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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


Louisville Regional Conference
November 6, 2015
Louisville, KY


Scottsdale Regional Conference
November 13, 2015
Scottsdale, AZ


Nashville Regional Conference
November 20, 2015
Nashville, TN


View a Full List of 2015
Regional Conferences
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National Conferences

Clinical Practice Compliance Conference

Save $300 before August 18

October 11 – 13, 2015
Philadelphia, PA


Healthcare Enforcement Compliance Institute

Save $175 before August 18

October 25 – 28, 2015
Washington, DC


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

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


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


October Basic Compliance Academy Nashville
October 26 – 29, 2015
Nashville, TN

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

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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


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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

Health Care Industry Enforcement: Significant False Claims Act And Related Developments
July 27, 2015


What All Healthcare Entities Should Know about CMS Guidance for an "Effective Compliance Program"
July 28, 2015


Embracing Quality: One Institution's Approach to Managing Compliance Risks
July 29, 2015


Clinical Integration and Alignment: Moving strategy to reality with a legal perspective
August 4


Emerging CDI Trends in 2015: CDI Survey Findings and Tips to Elevate Physician Engagement
August 5


The Role for Coders within the Private Physician Practice
August 13


Critical Compliance Areas for the Physician Office Laboratory
August 20


Proactively Detect Healthcare Privacy Breaches and Identity Theft by Insiders
August 26


Compliance and Managing the EMR Risks
August 27


View our List of remaining 2015 Web Conferences Click Here


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Vol. XVII, No. 29
July 24, 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 – July 24, 2015

Doctor sentenced to 21 months in prison for taking bribes as part of test-referral scheme with New Jersey clinical lab

Key member of scheme that illegally sought $20 million worth of expensive anti-psychotic drugs sentenced

Civil complaint alleges fraud by operators of community mental health clinics

Justice department reaches settlements with multiple health care providers to stop discrimination against persons with disabilities under the barrier free health care initiative

Medical billing manager sentenced in health care fraud case

BRF files antitrust lawsuit against Willis-Knighton Health System

Former Ft. Thomas x-ray technician sentenced to a year for health care fraud

SCCE Blog Weekly News

This Week’s Links

Regulatory News

CMS Releases First Round of Home Health Compare Quality of Patient Care Star Ratings

CMS Update

In the Federal Register

CMS Transmittals

From the OIG

Acronym Library


Headlines

Doctor sentenced to 21 months in prison for taking bribes as part of test-referral scheme with New Jersey clinical lab
On July 22, 2015, U.S. Attorney for the District of New Jersey Paul J. Fishman announced, “A Middlesex County doctor with practices in Jersey City, New Jersey, was sentenced today to 21 months in prison for accepting bribes in exchange for test referrals as part of a long-running and elaborate scheme operated by Biodiagnostic Laboratory Services LLC (BLS), of Parsippany, New Jersey, its president and numerous associates.

“Anthony DelPiano, 55, of Monmouth Junction, New Jersey, previously pleaded guilty before U.S. District Judge Stanley R. Chesler to an information charging him with one count of accepting bribes. Judge Chesler imposed the sentence today in Newark federal court.

“Including DelPiano, 38 people—26 of them doctors—have pleaded guilty in connection with the bribery scheme, which its organizers have admitted involved millions of dollars in bribes and resulted in more than $100 million in payments to BLS from Medicare and various private insurance companies. The investigation has to date recovered more than $11 million through forfeiture.” For more

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Key member of scheme that illegally sought $20 million worth of expensive anti-psychotic drugs sentenced
On July 20, 2015, the U.S. Attorney’s Office for the Central District of California announced, “One of the leaders of a conspiracy linked to a sham Glendale medical clinic was sentenced today to 15 years in federal prison for his role in a $20 million scheme to defraud Medicare and Medi-Cal by, among other things, fraudulently prescribing expensive anti-psychotic medications and then re-billing the government for those drugs over and over.

