This Week in Corporate Compliance


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2014 Regional Conference Prospectus Available

San Juan, PR Regional Conference
May 1-2, 2014
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Upper North Central Regional Conference
May 9, 2014
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May 16, 2014
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June 6, 2014
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Pacific Northwest Regional Conference
June 13, 2014
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West Coast Regional Conference
June 20, 2014
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New England Regional Conference
September 12th, 2014
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September 19th, 2014
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Midwest Regional Conference
September 29th, 2014
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Research Academy

November Research Basic Compliance Academy
November 3 – 6, 2014
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Compliance Academies

June Basic Compliance Academy SOLD OUT
June 9 – 12, 2014
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August Basic Compliance Academy
August 4 – 7, 2014
New York, NY

September Basic Compliance Academy
September 29 – October 2, 2014
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October Basic Compliance Academy
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Privacy Academy

June Health Care Privacy Basic Compliance Academy
June 16 – 19, 2014
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November 3 – 6, 2014
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National Conferences

Research Compliance Conference
June 1 – 4, 2014
Austin, TX

Clinical Practice Compliance Conference
October 12 - 14, 2014
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Looking for updated HIPAA Training Options?

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.
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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.
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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.
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Web Conferences

Is Your Compliance Program Window Dressing or Effective?
April 29, 2014

A Compliance Program Makeover...From Good to Great
May 12, 2014

Mentoring Other Compliance Professionals
May 13, 2014

Importance of Population Health Management and Case & Care Management Applications
May 15, 2014

The Data Deep Dive
May 19, 2014

Integrating PEPPER into your IRF Compliance/Quality Program
May 20, 2014

Sunshine Act - Update
May 27, 2014

Manage Evaluate Assess Treat (MEAT): Monitoring ICD-9 and ICD-10 Coding to Detect Fraud
May 28, 2014

The PPACA Mandate for Effective Compliance Programs: a Primer for Non-Institutional Providers
May 29, 2014

Current Fraud and Abuse Issues for Home Health Providers
June 4, 2014

HIPAA Business Associate Satisfactory Assurances: What Do We Ask For?
June 5, 2014

Fraud, Abuse and Compliance Risks in Everyday Agreements
June 11, 2014

Medicare's Physician Supervision Requirements and the False Claims Act
June 16, 2014

Lessons Learned From OIG's Evolving Approach to Corporate Integrity Agreements
June 17, 2014

Counterfeit Medicine, Careful Compliance
July 29, 2014

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DLA Piper

Vol. XVI, No. 17
April 25, 2014


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HCCAnet, HCCA’s Compliance & Ethics Social Network: What’s Being Talked About

This Week’s Headlines – April 24, 2014

3 American doctors killed in Kabul hospital attack
HEAT rises on health care fraud
Amedisys Home Health Companies agree to pay $150 million to resolve False Claims Act allegations
Durant hospital agrees to settle fraud case
Antitrust ruling against Idaho hospital merger could slow consolidation nationally
Surgeon Cully White sentenced to prison in health care fraud case
OCR levies $2 million in HIPAA fines for stolen laptops
Fla. doc faces 200 counts of health care fraud
Doctor enters guilty plea

This Week’s Links

Regulatory News

CMS Update

In the Federal Register

CMS Transmittals

From the OIG

Acronym Library

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3 American doctors killed in Kabul hospital attack
On April 24, 2014, Voice of America reported, “An Afghan security guard on Thursday opened fire at an international hospital in Kabul, killing three American doctors. The assailant was shot and wounded by his colleagues and has been hospitalized under police custody. The attack is said to be the sixth deadly incident this year in Afghanistan in which foreign civilians have been targeted.
“Afghan Interior Ministry officials say the deadly attack occurred when an Afghan security guard opened fire at Kabul’s Cure International Hospital.
“Ministry spokesman Sadiq Sidiqqi said the ‘unfortunate’ incident is under investigation and the assailant's motives have yet to be determined.  ‘The attacker was also shot by the other security guard and he is now under the serious watch of police but he is now in the hospital. We do not yet know the motives and the reasons behind this attack,’ he said.” For more


HEAT rises on health care fraud
On April 20, 2014, The Tennessean reported, “Health care lawyer Matthew Curley is in a room on top of the Nashville skyline, his hand resting on a glossy book chronicling dozens of stories of health care fraud.

