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National Conferences

2015 Compliance Institute

Register by February 28, receive a free HCCA Web conference CD*

April 19 – 22, 2015
Lake Buena Vista, FL


Research Compliance Conference

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May 31 – June 3, 2015
Austin, TX


Clinical Practice Compliance Conference
October 11 – 13, 2015
Philadelphia, PA


Healthcare Enforcement Compliance Institute
October 25-28, 2015
Washington, DC

Research Academies

March Research Basic Compliance Academy
March 2 – 5, 2015
San Diego, CA


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

Privacy Academies

March Health Care Privacy Basic Compliance Academy

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March 2 – 5, 2015
San Diego, CA


June Health Care Privacy Basic Compliance Academy
June 15 – 18, 2015
Las Vegas, NV


November Health Care Privacy Basic Compliance Academy
November 2 – 5, 2015
Orlando, FL

Regional Conferences

2015 Regional Conference Prospectus Available


St Louis Regional Conference
March 6, 2015
St Louis, MO

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This Week’s Headlines – February 27, 2015

Three individuals arrested for more than $2.4 million in Medicare and Medicaid fraud

Detroit area patient recruiter and physical therapist convicted in $1.6 million Medicare fraud scheme

Physician’s assistant admits taking more than $70,000 in bribes in test-referral scheme with New Jersey clinical lab

U.S. Attorney announces $650,000 settlement with Acadiana Cardiology, Acadiana Cardiovascular Center, and Convicted Doctor, Mehmood Patel, for false claims allegations

California oncologist agrees to pay $550,000 to resolve False Claims Act allegations

Nurse practitioner indicted on health care fraud and aggravated identity theft charges

Former owner of durable medical equipment company pleads guilty in $5 million health care fraud scheme

New Jersey doctor charged with fraudulently billing for office visits that were never rendered

Two Florida couples agree to pay $1.13 million to resolve allegations that they accepted kickbacks in exchange for home health care referrals

Psychologist and psychotherapy services owner sentenced in $1.5 million Medicare fraud

This Week’s Links

Regulatory News

CMS Update

From the GAO

In the Federal Register

CMS Transmittals

From the OIG

Acronym Library


Headlines

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Three individuals arrested for more than $2.4 million in Medicare and Medicaid fraud
On February 26, 2015, U.S. Attorney for the Southern District of Florida Wifredo A. Ferrer announced, “Three individuals have been arrested—one of whom was arrested in Colombia—for more than $2.4 million in Medicare and Medicaid fraud. The defendants in this case allegedly defrauded Medicaid and Medicare by paying and receiving kickbacks and bribes in return for creating and providing false and fraudulent home health prescriptions and plans of care to patient recruiters and causing the submission of false and fraudulent claims.”

According to the government press release, “Last month, a federal grand jury in Miami returned a four-count indictment charging Dr. Daniel Ronchetta, 77, Chiropractic Physician Assistant John Crowe, 76, and patient recruiter Frank Barrios, 48, for Medicare and Medicaid fraud. The defendants are charged with conspiracy to commit health care fraud and wire fraud, substantive counts of health care fraud, conspiracy to defraud the United States and pay and receive health care kickbacks.” For more

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Detroit area patient recruiter and physical therapist convicted in $1.6 million Medicare fraud scheme
On February 25, 2015, the Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced, “A federal jury in Detroit today convicted a patient recruiter and a physical therapist for their roles in a $1.6 million Medicare fraud scheme.

“Reginald Smith, 54, of Flint, Michigan, a patient recruiter, was found guilty of one count of conspiracy to commit health care fraud and one count of conspiracy to solicit and receive health care kickbacks. Rajan Patel, 30, of Clinton Township, Michigan, a physical therapist, was found guilty of one count of conspiracy to commit health care fraud, three counts of health care fraud, and three counts of making false statements relating to health care matters. Sentencing hearings are scheduled for April 16, 2015, and April 15, 2015, respectively, before U.S. District Judge Arthur J. Tarnow of the Eastern District of Michigan.” For more


Washington DC Regional Conference
March 13, 2015
Arlington, VA


Charleston Regional Conference
March 20, 2015
Charleston, SC


San Juan Regional ConferenceApril 30 - May 1, 2015
San Juan, PR

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Regional Conferences
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Physician’s assistant admits taking more than $70,000 in bribes in test-referral scheme with New Jersey clinical lab
On February 25, 2015, U.S. Attorney for New Jersey Paul J. Fishman announced, “A Staten Island, New York, physician’s assistant admitted 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.

