March Basic Compliance Academy
March 9 – 12, 2015
Las Vegas, NV
April Basic Compliance Academy
April 27 – 30, 2015
Lake Buena Vista, FL
June Basic Compliance Academy
June 8 – 11, 2015
August Basic Compliance Academy
August 10 - 13, 2015
New York, NY
September Basic Compliance Academy
Sept 28 - Oct 1, 2015
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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
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.”
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.”
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.”
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
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
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
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
This week, MediRegs provided TWCC readers with the following: From the GAO, In the Federal Register, CMS Transmittals and From the OIG
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.
- 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
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)