“Artak Ovsepian, 33, of Tujunga, one of the leaders of the conspiracy who oversaw the acquisition of drugs with bogus prescriptions, was sentenced by United States District Judge S. James Otero.

“Calling the offense ‘despicable’ and ‘horrific,’ Judge Otero noted that the scheme ‘preyed on some of those most vulnerable members of society, from the mentally ill, to down-and-out veterans, to elderly victims whose identities were stolen, which then interfered with their ability to obtain medical treatment’ that they truly needed.” For more

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Civil complaint alleges fraud by operators of community mental health clinics
On July 20, 2015, U.S. Attorney for the Eastern District of Pennsylvania Zane David Memeger announced, “the U.S. Attorney’s Office for the Eastern District of Pennsylvania filed a civil health care fraud lawsuit under the False Claims Act against Melchor Martinez, Melissa Chlebowski, both of Allentown, PA, and their businesses Northeast Community Mental Health Centers (in Philadelphia), Lehigh Valley Community Mental Health Centers (in Allentown, Easton and Bethlehem), and North Carolina Community Mental Health Centers (in Raleigh, North Carolina). The institutional defendants are community mental health clinics funded largely by Medicaid and Medicare.

“Martinez was convicted of Medicaid fraud in 2000 by the Commonwealth of Pennsylvania. As a result, he was excluded from participating in all federally funded health care programs, including Medicaid and Medicare. The exclusion prohibited Martinez from owning, managing or receiving payments from any federally funded health care provider. The United States alleges that in spite of his exclusion, Martinez, assisted by his wife Chlebowski, continued to own and operate the Northeast and Lehigh Valley clinics, and that, in 2009, while his exclusion was ongoing, he started up the North Carolina clinic in Raleigh, North Carolina.” For more

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Justice department reaches settlements with multiple health care providers to stop discrimination against persons with disabilities under the barrier free health care initiative
On July 20, 2015, the U.S. Department of Justice announced, “that, as part of its Barrier Free Health Care Initiative, it has reached three additional settlements with health care providers to ensure that they are complying with the Americans with Disabilities Act (ADA). The announcement comes as the department marks the 25th anniversary of the ADA. The Department of Justice, including the nation’s U.S. Attorneys and the Civil Rights Division, are proud to play a critical role in enforcing the ADA, working towards a future in which all the doors are open to equality of opportunity, full participation, independent living, integration and economic self-sufficiency for persons with disabilities.

“The new settlement agreements—entered into by the U.S. Attorney’s Office for the Eastern District of Virginia and the U.S. Attorney’s Office for the Eastern District of Michigan—address the requirements of the ADA for health care providers, such as hospitals, medical clinics, nursing homes, mental health facilities and doctor’s offices, to, among other things, provide effective communication to people who are deaf or have hearing disabilities in the provision of medical services. In addition, the U.S. Attorney’s Office for the Southern District of New York recently filed a lawsuit against, Emmanuel Asare, M.D. and Springfield Medical Aesthetic PC d/b/a Advanced Cosmetic Surgery of New York for failures to provide medical treatment for an individual with HIV.” For more

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Medical billing manager sentenced in health care fraud case
On July 17, 2015, U.S. Attorney for the Northern District of New York Richard S. Hartunian announced, “Bonnie Meislin, 43, of Utica, was sentenced to fifteen months’ imprisonment to be followed by three years of supervised release, a fine of $2,400.00 and restitution to Medicare of $84,265.11 following her convictions for health care fraud and conspiracy.

“Meislin was employed as the billing manager for Upstate Pain Medicine, a medical practice owned by Mahesh Kuthuru, M.D, with offices in Fulton and Utica, New York. Following a six day trial in February 2015, Meislin was found guilty on 23 counts of health care fraud and 1 count of conspiring with Kuthuru to send false and fraudulent billings to Medicare. Evidence at trial showed that in 2009, Dr. Kuthuru moved to Las Vegas where he opened a medical practice known as Desert Pain Management. Thereafter, Kuthuru began to spend the majority of his time in Las Vegas, returning to his Utica and Fulton offices only sporadically. From January 2010 through September 2011, Meislin and Kuthuru submitted false and fraudulent bills to Medicare which indicated that Kuthuru or another medical professional under his direct supervision had treated patients in the New York offices, when Kuthuru had not done so.” For more

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BRF files antitrust lawsuit against Willis-Knighton Health System
On July 16, 2015 KTBS reported, “Biomedical Research Foundation, the current manager of University Health in Shreveport, has filed an antitrust lawsuit against Willis-Knighton Health System, alleging the private health-care company has been unfairly taking away doctors and their privately insured patients.