“Leonard Marchetta, 48, pleaded guilty before U.S. District Judge Stanley R. Chesler in Newark federal court to an information charging him with one count of accepting bribes.

“Including Marchetta, 36 people—24 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 so far recovered more than $10.5 million to date through forfeiture.” For more

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U.S. Attorney announces $650,000 settlement with Acadiana Cardiology, Acadiana Cardiovascular Center, and Convicted Doctor, Mehmood Patel, for false claims allegations
On February 24, 2015, U.S. Attorney for the Western District of Louisiana Stephanie A. Finley announced, “a $650,000 settlement was reached with Acadiana Cardiology LLC, Acadiana Cardiovascular Center and convicted doctor, Mehmood Patel, M.D., concerning allegations that Patel performed unnecessary medical procedures and billed Medicare.

Compliance Academies

March Basic Compliance Academy

SOLD OUT!

March 9 – 12, 2015
Las Vegas, NV


April Basic Compliance Academy

SOLD OUT!

April 27 – 30, 2015
Lake Buena Vista, FL


June Basic Compliance Academy
June 8 – 11, 2015
Scottsdale, AZ


August Basic Compliance Academy
August 10 - 13, 2015
New York, NY


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

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“In the criminal proceedings, Patel was indicted on 94 counts of health care fraud on February 16, 2006, and a jury found him guilty on December 30, 2008 after a two-month trial of 51 counts of health care fraud. He was sentenced on June 4, 2009, to serve 120 months in prison and five years of supervised release. He was also ordered to pay $387,511 in restitution and a $175,000 fine. In August of 2006, Our Lady of Lourdes agreed to pay a $3.8 million settlement, and in January of 2008, Lafayette General Medical Center agreed to pay a $1.9 million settlement to settle claims.” For more

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California oncologist agrees to pay $550,000 to resolve False Claims Act allegations
On February 24, 2015, U.S. Attorney for the Eastern District of California Benjamin B. Wagner announced, “Prabhjit S. Purewal, M.D., a Manteca based oncologist, agreed to pay the United States $550,000 to settle allegations that he defrauded Medicare, Tricare and Medicaid by billing these public insurers for chemotherapy drugs the US Food and Drug Administration had not approved for use in the United States. Dr. Purewal has paid the United States $400,000 to date.

“The settlement resolves the United States’ contentions that Dr. Purewal had, over a two year period ending in May 2011, purchased chemotherapy drugs from Warwick Healthcare Solutions, Inc., also known as Richard’s Pharma (‘Warwick’), administered the drugs to his patients, and improperly sought and received reimbursement for the drugs from Medicare and other public insurers. Warwick, a former United Kingdom based drug distributer, did not have a license to distribute drugs in the United States, and many of the drugs Dr. Purewal purchased from Warwick were not FDA approved. The FDA regulates pharmaceuticals in the US to ensure the drugs are safe and effective. The United States contended that by claiming and receiving reimbursement from Medicare, Tricare, and Medicaid for these drugs, Dr. Purewal violated the federal False Claims Act.” For more

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Nurse practitioner indicted on health care fraud and aggravated identity theft charges
On February 24, 2015, Acting U.S. Attorney for the Northern District of Georgia John Horn announced, “Daphne Maria Patterson has been arraigned on federal charges of health care fraud and aggravated identity theft. She allegedly stole patients and their family member’s identities and billed insurance providers for services she did not render. Patterson was indicted by a federal grand jury on February 17, 2015.”

