This Week in Corporate Compliance HCCAnet Health Care Compliance Association Click here to Add TWCC to your Address Book to Ensure Delivery

Sponsor

The Master of Bioethics Degree, offered through the Center for Bioethics at Harvard Medical School, combines resources from the Center, Harvard teaching hospitals, and departments across the University.


Hall, Render, Killian, Heath & Lyman, P.C. focuses its practice on health law and is recognized as one of the nation’s preeminent health law firms.



Regional Conferences

2015 Regional Conference Prospectus Available


Philadelphia Regional Conference
June 5, 2015
Philadelphia, PA


Seattle Regional Conference
June 12, 2015
Seattle, WA


Santa Ana Regional Conference
June 19, 2015
Santa Ana, CA


Boston Regional Conference
September 11, 2015
Boston, MA


Minneapolis Regional Conference
September 18, 2015
Minneapolis, MN


View a Full List of 2015
Regional Conferences
Click Here

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
September 14 – 17, 2015
Chicago, IL


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


October Basic Compliance Academy
October 19 – 22, 2015
Las Vegas, NV

SCCE on Twitter
For news and updates on HCCA and Healthcare Compliance. No login or registration required.

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


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.
Click Here to Buy Now

Web Conferences

Exit Interviews: Best Practices for Compliance Effectiveness
June 9, 2015


Ethics of Denials Avoidance-The Power of Communicative Knowledge
June 10, 2015


Practical Auditing Methods and Solutions
June 15, 2015


Commercial and Medicare Risk Adjustment Audit Readiness
June 23, 2015


Heed the Warnings: Using FDA Warning Letters to Stay Audit Ready
June 29, 2015


View our List of remaining 2015 Web Conferences Click Here


Order Past HCCA Web Conferences Click Here


Vol. XVII, No. 21
May 29, 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 – May 29, 2015

OIG Releases FY 2015 Work Plan Mid-Year Update

Chicago-area psychologist pleads in nationwide Medicare fraud strike force takedown

Hamilton Health Center agrees to settlement of federal civil matter

Durable medical equipment suppliers to pay $7.5 million to resolve False Claims Act allegations

Owner of Los Angeles medical supply company sentenced to seven years in prison for $3.3 million Medicare fraud scheme

Detroit-area neurosurgeon admits causing serious bodily injury to patients in $11 million health care fraud scheme

Owner Of Parsippany-based diagnostic testing facility sentenced

Grassley presses CMS on Medicare Advantage fraud

Long-term care pharmacy to pay $31.5 million to settle lawsuit alleging violations of Controlled Substances Act and False Claims Act

SCCE Blog

This Week’s Links

Regulatory News

CMS Update

From the GAO

In the Federal Register

CMS Transmittals

From the OIG

Acronym Library


Headlines

OIG Releases FY 2015 Work Plan Mid-Year Update
On May 28, 2015, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced its FY 2015 HHS OIG Work Plan Mid-Year Update.

According to the OIG Website, “The HHS Office of Inspector General (OIG) Work Plan Mid-Year Update for Fiscal Year 2015 summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. This edition removes items that have been completed, postponed, or canceled and includes new items that have been started since October 2014. The Work Plan describes the primary objectives and provides for each review its internal identification code and the year in which we expect one or more reports to be issued as a result of the review. When reports are issued, they are posted to OIG's website. OIG's email list subscribers automatically receive notification when new reports are posted to the website.” For more

***top***

Chicago-area psychologist pleads in nationwide Medicare fraud strike force takedown
On May 27, 2015, U.S. Attorney for the Northern District of Illinois Zachary T. Fardon announced, “An area psychologist pled guilty today to engaging in a health care fraud scheme to defraud the Medicare program. Sharon A. Rinaldi, a licensed psychologist, was charged in a five-count indictment returned in October 2012 with defrauding Medicare by submitting thousands of false claims for providing psychotherapy services to Medicare beneficiaries residing in skilled nursing homes in the Chicago area. Rinaldi submitted false claims to Medicare seeking a total reimbursement of approximately $1.1 million and as a result of those false claims, Medicare paid Rinaldi at least $447,155 in funds to which she was not entitled. Rinaldi, 60, of Inverness, pled to one count of health care fraud before U.S. District Court Judge Robert M. Dow. Rinaldi also has agreed to forfeit of more than $100,000 that was seized from her home and a personal bank account in September 2012.” For more