“He and Anna Grizzle, both soft-spoken and cerulean blue-eyed, work on Bass Berry & Sims’ health care fraud task force. They were part of the team that published the firm’s 2013 Healthcare Fraud and Abuse Review, which is sitting near Curley on a conference room table.

“For attorneys who specialize in health care fraud, business is good. That’s because the feds are turbo-charging investigation efforts.

“It is bringing the HEAT, an acronym that stands for the “Health Care Fraud Prevention and Enforcement Action Team.” The unit was created in 2009 to hunt down providers, hospitals and other groups abusing Medicare and Medicaid claims.” For more


Amedisys Home Health Companies agree to pay $150 million to resolve False Claims Act allegations
On April 23, 2014, the U.S. Department of Justice announced in a press release, “Amedisys Inc. and its affiliates (Amedisys) have agreed to pay $150 million to the federal government to resolve allegations that they violated the False Claims Act by submitting false home healthcare billings to the Medicare program, the Department of Justice announced today.  Amedisys, a Louisiana-based for-profit company, is one of the nation’s largest providers of home health services and operates in 37 states, the District of Columbia and Puerto Rico.”   

According to the government press release, “The settlement announced today resolves allegations that, between 2008 and 2010, certain Amedisys offices improperly billed Medicare for ineligible patients and services.  Amedisys allegedly billed Medicare for nursing and therapy services that were medically unnecessary or provided to patients who were not homebound, and otherwise misrepresented patients’ conditions to increase its Medicare payments.  These billing violations were the alleged result of management pressure on nurses and therapists to provide care based on the financial benefits to Amedisys, rather than the needs of patients.   

“Additionally, this settlement resolves certain allegations that Amedisys maintained improper financial relationships with referring physicians.  The Anti-Kickback Statute and the Stark Statute restrict the financial relationships that home healthcare providers may have with doctors who refer patients to them.  The United States alleged that Amedisys’ financial relationship with a private oncology practice in Georgia – whereby Amedisys employees provided patient care coordination services to the oncology practice at below-market prices – violated statutory requirements.” For more


Durant hospital agrees to settle fraud case
On April 21, 2014, NewsOK reported, “A hospital in Durant and its parent company have agreed to pay $1.5 million to resolve claims alleging that an otolaryngologist billed the state's Medicaid program for unnecessary sinus surgeries performed on children.

“U.S. Attorney Mark Green said the Medical Center of Southeastern Oklahoma and its parent company, Health Management Associates Inc., will pay $1,065,000 to the federal government and $435,000 to SoonerCare, the state's Medicaid program.”

According to the news report, “The claims were first raised in a whistleblower lawsuit. The suit alleged that an otolaryngologist performed unnecessary functional endoscopic sinus surgeries on children who did not need the procedures. The suit also claimed that Medical Center of Southeastern Oklahoma billed SoonerCare for hospital services that the doctor did not perform.” For more


Antitrust ruling against Idaho hospital merger could slow consolidation nationally
On April 22, 2014, MedCity News reported, “When Idaho's largest hospital system bought the state's largest doctor practice in 2012, the groups expressed hope that the deal would spark a revolution in delivering better-quality care.

“Instead, it ignited a costly legal battle with state and federal regulators and rival hospital systems.

“Officials at Boise-based St. Luke's Health System thought they had the Obama administration on their side because the federal health law encourages hospitals to collaborate with doctors to improve quality and lower costs.

“But the Federal Trade Commission filed suit, arguing that St. Luke's purchase of the 43-physician Saltzer Medical Group in Nampa was anticompetitive and would lead to higher prices for Idaho patients.” For more


Surgeon Cully White sentenced to prison in health care fraud case
On April 23, 2014, the Journal Sentinel (WI) reported, “A suspended Milwaukee-area spine doctor was sentenced Wednesday to six months in prison and six months on house arrest at his Pewaukee Lake mansion after pleading guilty to federal health care fraud.

“Cully White, 45, who had surrendered his medical license last year after complaints about substandard surgeries going back to 2004, also was fined $60,000.

“The government had recommended a $250,000 fine, noting White has assets of $22 million.

“‘The greed in this context borders on the obscene,’ Assistant U.S. Attorney Matthew Jacobs said. He pointed out that while White was making as much as $10 million a year, he engaged in fraud to net less than $82,000.

