayments and Underpayments - 2nd Qtr Notification for FY 2015 (PDF) For more

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From the OIG
Audit Reports

  • Medicare Paid Suppliers for Power Mobility Device Claims That Did Not Meet Federal Requirements for Physicians' Face-to-Face Examinations of Beneficiaries (A-09-12-02068) (01/16/2015) (PDF) For more
  • Palmetto Government Benefits Administrator, LLC, Claimed Unallowable Medicare Excess Plan Costs for Fiscal Years 2005 Through 2011 (A-07-14-00443) (01/13/2015) (PDF) For more
  • Medicare Compliance Review of Ochsner Medical Center for the Period January 1, 2011, Through September 30, 2012 (A-06-13-00042) (12/29/2014) (PDF) For more

Evaluation and Inspection Reports

  • Medicare's Oversight of Compounded Pharmaceuticals Used in Hospitals (OEI-01-13-00400) (01/2015) For more

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Compliance and Ethics: An Introduction for Health Care Professionals

Compliance and Ethics: An Introduction for Health Care Professionals

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Web Conferences

Updates on the Latest Audit Activities
February 2


Real or Imaginary -- Manipulation of digital medical records
February 4


It’s In The Cloud But Is It Secure?
February 5


Starting Urgent Care Business with Confidence
February 11


A Practical Guide to Using Encryption for Reducing HIPAA Data Breach Risk
February 18


Compliance Strategies to Protect your Revenue in a Changing Regulatory Environment
February 19


Auditor Secrets: How to Survive a HIPAA Security Audit
February 26


View our List of remaining 2015 Web Conferences Click Here


Order Past HCCA Web Conferences Click Here

This Week’s HCCA Corporate Members

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Vol. XVII, No. 04
January 30, 2015

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Acronym Library

MDSRH Medicare Dependent Small Rural Hospital
MDSS Medicare Decision Support System
MEASURES Medicare/Medicaid Automated Survey Reporting System
MECA Medicare Expanded Choice Act of 1987

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:
6500 Barrie Road, Suite 250
Minneapolis, MN 55435
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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