***top***

Hamilton Health Center agrees to settlement of federal civil matter
On May 27, 2015, the U.S. Attorney’s Office for the Middle District of Pennsylvania announced,  “Hamilton Health Center, Inc., a federally qualified health center in Harrisburg, Pennsylvania, has agreed to pay the United States $270,000 to settle False Claims Act allegations. The settlement results from a self-disclosure by Hamilton to the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) through the OIG’s Provider Self-Disclosure Protocol.” For more

***top***

Durable medical equipment suppliers to pay $7.5 million to resolve False Claims Act allegations
On May 27, 2015, the U.S. Department of Justice announced, “Orbit Medical Inc. and Rehab Medical Inc. will pay $7.5 million to resolve allegations that Orbit submitted false claims to federal health care programs for power wheelchairs and accessories.”

The Salt Lake City Tribune reported on May 28, 2015, “Orbit Medical Inc., of Murray, and Rehab Medical Inc., of Indianapolis, which split off from the Utah-based operation after the fraudulent actions occurred, agreed to the settlement with the Department of Justice and two former employees who filed a federal court lawsuit alleging fraud.” For more | DOJ

***top***

Owner of Los Angeles medical supply company sentenced to seven years in prison for $3.3 million Medicare fraud scheme
On May 26, 2015, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced, “The former owner of a Los Angeles-based medical supply company was sentenced today to seven years in prison for his role in a fraud scheme that resulted in $3.3 million in fraudulent claims to Medicare.”

According to the government press release, “Hakop Gambaryan, 55, of East Hollywood, California, was convicted following a jury trial on March 20, 2015, of four counts of health care fraud.  In addition to the prison sentence, U.S. District Court Judge Otis D. Wright II of the Central District of California ordered Gambaryan to pay $1,740,009 in restitution.

“At trial, the evidence showed that Gambaryan, the former owner of a durable medical equipment supply company, fraudulently billed more than $3 million to Medicare for durable medical equipment, such as expensive power wheel chairs, that was not medically necessary.  Medicare paid approximately $1.7 million on those fraudulent claims.” For more

***top***

Detroit-area neurosurgeon admits causing serious bodily injury to patients in $11 million health care fraud scheme
On May 22, 2015, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced, “A Detroit-area neurosurgeon pleaded guilty today in two separate criminal cases that resulted in serious bodily injury to his patients and more than $11 million in (fraudulent charges to) Medicare, Medicaid and private insurance companies.”

MLive reported May 26, 2015 “Dr. Aria O. Sabit, 39, of Birmingham, in some cases, cared more about how much he could bill insurance companies for a surgery than whether his patients really needed it, the federal government says.

“Sabit, who owns and operates the Michigan Brain and Spine Physicians Group with offices in Southfield, Clinton Township and Dearborn, on Tuesday pleaded guilty to four counts of health care fraud, each punishable by up to 10 years in prison; one count of conspiracy to commit health care fraud and one count of unlawful distribution of a controlled substance.” For more | DOJ

***top***

Owner Of Parsippany-based diagnostic testing facility sentenced
On May 21, 2015, U.S. Attorney for New Jersey Paul J. Fishman announced, “A Morris County, New Jersey, man was sentenced today to 12 months in prison for his role in a scheme to bill for diagnostic testing services he did not render and to enable a cardiologist to evade the Medicare program’s pre-payment review of his claims.”