According to the government press release, “Daphne Patterson is a registered nurse practitioner and owner of Healthier U 4 Ever Wellness Center, a clinic in Stone Mountain, Georgia. The indictment alleges that while employed with another medical practice in Lawrenceville, Georgia, Patterson stole the personal information of her patients to file false claims with United Insurance Company for various allergy tests and treatment that the patients never received. Additionally, she used her access to the patients’ personal information in order to steal family members’ identifying information and to seek further reimbursement from United for services she had not rendered to patients she had never seen.” For more

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Former owner of durable medical equipment company pleads guilty in $5 million health care fraud scheme
On February 24, 2015, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced, “Angel M. Mirabal, 62, of Miami, Florida, pleaded guilty to one count of conspiracy to commit wire fraud and health care fraud before U.S. District Judge Marcia G. Cooke of the Southern District of Florida. A sentencing hearing is scheduled for May 6, 2015.

“In connection with his guilty plea, Mirabal admitted that he was the owner, president and manager of Quick Solutions Medical Supplies Inc. (Quick Solutions), a durable medical equipment (DME) supply company located in Houston, Texas. Mirabel further admitted that from April 2010 through July 2013, he and his co-conspirators operated Quick Solutions for the purpose of billing the Medicare program for, among other things, expensive DME that was medically unnecessary and in many instances not provided to the Medicare beneficiaries. Indeed, many of the beneficiaries who purportedly received the DME resided hundreds of miles away in Miami.” For more

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New Jersey doctor charged with fraudulently billing for office visits that were never rendered
On February 23, 2015, U.S. Attorney Paul J. Fishman announced, Albert Ades, 60, of Englewood, New Jersey, “A family medicine physician with offices in Cresskill and Little Falls, New Jersey, was arrested and charged with fraudulently billing Medicare, Medicaid and private health care insurance companies hundreds of thousands of dollars for physician office visits that were never rendered.”

According to the government press release, “Ades, a licensed family medicine doctor who owns and operates Albert Ades M.D., P.A., fraudulently billed insurers for face-to-face physician office visits. Instead, he wrote prescriptions, authorized refills, or performed other tasks, without ever seeing those patients on the billed dates. Ades altered, and instructed individuals working at his medical practice to alter, patients’ medical charts by inserting fabricated blood pressure readings, among other notations, to make it appear as if patients had visited Ades’s office on dates for which Ades had billed their insurance plans.” For more

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Two Florida couples agree to pay $1.13 million to resolve allegations that they accepted kickbacks in exchange for home health care referrals
On February 23, 2015, the U.S. Department of Justice announced, “Two South Florida medical doctors and their wives have agreed to settle allegations that they violated the False Claims Act when their wives accepted sham marketer salaries in exchange for their husbands’ referrals to a home health care company called A Plus Home Health Care Inc. Under the settlements, Dr. Alan and Lynn Buhler will pay to the United States $1.047 million and Dr. Craig and Cynthia Prokos will pay $90,000. Dr. Buhler practices in Plantation, Florida, and Dr. Prokos practices in Jupiter, Florida.” For more

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Psychologist and psychotherapy services owner sentenced in $1.5 million Medicare fraud
On February 23, 2015, the U.S. Attorney’s Office for the Northern District of Illinois announced, “Bryce Woods, 37, an employee of Take Action, Inc., and Inner Arts, Inc., which claimed to provide psychotherapy services to Medicare beneficiaries residing in skilled nursing homes in the Chicago area, was sentenced today by U.S. District Court Judge Virginia M. Kendall to 70 months in federal prison for submitting false claims totaling more than $1.5 million to Medicare for psychotherapy services. Codefendant Keenan R. Ferrell, 55, who was the owner and operator of Take Action, Inc., and Inner Arts, Inc., as well as a licensed psychologist in Illinois, was sentenced to 88 months in federal prison back in August 2014.” For more

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This Week’s Links:
BloombergBusiness: “SEC Broker Scrutiny, Eskom Bailout, Yellen: Compliance” For more

Physician’s News Digest: “Medicare Physicians Must Be Aware of Overpayments and the False Claims Act” For more

The New York Times : “Justices Find Antitrust Law Valid Against Dental Board” For more

U.S. Consumer Product Safety Commission: General Electric Agrees to $3.5 Million Civil Penalty, Internal Compliance Program for Failure to Report Defective Ranges and Dishwashers 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: From the GAO, In the Federal Register, 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:

