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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

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


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

Research Academies

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

Privacy Academies

November Health Care Privacy 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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Products

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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


NEW!

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

Examining Physician Compensation Arrangements
July 13, 2015


Mitigating Risk in the Revenue Cycle- Breaking the Code in the Appropriate Patient Status
July 16, 2015


How to Prepare for an OCR Compliance Audit
July 20, 2015


Long Term Care Hot Topics in Compliance
July 21, 2015


Aligning your Research Compliance Work Plan with the Unrecognized Risks of Conducting Human Research
July 22, 2015


Millennials in Compliance - Technology and Social Demographics driving Agile Compliance
July 23, 2015


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


View our List of remaining 2015 Web Conferences Click Here


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Vol. XVII, No. 26
July 3, 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 3, 2015

Minnesota device makers paid out $211 million to doctors, hospitals in 2014

U.S. Attorney’s Office recovers over twenty million dollars in case against Community Health Network

Toms River, New Jersey, sports medicine doctor admits accepting $60,000 in cash bribes for prescription referrals, health care fraud

John Muir Health agrees to pay $550,000 to resolve false claims allegations

Missouri physician sentenced on health care fraud charges

Miami couple sentenced for operating clinic to defraud Medicare

U.S. Attorney's Office recovers $1.5 million in case against Indianapolis home healthcare company

Former owner of medical equipment supply company sentenced for $3.5 million Medicare and Medi-Cal fraud scheme

Former OtisMed CEO sentenced for selling unapproved surgical devices

SCCE Blog Weekly News

This Week’s Links

Regulatory News

CMS Update

CMS Transmittals

From the OIG

Acronym Library


Headlines

Minnesota device makers paid out $211 million to doctors, hospitals in 2014
On June 30, 2015, the Star-Tribune reported, “A handful of physicians received big paydays from Minnesota medical device companies last year, new federal data show.

“A review of payments of $1 million or more shows that eight doctors across the country collected a combined $81 million from Medtronic PLC and St. Jude Medical. All told, Minnesota companies paid out more than $211 million to doctors and hospitals in non-research payments last year, according to the federal Open Payments database for 2014 that was published Tuesday.

“The single largest payment by a Minnesota health care company last year went to a Georgia cardiologist who got $15.4 million from Little Canada-based St. Jude as part of the terms of the acquisition of his former company, CardioMEMS.” For more

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U.S. Attorney’s Office recovers over twenty million dollars in case against Community Health Network
On June 30, 2015, U.S. Attorney for the Southern District of Indiana Josh J. Minkler announced, “a $20,324,902.22 civil settlement with Community Health Network (ACHN), a non-profit health system with more than 200 sites of care and affiliates throughout the State of Indiana.  The settlement will resolve allegations that CHN submitted false claims to the Medicare and Medicaid programs.”

According to the government press release, “Specifically, the United States alleges that since the late 1990s through October 2009, CHN had contracts with free-standing ambulatory surgery centers or 'ASCs' not owned by CHN.  Through these contracts, the ASCs would provide out-patient surgical services to CHN patients.  CHN would then bill Medicare and Medicaid for the surgical services through the billing departments of its hospitals.  When CHN presented the bill to the Medicare and Medicaid contractors, however, the billing information represented that the surgery was performed in the out-patient department of one of CHN’s hospitals, rather than in an ASC.  Because the Medicare and Medicaid billing rates for surgeries performed in an ASC are generally lower than the billing rates for out-patient surgeries performed in a hospital, CHN received higher reimbursement from the Medicare and Medicaid programs than it was entitled.  According to the United States, medical providers were specifically placed on notice by the Centers for Medicare and Medicaid Services (CMS) in late November 2007 that services provided in an ASC should only be billed at ASC rates, but CHN continued this
practice until October 1, 2009.” For more

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Toms River, New Jersey, sports medicine doctor admits accepting $60,000 in cash bribes for prescription referrals, health care fraud
On June 29, 2015, U.S. Attorney for New Jersey Paul J. Fishman announced, “A sports medicine doctor with a practice in Toms River, New Jersey, today admitted accepting more than $60,000 in cash bribes in return for referring pain cream prescriptions and falsifying health records on behalf of Prescriptions R Us (PRU), a compound pharmacy in Lakewood, New Jersey.

“James Morales, 45, of Toms River, pleaded guilty before U.S. District Judge Joseph H. Rodriguez in Camden federal court to an information charging him with conspiracy to accept kickbacks and commit health care fraud.” For more

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John Muir Health agrees to pay $550,000 to resolve false claims allegations
On June 29, 2015, U.S. Attorney for the Northern District of California Melinda Haag announced, “John Muir Health has agreed to pay the government $550,000 to resolve allegations that it submitted false claims for Medicare reimbursement.”

According to the government press release, “The settlement, unsealed by U.S. District Judge Samuel Conti, resolves a whistleblower lawsuit filed in the United States District Court for the Northern District of California. The United States’ investigation revealed that between January 1, 2009, and December 31, 2013, physicians who were contracted with John Muir Health to deliver radiation therapy failed to adequately supervise that treatment. The proper supervision of radiation therapy is a condition of payment for Medicare.