“‘That's the type of fraud that needs real deterrence,’ Jacobs said.” For more


OCR levies $2 million in HIPAA fines for stolen laptops
On April 23, 2014, Fierce HealthIT reported, “The U.S. Department of Health & Human Services Office for Civil Rights has levied combined fines of nearly $2 million against two healthcare organizations to settle potential HIPAA violations from unencrypted laptops that were stolen.

“‘Covered entities and business associates must understand that mobile device security is their obligation,’ Susan McAndrew (pictured), OCR's deputy director of health information privacy, said in an announcement. ‘Our message to these organizations is simple: encryption is your best defense against these incidents.’

“Humana subsidiary Concentra Health Services has agreed to pay $1,725,220 after an unencrypted laptop was stolen from one of its facilities, the Springfield Missouri Physical Therapy Center. Though Concentra had conducted multiple risk analyses citing the lack of encryption on its computers and other devices, it had not completed the task of installing encryption, leaving patient information vulnerable throughout the organization. OCR also cited insufficient security management processes in place to safeguard patient information.” For more | HHS Press Release


Fla. doc faces 200 counts of health care fraud
On April 24, 2014, the Houston Chronicle reported, “A Gainesville doctor surrendered this week after she was charged with more than 200 counts of health care fraud for allegedly charging the government full price for prescription drugs, even though she was giving patients cheaper drugs not approved by the Food and Drug Administration.

“U.S. Attorney's officials said Ona Colasante, 57, turned herself in Tuesday after being indicted by a grand jury.

“Colasante ‘misleadingly’ billed Medicare, Medicaid, and Blue Cross Blue Shield of Florida for medical tests, including colonoscopies, X-rays, and hearing tests that patients didn't need. She also billed for substance abuse counseling, smoking cessation and other treatments that patients never received, authorities said.” For more


Doctor enters guilty plea
On April 24, 2014, Tri-Town News (NJ) reported, “A chiropractor who resides in Jackson and operates a practice in Toms River admitted on April 9 to accepting bribes to refer a number of his patients to a New Jersey-licensed pain management physician, U.S. Attorney Paul J. Fishman announced.

“Norman Eastburn, 48, pleaded guilty to an information charging him with one count of violating the Anti-Kickback statute. He entered his guilty plea before U.S. District Judge Stanley R. Chesler in Newark federal court.” For more


This Week’s Links

Bloomberg Businessweek: “Zimmer to Buy Biomet for $13.4 Billion to Gain in Orthopedics” For more

Gulf Business: “Good Business: Why Placing Ethics Before Profits Pays Off” For more

HealthIT Security: “Kentucky passes state data breach notification law” For more

International Business Times: “GlaxoSmithKline bribery probe extended to Jordan and Lebanon” For more

HCCA and SCCE: “Businesses across the globe to participate in Tenth Annual Corporate Compliance and Ethics Week, May 4 - 10, 2014” For more

SCCE: “Compliance and ethics case studies offered by Dell, Aetna, Bain Capital, Mercer, The Nature Conservancy, Johnson & Johnson, Gallup and others to be featured at SCCE's 13th Annual Compliance & Ethics Institute” For more


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 Update

Dates & Times of Upcoming National Provider Calls
Registration Opening Soon for the following CMS Calls:
- Monday, May 19; 2-3:30pm ET - Individualized Quality Control Plan for CLIA Laboratory Non-Waived Testing  
- Tuesday, May 20; 1:30-3:00pm ET - National Partnership to Improve Dementia Care in Nursing Homes
- Thursday, May29; 1:30-3pm ET - Stage 2 Meaningful Use Requirements, Reporting Options, and Data Submission Processes for Eligible Professionals — Registration Opening Soon

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

Wednesday, May 7; 3-4pm ET- Comparative Billing Report on Diabetic Testing Supplies

Presenter Information:
• Speakers: Cheryl Bolchoz, Melissa Parker, Jonathan Savoy, Mark Scogin, Molly Wesley
• Organizations: eGlobalTech and Palmetto GBA

How to Register
Register online and join the live event.

• Test your connection: This event is being streamed. Please test your connection prior to joining at the CBR Connection Test Link.

