This Week in Corporate Compliance

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National Conferences


SCCE 10th Anniversary video


Clinical Practice Compliance Conference
October 12 - 14, 2014
Philadelphia, PA

Register by August 19 and save $300

Research Academy

November Research Basic Compliance Academy
November 3 – 6, 2014
Orlando, FL

Privacy Academy

September Health Care Privacy Basic Compliance Academy
September 8 – 11, 2014
San Francisco, CA


November Health Care Privacy Basic Compliance Academy
November 3 – 6, 2014
Orlando, FL

Regional Conferences

2014 Regional Conference Prospectus Available


New England Regional Conference
September 12th, 2014
Boston, MA


Upper Midwest Regional Conference
September 19th, 2014
Minneapolis, MN


Midwest Regional Conference
September 29th, 2014
Overland Park, KS


North Central Regional Conference
October 6,2014
Indianapolis IN


East Central Regional Conference
October 10,2014
Pittsburgh PA


Hawaii Regional Conference
October 16 - 17, 2014
Honolulu HI


View a Full List of 2014
Regional Conferences

Click Here

Compliance Academies

September Basic Compliance Academy
SOLD OUT

September 29 – October 2, 2014
Nashville, TN


October Basic Compliance Academy
SOLD OUT
October 20 – 23, 2014
Las Vegas, NV


October Basic Compliance Academy
SOLD OUT
October 27 – 30, 2014
Chicago, IL


November Basic Compliance Academy
SOLD OUT
November 17 – 20, 2014
Lake Buena Vista, FL


December Basic Compliance Academy
December 1 – 4,2014
San Diego, CA

Products


Looking for updated HIPAA Training Options?

HCCA HIPAA Training Guide

3rd edition

a brief handbook for frontline healthcare workers Learn more


HIPAA Rules & Compliance

a DVD produced by
Coastal Training/DuPont

Click here to learn more

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

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

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.
Click Here to Buy Now

Web Conferences

Inside the Halifax Case: A Discussion with the Government’s Expert Witness
August 19, 2014


Are you ready for an FDA Inspection? Preparing Research & Medical Staff for an FDA visit.
August 20, 2014


Risk Adjustment Data Validation Audit (RADV) Readiness
August 25, 2014


Management and Oversight of Research Compliance at Predominantly Undergraduate Institutions (PUIs)
August 26, 2014


The Latest Stark Law Developments: New Theories, New Risks, New Issues
August 27, 2014


Risk-Based Monitoring: Not a One-Size-Fits-All Approach
September 4, 2014


FY 2014: Hot Topics in Research Compliance September 9, 2014


Integrating PEPPER into your SNF Compliance Program
September 23, 2014


The Risk Analysis/Risk Management Cycle: The Foundation for an Effective Security & Privacy Program
September 25, 2014


OCR is Coming! Be Prepared for OCR Audits and Breach Investigations
September 29, 2014


View our List of 2014 Web Conferences Click Here


Order Past HCCA Web Conferences Click Here

This Week’s HCCA Corporate Members

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AAPC is the nation's largest training and credentialing organization for the business side of medicine.

Altegra Health


Vol. XVI, No. 33
August 15, 2014

 

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


This Week’s Headlines – August 15, 2014

Report: Medicare agency not doing enough to stop duplicate audits

NY Attorney General announces four arrests and $6.5 million settlement for Medicaid fraud at Brooklyn adult care facility

‘Fraud’ lawsuit against Brattleboro Retreat dismissed

Anti-fraud bill presses CMS to nix Social Security numbers on Medicare cards

Medical device company officials admit scheme to defraud hospitals of $800,000

Disbarred attorney sentenced to prison for her role in $28.3 million Medicare fraud scheme

Owners of Ohio Medical Clinics plead guilty to conspiracy to commit health care fraud

Co-owner of Atlanta-based medical clinic chain and hospital CEO plead guilty 

Speech therapy office manager guilty of health care fraud

This Week’s Links

Regulatory News

CMS: Open Payments System Reopens, Extends Physician Registration and Review Period

CMS Update

In the Federal Register

CMS Transmittals

From the OIG

Acronym Library


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Headlines

Report: Medicare agency not doing enough to stop duplicate audits
On August 13, 2014, The Hill reported, “The Centers for Medicare and Medicaid Services (CMS) must do a better job of ensuring its auditors aren’t conducting duplicate reviews of payments to healthcare providers, according to the Government Accountability Office.

“While the CMS has improved its oversight of contractors, the accountability office said the agency still can’t reliably ensure that payments aren’t reviewed twice.”

According to The Hill, legislators “have been highly critical of the Recovery Audit Contractor program, which lawmakers have said is threatening to put some healthcare providers out of business because of lengthy and frivolous investigations.”
For more | GAO Report

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NY Attorney General announces four arrests and $6.5 million settlement for Medicaid fraud at Brooklyn adult care facility
On August 12, 2014, New York Attorney General Eric T. Schneiderman announced, “four employees of the Northern Manor Adult Day Health Care Program (Northern Manor ADHC), a health care facility in Brooklyn providing services to the elderly, have been arrested after a long-term investigation. As a condition of the settlement, Attorney General Schneiderman required that the facility be shut down. Furthermore, Northern Manor Multicare Center, Inc., the nursing home that operates the Brooklyn program, has agreed to pay a $6.5 million civil settlement in connection with this case.