“The suit, filed Wednesday in U.S. District Court in Shreveport, asks a judge to prevent Willis-Knighton from those alleged practices.” For more

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Former Ft. Thomas x-ray technician sentenced to a year for health care fraud
On July 16, 2015, the U.S. Attorney’s Office for the Eastern District of Kentucky announced, “A former x-ray technician from Ft. Thomas, Ky., who previously admitted to defrauding state and federal health care programs out of thousands of dollars, has been sentenced to one year in federal prison.”

The government press release noted, “According to court records, starting in June 2010 and continuing until December 2011, Robert Moyer, who owned Mobile Medical Resources, knowingly allowed an unlicensed individual to administer x-rays to Medicare and Medicaid patients from Kentucky and Ohio. He then falsified documentation to conceal who performed the x-ray services. Under federal law, the Medicare and Medicaid programs only reimburse for such medical services when they are provided by a licensed professional.” For more

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SCCE Blog Weekly News

Our “Respond”sibility
“Compliance is everyone’s responsibility.” This is a statement you have probably heard before. What does that really mean? It means: Being aware of our surroundings and expected standards to help maintain our compliance, Reporting concerns so they are properly addressed is everyone’s responsibility, regardless of position, and Being accountable for compliance is different depending on our roles within the organization. For more

Is the Word Ethical Being Used in an Unethical Way?
I saw a recent post on LinkedIn that talked about whether it was ethical for Starbucks to talk about race relations. Starbucks was apparently encouraging their employees to support positive race relations in their stores. The author was asking if what Starbucks was doing was ethical. He questioned if their company’s resources should be used to weigh in on issues such as race relations. He questioned their ethical decision making. One could legitimately ask the question “Is it ethical to tell others (including a company) that they can’t support positive race relations?” Is Starbuck’s unethical or are the people saying Starbucks should not use their resources to support race relations unethical?” The point here is not the answer to that question. The point here is…are we using the word ethical correctly? For more

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This Week’s Links:

Associated Press: “Lawmakers: VA hid details as budget crisis loomed
For more

Bloomberg Business: “Here's a Simple Lesson on Business Ethics From the Former CFO of Enron” For more

The Irish Times: “Risk, ethics and whistleblowing in business” For more

TIME: “Toshiba Bosses Accused of Padding Profits by $1.2 Billion”
For more

OIG: Advisory Opinion No. 15-09 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 Releases First Round of Home Health Compare Quality of Patient Care Star Ratings
Ratings to Help Consumers Compare and Choose among Home Health Agencies
On July 16, the Centers for Medicare and Medicaid Services (CMS) announced, for the first time the agency “published star ratings on Home Health Compare (https://www.medicare.gov/homehealthcompare/), a CMS public information website for Home Health Agencies (HHAs). Star ratings can help consumers more quickly identify differences in quality and make use of the information when selecting a health care provider. In addition to summarizing certain data about HHA performance for consumers, star ratings can also help the agencies identify areas for improvement.
For More Information:

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CMS Update

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

Wednesday, July 29; 2-3:30pm ET - ESRD QIP: Proposed Rule for Payment Year 2019

Tuesday, August 11; 2:30-4pm ET - Proposed Reform of Requirements for Long-Term Care Facilities Call

Thursday, August 13; 1:30-3pm ET - Hospital Compare Overall Star Ratings Methodology Call

Thursday, August 27, 2015; 2:30 PM - 4:00 PM ET: Countdown to ICD-10

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.