“A former employee of John Muir Health filed the case pursuant to the qui tam provisions of the False Claims Act, 31 U.S.C. §§ 3729-33. Under those provisions, private citizens, known as ‘relators,’ may file lawsuits on behalf of the United States and receive a portion of a settlement or judgment. In this case, the relator will receive $110,000 as her share of the government’s recovery.” For more

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Missouri physician sentenced on health care fraud charges
On June 26, 2015, the U.S. Attorney’s Office for the Eastern District of Missouri announced, “Dr. Devon Golding was sentenced yesterday to four months imprisonment and eight months home detention on multiple health care fraud related charges for billing for services not rendered and false statements involving a health care benefit plan. Dr. Golding will also have to pay over $145,000 in restitution.

“According to testimony presented at trial, Dr. Golding billed for services on multiple occasions when he was actually out of town. Dr. Golding employed a registered nurse, who at various times during her employment from September 2009 to November 2011, took the examination to become certified as a nurse practitioner. Each time, she failed the examination and advised Dr. Golding that she had failed the examination.  She worked five days a week and saw patients on these days. Dr. Golding typically came to the office 2-3 days a week. In Dr. Golding’s absence, the registered nurse examined and diagnosed patients, prescribed narcotic medications and ordered lab tests for the patients. The registered nurse also completed progress notes for the patients, which Dr. Golding signed upon his return to the office, and thereby falsely indicated that he had seen the patients. Dr. Golding directed the registered nurse to provide these services, although he knew these services were beyond the scope of her license as a registered nurse.” For more

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Miami couple sentenced for operating clinic to defraud Medicare
On June 29, 2015, the U.S. Attorney’s Office for the Middle District of Florida announced, “U.S. District Judge Susan C. Bucklew sentenced a Miami couple today for their roles in operating a sham clinic. Gladys Fuertes (41) was sentenced to 19 years and 6 months in federal prison for engaging in a conspiracy to commit healthcare fraud, healthcare fraud, aggravated identity theft, and obstruction of a healthcare fraud investigation. Her husband and business partner, Mario Fuertes (41) was sentenced to 11 years and 3 months in federal prison for conspiracy to commit healthcare fraud, healthcare fraud, and obstruction of a healthcare fraud investigation.  The Court also ordered them to forfeit $1,036,759.72, proceeds that are traceable to the charged conduct.  The Fuerteses were convicted by a federal jury on March 24, 2015.” For more

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U.S. Attorney's Office recovers $1.5 million in case against Indianapolis home healthcare company
On June 29, 2015, U. S. Attorney for the Southern District of Indiana Josh J. Minkler announced, “a civil settlement with United Home Healthcare, Inc. and B&L Personal Services, Inc. (known collectively as ‘United’).  Both companies are located in Indianapolis and are owned and operated by Byron and Laura Harris.  The settlement will result in a total payment of $1.5 million to the United States and the State of Indiana.

“United provided home healthcare services such as personal and attendant care services throughout Central Indiana.  In 2012, the Department of Health and Human Services – Office of the Inspector General and the State of Indiana Attorney General’s Office Medicaid Fraud Control Unit began investigating a complaint that United was billing for services that it did not actually provide. Agents and investigators with HHS and the Indiana Attorney General’s Office interviewed patients and former employees, and reviewed multiple patient files.

“According to Assistant United States Attorney Shelese Woods, who handled the case for the United States, the review of patient files showed that from 2012 through 2014 United had engaged in a pattern of overbilling services.  Specifically, the patient files and corresponding billing data showed that many services billed for personal care and attendant care services were not documented; that there were dates for which United was reimbursed where the patient file showed that the patient did not receive the service; or that United over-billed the number of service hours actually provided to the patient.” For more

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Former owner of medical equipment supply company sentenced for $3.5 million Medicare and Medi-Cal fraud scheme
On June 29, 2015, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced, “The former owner of Ezcor Medical Supply was sentenced today to serve 97 months in prison for her role in a fraud scheme that resulted in $3.5 million in fraudulent claims to Medicare and Medi-Cal.”

According to the government press release, “Sylvia Walter-Eze, 48, of Stevenson Ranch, California, was found guilty by a federal jury on March 20, 2015, of conspiracy to commit health care fraud, four counts of health care fraud, and one count of conspiracy to pay illegal health care kickbacks.  In addition to imposing the term of imprisonment, U.S District Judge R. Gary Klausner ordered Walter-Eze to pay restitution in the amounts of $1,866,260 to Medicare and $73,268 to Medi-Cal.” For more

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Former OtisMed CEO sentenced for selling unapproved surgical devices
On June 26, 2015, the U.S. Department of Justice announced, “The former president and CEO of OtisMed Corporation was sentenced today to serve two years in prison for intentionally distributing a medical device used in knee replacement surgery after its application for marketing clearance had been rejected by the Food and Drug Administration (FDA).