“The arrests and the civil settlement came after an investigation conducted by the Attorney General’s Medicaid Fraud Control Unit (MFCU) into the adequacy of adult day health care (ADHC) services provided at the Brooklyn facility.” For more

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‘Fraud’ lawsuit against Brattleboro Retreat dismissed
On August 12, 2014, the Brattleboro Reformer reported, “A federal judge has dismissed a lawsuit that claimed the Brattleboro Retreat defrauded the United States government of nearly $11 million between 2005 and 2012.”

According to the report, “Thomas Joseph, a former employee of the Retreat, claimed his ‘investigation’ of the organization's finances revealed discrepancies he believed proved his contention. Throughout the 30-page dismissal notice, Judge William Sessions puts investigation inside quote marks, and notes many of Joseph's examples are inferences that do not provide a basis for his assertions.” For more

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Anti-fraud bill presses CMS to nix Social Security numbers on Medicare cards
On August 12, 2014, Roll Call reported, “Medicare identification cards would no longer display beneficiaries’ Social Security numbers under a new bill outlined recently by the chairman of the House Ways and Means Subcommittee on Health. Rep. Kevin Brady, R-Texas, released the draft text of a measure that compiles a wide range of suggestions to thwart Medicare and Medicaid payment fraud and abuse.” For more

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Medical device company officials admit scheme to defraud hospitals of $800,000
On August 12, 2014, U.S. Attorney for the District of New Jersey Paul J. Fishman announced, “A regional manager and a product specialist selling medical devices to hospitals for Integra LifeSciences Corp. of Plainsboro, New Jersey, today admitted their roles in a scheme to defraud hospitals of more than $800,000.

“Daniel Metz, 34, of Fairfield, New Jersey, and Charles B. Carey Jr., 35, of Clark, New Jersey, each pleaded guilty before U.S. District Judge Joel A. Pisano in Trenton federal court to separate informations charging them with conspiracy to commit wire fraud.”

According to the government press release, “Integra is a provider of orthopedic products, including devices and implants for the spine, foot and ankle, hand and wrist, and shoulder and elbow. Metz worked there from July 2005 until his termination in April 2013, first as a product specialist (also referred to as a sales representative) and then as Northeast regional manager, supervising 16 product specialists and assistant sales representatives in Massachusetts, New Jersey, New York, and Pennsylvania. Carey was a product specialist, reporting to Metz, from January 2009 until he resigned in April 2011.” For more

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Disbarred attorney sentenced to prison for her role in $28.3 million Medicare fraud scheme
On August 7, 2014, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced, “A disbarred Florida attorney was sentenced in federal court in Tampa, Florida today to serve 70 months in prison in connection with her role in a $28.3 million Medicare fraud scheme involving false claims for physical and occupational therapy services.”

According to the government press release, “Margarita Grishkoff, 60, of Charlotte, North Carolina, formerly of southwest Florida, pleaded guilty on Jan. 24, 2014, to conspiracy to commit health care fraud. In addition to serving a prison term of 70 months, Grishkoff was sentenced to serve three years of supervised release and ordered to pay $14,424,856 in restitution, jointly and severally with her co-conspirators.” For more

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Owners of Ohio Medical Clinics plead guilty to conspiracy to commit health care fraud
On August 8, 2014, U.S. Attorney for the Southern District of Ohio Carter M. Stewart announced, “Four people involved in the operation of Advanced Family Medical Center and Watkins-Tsai Imaging in Coal Grove, Ohio have pleaded guilty to conspiracy to commit health care fraud, admitting that they improperly charged government insurance programs for medically unnecessary procedures.”

According to the government press release, “Peter Tsai, 45, owner of Advanced Family Medical Center, his father and mother, Tahsiung Tsai, 73, and Ruey Tsai, 68, who owned Watkins-Tsai Imaging, and Peter Tsai’s cousin, Wei Lih Sheih, aka ‘Wendy’, 42, who worked for both clinics, admitted that they had conspired to defraud health care benefit programs including Medicaid, Medicare and Tri-Care between 2004 and 2013 when they were indicted.” For more

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Co-owner of Atlanta-based medical clinic chain and hospital CEO plead guilty
On August 7, 2014, Principal Deputy Assistant Attorney General Marshall L. Miller of the Justice Department’s Criminal Division announced, “A CEO of an Atlanta-area hospital and the co-owner and chief operating officer of an Atlanta-based medical clinic chain pleaded guilty in connection with the payment of illegal kickbacks to clinics in exchange for Medicaid patient referrals to hospitals in the Atlanta area and on Hilton Head Island, South Carolina.”