Updated Open Payments CME Guidance
CMS updated the Open Payments Law and Policy web page with information about the new reporting requirements for Continuing Medical Education (CME) in the 2015 Medicare Physician Fee Schedule final rule. See the FAQ for more information.

The Help Desk is now available by calling 855-326-8366 or openpayments@cms.hhs.gov; Monday through Friday from 9am to 5pm ET.

Home Health Agencies to Receive PEPPER
Provider-specific comparative data reports for Home Health Agencies (HHAs) will be available from CMS starting July 20, 2015. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) summarizes HHA claims data statistics for areas that may be at risk for improper Medicare payments. PEPPER is a free report comparing an HHA’s Medicare billing practices with other HHAs in the nation, Medicare Administrative Contractor (MAC) jurisdiction, and state. HHAs can use the data to support internal auditing and monitoring activities. The HHA PEPPER contains claims data statistics for:

  • Average case mix
  • Average number of episodes
  • Episodes with 5 or 6 visits
  • Non- Low Utilization Payment. Adjustment (LUPA) payments
  • High therapy utilization episodes
  • Outlier payments

CMS has contracted with TMF® Health Quality Institute to develop and distribute the reports. The HHA PEPPER will be available for access electronically on July 20, 2015, via the PEPPER Resources Portal; review the HHA PEPPER User’s Guide for details on accessing the report. 
For more information on the HHA PEPPER, including a sample HHA PEPPER, please visit PEPPERresources.org. A WebEx training session introducing and reviewing the PEPPER is scheduled for July 30; for more information, visit the Training web page. Questions about PEPPER may be submitted through the Help Desk

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In the Federal Register
Proposed rule: Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities
As stated by CMS:
"This proposed rule would revise the requirements that Long- Term Care facilities must meet to participate in the Medicare and Medicaid programs. These proposed changes are necessary to reflect the substantial advances that have been made over the past several years in the theory and practice of service delivery and safety." For more

Proposed rule: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016
As stated by CMS:
"This major proposed rule addresses changes to the physician fee schedule, and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute.” For more

Conditions of Participation for Hospitals
Rule: Conditions of Participation for Hospitals 40923 [2015-17127] For more

Acquisition, Protection, and Disclosure of Quality Improvement Organization Information
Rule: Acquisition, Protection, and Disclosure of Quality Improvement Organization Information 40923 [2015-17128] For more

Proposed rule: Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services
As stated by CMS:
"This proposed rule proposes to implement a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CCJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedures will be included in the episode of care." For more  

Veterans Affairs

  • Rule: Agency Interpretation of Prosthetic Replacement of a Joint 42040-42042 [2015-17417] For more

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CMS Transmittals
2015 Transmittals and MLN Matters For more

Program Integrity (PUB. 100-08)
Transmittal #601 Date: July 2, 2015 - Review of Home Health Claims. (PDF) For more

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From the OIG
Audit Reports

  • The Fraud Prevention System Increased Recovery and Prevention of Improper Medicare Payments, but Updated Procedures Would Improve Reported Savings (A-01-14-00503) (06/05/2015) (PDF) For more
  • Medicare Compliance Review of Saint Mary's Health Center for 2011 and 2012 (A-07-14-05065) (07/01/2015) (PDF) For more
  • The Medicare Contractor for Jurisdiction 1 Overpaid a Provider That Incorrectly Billed for Aflibercept (A-06-14-00055) (06/30/2015) (PDF) For more

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Acronym Library

MEDPAR Medicare Provider Analysis & Review
MEDPARD Medicare Participating Physician/Supplier Directory
MEDSTAT Medicaid Statistical Information (Reporting) System (now MSIS)
MEDTEP Medical Treatment Effectiveness Program
MEF Master Earnings File (SSA)
MEI Medical Economic Index

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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This Week’s HCCA Corporate Members

Krieg DeVault LLP Since its establishment in 1999, LTCI has been dedicated to improving long-term care delivery systems and quality of life for residents and patients in residential and community health-care settings.

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