“Charlie Chi, 46, of San Francisco, pleaded guilty in December 2014 to three counts of distributing adulterated medical devices in interstate commerce in violation of the federal Food, Drug, and Cosmetic Act (FDCA) after having been told by the FDA, legal counsel and his own board of directors not to do so.  U.S. District Judge Claire C. Cecchi in Newark, New Jersey, delivered Chi’s 24-month sentence today and also ordered him to serve one year of supervised release and to pay a $75,000 fine.  In September 2014, Judge Cecchi sentenced OtisMed Corporation, now a subsidiary of Stryker Corporation, to a criminal fine of $34.4 million and ordered the company to pay $5.16 million in criminal forfeiture.  Stryker acquired the company after the criminal conduct for which he was sentenced today.  In a related civil settlement, OtisMed agreed to pay approximately $41.2 million, including interest, to resolve its civil liability for submitting false claims to the Medicare, TRICARE, Federal Employees Health Benefits and Medicaid programs.” For more

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SCCE Blog Weekly News

CCO liability: Winds of change at the SEC?
Chief Compliance Officer Eugene Mason recently agreed to pay $25,000 to settle SEC charges that his failure to “effectively implement” a company compliance policy was a “willful violation” of the Investment Advisers Act. Given the nature of the accused conduct, this case may signal a troublesome shift in SEC enforcement policy towards compliance officers; at the very least, it deserves a close look. For more

Depressing, inevitable and useful numbers        
Every year at the time of our Compliance and Ethics Institute, we release our new Scalendar. It’s a calendar in the SCCE Resource Guide, and the HCCA one, too, that includes dates for our conferences but also corporate scandal dates: when Martha Stewart went to jail, when Bernie Madoff was arrested, and lots of big fines and settlements. For more

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This Week’s Links:

KVNO News: “Health Care Fraud Costs Nebraska Millions” For more

Reuters: “Whistleblower to get $7 mln from 2nd whistleblower, judge rules” For more

OIG:
- Daniel R. Levinson Gives Remarks at Health Care Fraud Takedown Press Conference (Video) For more
-Fact Sheet: U.S. Department of Health and Human Services
Office of Inspector General National Health Care Fraud Take-Down 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

CMS Update

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

Wednesday, July 8; 1:30-3pm ET - ESRD QIP System Training — Save the Date

Thursday, July 9; 2-3pm ET - ESRD QIP: Reviewing Your Facility's PY 2016 Performance Data

Thursday, July 16, 2015; 1:30 PM - 3:00 PM Eastern Time - 2016 PFS Proposed Rule: Medicare Quality Reporting Programs

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

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.

Webcast
Wednesday, July 15; 1:30-3:30pm ET - IQCP for CLIA Laboratory Nonwaived Testing: Workbook Tool To Register: Visit MLN Connects® Event Registration. Space may be limited, register early.

Open Payments Posts Full Year of 2015 Financial Data
On June 30, the Center for Medicare and Medicaid Services (CMS) announced in a press release it had “published 2014 Open Payments data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions, attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion.

“For all 2014 and 2013 data, CMS was able to validate that 98.8% of all records submitted in the Open Payments system contained accurate identifying information about the associated covered recipient. Records that could not be verified to align to an individual covered recipient were rejected and were not processed by the system. CMS will continue to update the Open Payments website annually with data collected from the previous year.”

The agency noted it “will refresh and publish an update to the full calendar year of 2014 financial data in early 2016. For more information, please visit the Open Payments website.” For more

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CMS Transmittals
2015 Transmittals and MLN Matters For more

Medicare Claims Processing (PUB. 100-04)
Transmittal #3285 Date: June 19, 2015 - Screening for Hepatitis C Virus (HCV) in Adults Implementation of Additional Common Working File (CWF) and Shared System Maintainer (SSMs) Edits. (PDF) For more

CMS Program Manuals - Provider Reimbursement (PUB. 15)
Transmittal 6, Date: June 19, 2015, Organ Procurement Organization and Tissue Typing Laboratory Cost Reports, Form CMS-216-94 (PDF) For more

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

  • OIG Videos - Last Updated: 06/18/2015 For more

 Audit Reports - Centers for Medicare and Medicaid Services

  • CMS's Reliance on Accreditation Surveys Could Not Ensure the Quality of Care Provided to Medicare Hospice Beneficiaries by The Community Hospice, Inc. (A-02-11-01027) (06/16/2015) (PDF) For more
  • AgeWell Physical Therapy & Wellness, P.C., Claimed Unallowable Medicare Part B Reimbursement for Outpatient Therapy Services (A-02-13-01031) (06/15/2015) (PDF) For more

Evaluation and Inspection Reports - Centers for Medicare and Medicaid Services

  • Ensuring the Integrity of Medicare Part D (06/2015) (PDF) For more
  • Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D (06/2015) (PDF) For more

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Acronym Library

MEDIGAP Medicare Gap (Medicare complementary insurance program)
MEDIRS Medicaid Eligibility Determination & Information Retrieval System
MEDMRG Medicaid Merge Program (HDMEDMRG)
MEDPAC Medicare Payment Advisory Commission

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

Houston Area Community Services Inc

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