According to the government press release, “Tracey Cota, 50, pleaded guilty on Aug. 6, 2014, and Gary Lang, 58, pleaded guilty on Aug. 7, 2014. Both pleaded guilty to conspiracy to violate the Anti-Kickback Statute by paying and receiving illegal remuneration in exchange for Medicaid patient referrals to hospitals in the Atlanta area and on Hilton Head Island.” For more

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Speech therapy office manager guilty of health care fraud
On August 8, 2014, U.S. Attorney for the Southern District of Texas Kenneth Magidson announced, “Tiffany Nicole Thompson, 31, has been convicted of conspiracy to commit health care fraud and four counts of health care fraud in relation to nearly $4 million in fraudulent health care claims.” For more

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This Week’s Links

ABC News: “Why Sen. Chuck Schumer Thinks FitBit Is a ‘Privacy Nightmare’” For more

FierceHealthcare: “What healthcare providers should know about reverse false claims” For more

Moyers & Company: “Two Health Care Giants Flee US Taxes — While Living on Them” For more

Phys.org: “Effective corporate governance employs multiple strategies, study says” For more

FCPA Blog: “FinCEN advisory defines ‘culture of compliance’” For more

OIG:
Guidance for Submitting a Contractor Self-Disclosure For more
Saint Joseph's Medical Center in New York Settles Case Involving a Patient Dumping Allegation For more

HCCA Video of the Week: Board Oversight For more
Sean Casey, Board Member, Southwestern Vermont Medical Center, Managing Partner And Director Of Public Affairs, Eric Mower And Associates 

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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: Open Payments System Reopens, Extends Physician Registration and Review Period
On August 15, 204, CMS announced, “the Open Payments system is once again available for physicians and teaching hospitals to register, review and, as needed, dispute financial payment information received from health care manufacturers. The system was taken offline on August 3 to resolve a technical issue. To account for system down time, CMS is extending the time for physicians and teaching hospitals to review their records to September 8, 2014. The public website will be available on September 30, 2014.” For more

CMS Update

Dates & Times of Upcoming National Provider Calls
Registration is now open for the following CMS Calls:
-Tuesday, August 19, 2014; 1:30 PM - 3:00 PM ET - National Partnership to Improve Dementia Care in Nursing Homes: Improved Care Transitions

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.


The FY 2014 Inpatient Prospective Payment System (PPS) Pricer has been updated with the July provider data. The latest version is now available on the Acute Inpatient PPS web page in the “Downloads” section.

The FY 2014 Inpatient Prospective Payment System (PPS) PC Pricer has been updated with the July provider data. The latest version is now available on the Inpatient PPS PC Pricer web page in the “Downloads” section.

From MLN:
Medicare Fraud & Abuse: Prevention, Detection, and Reporting" Fact Sheet – Revised

“Extension of Provider Enrollment Moratoria for Home Health Agencies and Part B Ambulance Suppliers” MLN Matters® Article – Released

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In the Federal Register

Final rule: Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year Beginning October 1, 2014 (FY 2015)
As stated by CMS:
"This final rule will update the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs). These changes will be applicable to IPF discharges occurring during the fiscal year (FY) beginning October 1, 2014 through September 30, 2015."

  • Rule: Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year.. 45937-46009 [2014-18329] For more

Final rule: Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2015
As stated by CMS:
"This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2015 as required by the statute. This final rule finalizes a policy to collect data on the amount and mode (that is, Individual, Concurrent, Group, and Co-Treatment) of therapy provided in the IRF setting according to therapy discipline, revises the list of diagnosis and impairment group codes that presumptively meet the "60 percent rule" compliance criteria, provides a way for IRFs to indicate on the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF- PAI) form whether the prior treatment and severity requirements have been met for arthritis cases to presumptively meet the "60 percent rule" compliance criteria, and revises and updates quality measures and reporting requirements under the IRF quality reporting program (QRP)."

  • Rule: Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year.. 45871-45936 [2014-18447] For more

Final rule: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2015
As stated by CMS:
"This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2015. In addition, it adopts the most recent Office of Management and Budget (OMB) statistical area delineations to identify a facility's urban or rural status for the purpose of determining which set of rate tables will apply to the facility, and to determine the SNF PPS wage index including a 1-year transition with a blended wage index for all providers for FY 2015."

  • Rule: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities.. 45627-45659 [2014-18335] For more

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CMS Transmittals

2014 Transmittals and MLN Matters: For more

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From the OIG

Audit Reports - Centers for Medicare and Medicaid Services

  • The Centers for Medicare & Medicaid Services Provided Medicare Part D Coverage to Beneficiaries Confined in Mental Health Facilities for Court-Ordered Purposes (A-07-13-06041) (07/31/2014) (PDF) For more
  • Weaknesses in Molina's Information System General Controls Over Its Medicaid Claims Processing System Increase Vulnerabilities (A-09-13-03001) (07/31/2014) (PDF) For more

Audit Reports - General Departmental

  • The Office of the National Coordinator for Health Information Technology's Oversight of the Testing and Certification of Electronic Health Records (A-06-11-00063) (08/01/2014) (PDF) For more

Evaluation and Inspection Reports

  • Part D Beneficiaries With Questionable Utilization Patterns for HIV Drugs (OEI-02-11-00170) (8/14) (PDF) For more

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Acronym Library

LCL Lowest Charge Levels
LIL Limitation of Liability
LMRP Local Medical Review Policy 

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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