CMS National Dry Run of the Standardized Readmission Ratio for Dialysis Facilities Ends May 2
Since March 31, 2014, CMS has been conducting a dry run of the Standardized Readmission Ratio (SRR) for dialysis facilities. The dry run is hosted on the website. The dry run lasts through May 2, 2014; this is the final day that facility reports for the readmission measure will be available for download on the website. This is also the last day in which users can request the discharge level data files for their facilities. CMS strongly encourages facilities to download their reports, and to provide feedback on the measure, the dry run process, and the dry run website. If you have any questions about the dry run, please contact the helpdesk at 855-764-2885 of

Hospice Item Set Manual: Change Table for V1.00.0 to V1.01 Now Available
The change table from V1.00.0 to V1.01 of the Hospice Item Set (HIS) Manual is now available as a download on the HIS web page of the Hospice Quality Reporting Program (HQRP) website. For more

April 2014 Outpatient Prospective Payment System Pricer File Update
The Outpatient Prospective Payment System (OPPS) Pricer web page has been updated with a Pricer file and outpatient provider data for April 2014. The April provider data is available for use and may be downloaded from the OPPS Pricer web page under “2nd Quarter 2014 Files.” For more

New from MLN

“Provider Compliance Tips for Computed Tomography (CT Scans)” Fact Sheet — Released

“Duplicate Claims – Outpatient” Podcast — Released

“The Basics of Medicare Enrollment for Physicians and Other Part B Suppliers” Fact Sheet — Revised


In the Federal Register

Proposed Rule: Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities
On April 16, 2014, CMS issued this proposed rule that amended the fire safety standards for Medicare and Medicaid participating hospitals, critical access hospitals (CAHs), long-term care facilities, intermediate care facilities for individuals with intellectual disabilities (ICF-IID), ambulatory surgery centers (ASCs), hospices which provide inpatient services, religious non-medical health care institutions (RNHCIs), and programs of all-inclusive care for the elderly (PACE) facilities.

  • Proposed Rule: Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities 21551-21576 [2014-08602]: For more


  • Rule: Physical Medicine Devices; Reclassification of Stair-Climbing Wheelchairs 20779-20783 [2014-08257]: For more
  • Proposed Rule: National Vaccine Injury Compensation Program: Revisions to the Vaccine Injury Table 21187-21188 [2014-08395]: For more


CMS Transmittals

2014 Transmittals and MLN Matters: For more

Medicare Claims Processing (PUB. 100-04)

  • Transmittal #2931 Date: April 15, 2014 - Aprepitant for Chemotherapy-Induced Emesis *Rescinds and Replaces Transmittal 2883, dated February 21, 2014* (PDF): For more

Financial Management (PUB. 100-06)

  • Transmittal #234, Date: April 14, 2014 Notice of New Interest Rate for Medicare Overpayments and Underpayments - 3rd Qtr Notification for FY 2014 (PDF): For more


From the OIG

Podcasts, Spotlight Articles, Videos and Related Materials

  • OIG Podcasts about Reports - Last Updated: 04/17/2014: For more
  • OIG Videos - Last Updated: 04/16/2014: For more

Audit Reports

  • Medicare Improperly Paid Providers Millions of Dollars for Entitlement-Terminated Beneficiaries Who Received Services During 2010 Through 2012 (A-07-13-01127) (4/7/14) (PDF): For more
  • The Medicare Contractor for Jurisdiction 10 Overpaid Providers for Selected Outpatient Drugs (A-04-13-00090) (4/8/14) (PDF): For more
  • Medicare and Beneficiaries Could Save Billions If CMS Reduces Hospital Outpatient Department Payment Rates for Ambulatory Surgical Center-Approved Procedures to Ambulatory Surgical Center Payment Rates (A-05-12-00020) (4/16/14) (PDF): For more
  • U.S. Department of Health and Human Services Met Many Requirements of the Improper Payments Information Act of 2002 but Did Not Fully Comply for Fiscal Year 2013 (A-17-14-52000) (4/15/2014) (PDF): For more

Evaluation and Inspection Reports

  • Utah State Medicaid Fraud Control Unit: 2013 Onsite Review (OEI-09-13-00490) (4/2014) (PDF): For more
  • Texas State Medicaid Fraud Control Unit: 2013 Onsite Review (OEI-06-13-00300) (4/2014) (PDF): For more


Acronym Library

IOC Inspection of Care
IP/SNF Inpatient SNF
IPRP Interim Payment Review Program  
IPS  Institutional Provider of Service

Click here for more from CMS Acronyms


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Contact: Margaret Dragon, Editor, This Week in Corporate Compliance: 781-593-4924

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