  • Tuesday, March 10, 1:30 PM - National Partnership to Improve Dementia Care in Nursing Homes and QAPI
  • Save the dates for the upcoming calls in 2015:
    • Tuesday, June 16 from 1:30-3pm ET
    • Thursday, September 3 from 1:30-3pm ET
    • Tuesday, December 1 from 1:30-3pm ET
  • Wednesday, March 18, 1:30 PM - 3:00 PM ET - Physician Quality Reporting Programs: Reporting Once in 2015

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

Medicare Geographic Reclassification under the IPPS Wage Index for FY 2016
The Medicare Geographic Classification Review Board (MGCRB) has begun sending out their decisions concerning geographic reclassification under the Inpatient Prospective Payment System (IPPS) wage index for FY 2016. CMS encourages hospitals to carefully review the decision issued by the MGCRB. If you believe the data in your decision is incorrect, you may appeal the decision to the Administrator within 15 days after the date the MGCRB issues its decision; please refer to 42 CFR 412.278 for information regarding appeals of MGCRB decisions to the Administrator.
Please note:

  • The Three Year MGCRB Reclassification Data for FY 2016 Applications file is available for download on the Wage Index  website and corresponds to tables 3A-2 and 3B-2 in the FY 2016 IPPS final rule wage index tables
  • Tables 3A-2 and 3B-2 are available for download on the  Acute IPPS  website

New FAQs on CY 2015 DMEPOS Medicare Payment Final Rule
New  Frequently Asked Questions and Answers  ( FAQs ) are available on the CY 2015 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) 2015 Medicare payment final rule,  CMS-1614-F :

  • The methodology for adjusting DMEPOS fee schedule payment amounts using information from the Medicare DMEPOS Competitive Bidding Programs (CBPs)
  • The payment rules for standard power wheelchairs and Continuous Positive Airway Pressure (CPAP) devices under certain Medicare DMEPOS CBPs

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From the GAO
Improper Payments: TRICARE Measurement and Reduction Efforts Could Benefit from Adopting Medical Record Reviews GAO-15-269: Published: Feb 18, 2015. Publicly Released: Feb 18, 2015 (PDF)

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Web Conferences

Increase Your Value Through HIPAA Education
March 3


Preparing Your Organization for Round Two: Tips for Surviving Privacy & Security Desk Audits
March 5


Patient and Data Privacy Considerations in a Private Health Information Exchange
March 11


Settling False Claims Act Cases With the Federal Government
March 16


Medical Necessity Compliance and the Two-Midnight Rule
March 18


Internal Compliance Surveys: Measuring Your Departments Effectiveness
March 30


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In the Federal Register
Extension of timeline for publication of a final rule: Medicare Program; Reporting and Returning of Overpayments; Extension of Timeline for Publication of the Final Rule
As stated by CMS:
"This document announces the extension of the timeline for publication of the "Medicare Program; Reporting and Returning of Overpayments" final rule. We are issuing this notice in accordance with the Social Security Act (the Act) which requires notice to be provided in the Federal Register if there are exceptional circumstances that cause us to publish a final rule more than 3 years after the publication date of the proposed rule." For more

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CMS Transmittals
2015 Transmittals and MLN Matters For more  

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From the OIG

  • Louisiana Complied With the Federal Medicaid Requirements for Billing Manufacturers for Rebates for Physician-Administered Drugs (A-06-14-00031) (02/10/2015) (PDF)
    For more
  • Prosthetic Science San Antonio, Inc., Generally Met Medicare Documentation Requirements for Lower Limb Prosthetic Claims (A-06-14-00034) (02/05/2015) (PDF)
    For more

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Acronym Library

MDSRH Medicare Dependent Small Rural Hospital
MDSS Medicare Decision Support System
MEASURES Medicare/Medicaid Automated Survey Reporting System
MECA Medicare Expanded Choice Act of 1987

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
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HCCA Phone: 888-580-8373
Fax: 952-988-0146
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Email: service@hcca-info.org
Contact: Margaret Dragon, Editor, This Week in Corporate Compliance: 781-593-4924

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Health Care Compliance Association
Vol. XVII, No. 08 | February 27, 2015

Copyright © 2015 Health Care Compliance Association


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