January Basic Compliance Academy-Puerto Rico
March Basic Compliance Academy
April Basic Compliance Academy
View a Full List of Basic Compliance Academies in 2016 Click Here
March 14 – 17, 2016
June Health Care Privacy Basic Compliance Academy
March Research Basic Compliance Academy
November Research Basic Compliance Academy
Atlanta Regional Conference
Orlando Regional Conference
Portland Regional Conference
Dallas Regional Conference
Anchorage Regional Conference
View a Full List of 2016
Managed Care Compliance Conference
Audit & Compliance Committee Conference
20th Annual Compliance Institute
Research Compliance Conference
HCCA HIPAA Training Guide
a brief handbook for frontline healthcare workers Learn more
HIPAA Rules & Compliance
a DVD produced by
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
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.
Fraud and Abuse - Year in Review
Leveraging Agility in Governing Health IT Compliance
Vol. XVIII, No. 1
Copyright © 2015 Health Care Compliance Association
This Week’s Headlines – January 8, 2016
Florida woman died after hospital thought she was faking: lawyers
"Barbara Dawson, 57, complained of abdominal pains at Calhoun Liberty Hospital in the Florida Panhandle town of Blountstown five days before Christmas, but medical staff examined and released her.
"When she refused to leave, the hospital called the police, who handcuffed her and took her outside, where she collapsed in the hospital driveway. Dawson was returned to the hospital but died of a blood clot in her lungs the next day." For more
St. Luke's insurer ordered to cover legal fees
Health care fraud charges and plea agreements filed against physician and two others
"According to U.S. Attorney Peter Smith, in April 2013, Dr. Terry allegedly caused Medicare to be billed for fraudulent prescriptions intended for Stephen Heffner, Jr., age 46, of Elkland, knowing that Heffner was not his patient and that the Oxycodone was not actually intended for Heffner but for Dr. Terry's patient, David Hatch, age 28, of Addison, New York. Medicare paid for the prescription received by Heffner but actually delivered to Hatch." For more
Research: Not nearly as transparent as it needs to be
"But scientific data Let's start with these two glaring examples from the past decade or so:
Owner of three Los Angeles clinics sentenced to 78 months in prison for Medicare fraud
According to the government press release, "Hovik Simitian, 48, of Los Angeles, pleaded guilty to one count of conspiracy to commit health care fraud on Aug. 18, 2015, and was sentenced today by U.S. District Court Judge Beverly Reid O'Connell of the Central District of California, who also ordered Simitian to pay $1,668,559 in restitution to Medicare.
"Simitian owned and operated Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic, three medical clinics in Los Angeles. In connection with his guilty plea, Simitian admitted that from approximately February 2010 through June 2014, he and his co-conspirators paid illegal cash kickbacks to patient recruiters who brought Medicare beneficiaries to the clinics." For more
San Diego genetics laboratory pays $4 million to settle federal kickback allegations in connection with patient referrals
According to the government press release, "The settlement resolves allegations that Pathway induced health care providers to refer Pathway genetic testing kits and services, and then received government reimbursement for those tests in violation of the law. As alleged, Pathway offered physicians and medical groups reimbursements of up to $20 for each saliva kit they collected and submitted to Pathway for testing. The United States alleges that individual physicians received as much as $13,534 in reimbursements from Pathway and that most of the physicians had never ordered these costly genetic tests before enrolling in Pathway's reimbursement program. It is further alleged that, as its referrals increased, Pathway billed the high costs of these laboratory analyses to federal health care programs such as Medicare and TRICARE. Pathway has since voluntarily discontinued its physician reimbursement program." For more
CVS among hundreds of providers violating HIPAA, review finds
"Fenity worked on a small team at CVS Health that dealt with complaints directed to the company president's office, assuring customers their situations were rare. 'I sincerely apologize on behalf of CVS Health,' Fenity says he'd respond. 'This is not how we handle things. The breach of your protected health information was an isolated incident and we'll do better.'" For more
Government health care fraud recoveries slide
"The decline is largely due to the absence of major drug industry settlements, and doesn't reflect an easing of DOJ scrutiny of healthcare fraud, experts say." For more
Government settles alleged False Claims Act violations with Memorial Health, Inc.
U.S. settles with Aria Health Systems over unnecessary invasive procedures and improper compensation claims
Clinical director of home care agency sentenced in Medicare fraud scheme
"Janie Troisi, 66, of Revere, was sentenced by U.S. District Court Judge Douglas P. Woodlock to three years in prison and three years of supervised release. In August 2015, Troisi was convicted following a five-day trial of conspiracy to commit health care fraud and 10 counts of health care fraud.
"Troisi, a registered nurse, was the Clinical Director of At Home VNA (AHVNA), a home health agency located in Waltham, which was owned and operated by her co-conspirator, Michael Galatis, also a registered nurse. From 2009 to 2012, Troisi conspired with Galatis to submit more than $3.5 million in fraudulent home health care claims to Medicare." For more
Coloplast Corp. and Liberator Medical agree to pay $3.6 million to resolve kickback allegations
According to the government press release, "The settlement with Coloplast resolves allegations that it paid kickbacks to Byram Healthcare Centers, Inc.; CCS Medical, Inc.; Liberator; Liberty Medical, Inc.; and Handi Medical, Inc. in return for marketing promotions and conversion campaigns. In the case of Byram, Liberty, and Handi, Coloplast's promotional campaigns allegedly included kickbacks in the form of funding for cash incentives - sometimes known as "spiffs" - paid to the suppliers' sales personnel to induce them to refer patients to Coloplast products. In other instances, Coloplast allegedly gave rebates or price concessions as inducements for the promotional campaigns.
"The settlement with Liberator resolves allegations that Liberator received kickbacks from Coloplast, in the form of price concessions, in return for Liberator's agreement to conduct two campaigns promoting Coloplast ostomy products to Liberator's customers." For more
SCCE Blog Posts
Time management: Fifty bucks worth
This Week’s Links:
FierceHealthFinance: "2016: More antitrust actions, Medicare expansion tussles likely" For more
The Huffington Post: "Commonly Encountered Federal Business Fraud Statutes" For more
South Florida Business Journal: "5 news-making cases of alleged health care fraud from 2015" For more
GAO: DOD And VA Health Care: Actions Needed to Help Ensure Appropriate Medication Continuation and Prescribing Practices.
OIG Advisory Opinions:
- Advisory Opinion 15-16 For more
Dates & Times of Upcoming National Provider Calls
Tuesday, January 19, 2016; 2:00 - 3:30 PM ET - ESRD QIP: Payment Year 2019 Final Rule Call
Wednesday, January 20, 2016; 2:30 - 4:00 PM ET - Collecting Data on Global Surgery as Required by MACRA Listening Session
Thursday, February 4, 2016; 1:30 - 3 PM ET - IMPACT Act: Connecting Post-Acute Care across the Care Continuum Call
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.
In the Federal Register
Final rule, correction: Medicare Program; End-Stage Renal Disease Prospective Payment System, and Quality Incentive Program; Correction
Final rule: Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
2015 Transmittals and MLN Matters For more
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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