“Vijay Patel, 57, of Parsippany, New Jersey, previously pleaded guilty before U.S. District Judge Esther Salas to an information charging him with one count of health care fraud. Judge Salas imposed the sentence today in Newark federal court.” For more

***top***

Grassley presses CMS on Medicare Advantage fraud
On May 21, 2015, Modern Healthcare reported, “Sen. Chuck Grassley is pressing the CMS and the U.S. Justice Department to crack down on Medicare Advantage fraud—an issue that's spurring a growing number of lawsuits and could be costing the government billions.

“The Iowa Republican, who leads the congressional Judiciary Committee, sent letters Tuesday to Andrew Slavitt, CMS' acting administrator, and U.S. Attorney General Loretta Lynch imploring them to take action. He cited government agency and news reports from The Center for Public Integrity outlining the issue.” For more

***top***

Long-term care pharmacy to pay $31.5 million to settle lawsuit alleging violations of Controlled Substances Act and False Claims Act
On May 14, 2015, U.S. Department of Justice announced, “PharMerica Corporation has agreed to pay the United States $31.5 million to resolve a lawsuit alleging that they violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription and violated the False Claims Act by submitting false claims to Medicare for these improperly dispensed drugs.” For more

***top***

SCCE Blog Weekly News

Blinded by Human Nature and Compliance:
We all like to think we’d act quickly and effectively to stop ongoing, illegal, dangerous, or unethical acts once we had notice or a whiff of knowledge of improper behavior. That’s one reason why the apparent inaction of many in the face of allegedly cruel, sadistic, and criminal conduct at Penn State is so shocking. That could not be me, we say. I know I’d have behaved differently. That was certainly my first reaction. For more

***top***

This Week’s Links:

BloombergBusiness: “CVS deal for Omnicare seen avoiding PharMerica antitrust stumble” For more

FierceHealthPayer: “Blue Cross and Blue Shield faces antitrust allegations” For more

McKnight’s Long Term Care News: “Supreme Court whistleblower rulings a mixed blessing for providers” For more

GAO
-Medicare: Results from the First Two Years of the Pioneer Accountable Care Organization Model. GAO-15-401, April 22.  For more

-Medicare Physician Payment Rates: Better Data and Greater Transparency Could Improve Accuracy. GAO-15-434, May 21.   For more

***top***

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:

Wednesday, June 3, 1:30-3pm ET - 2014 Mid-Year QRURs

Tuesday, June 9, 2:30-4pm ET - Medicare Shared Savings Program ACO: Application Review

Tuesday, June 16 from 1:30-3 pm ET - National Partnership to Improve Dementia Care in Nursing Homes and QAPI

Wednesday, June 17; 1:30-3pm ET - Hospice Quality and Hospice Item Set Manual V1.02

Thursday, June 18, 1:30-3pm ET - ICD-10: Preparing for Implementation and New ICD-10-PCS Section X

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

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

Special Open Door Forum:
Tuesday, June 2; 1:30-2:30pm ET - Home Health Quality Reporting Requirements
For more: For more

New from MLN
“Medically Unlikely Edits Compliant” Podcast — Released

“Medicare Appeals Process” Fact Sheet — Revised 

***top***

From the GAO
Older Adults: Federal Strategy Needed to Help Ensure Efficient and Effective Delivery of Home and Community-Based Services and Supports GAO-15-190: Published: May 20, 2015. Publicly Released: May 20, 2015 (PDF) For more

***top***

In the Federal Register
Final rule: Medicare and Medicaid Programs: Revisions to Deeming Authority Survey, Certification, and Enforcement Procedures
As stated by CMS:
"This final rule revises the survey, certification, and enforcement procedures related to CMS oversight of national accrediting organizations (AOs). The revisions implement certain provisions under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)." For more

SSA
Rule: Revised Medical Criteria for Evaluating Cancer (Malignant Neoplastic Diseases) 28821-28832 [2015-11923] For more

***top***

CMS Transmittals
2015 Transmittals and MLN Matters For more

***top***

From the OIG
Corporate Integrity Agreements
PharMerica Corporation - Louisville, KY - 05/11/2015 (PDF) For more

Audit Reports

  • First Coast Service Options, Inc., Paid Some Unallowable Sleep Study Claims (A-04-13-07039) (05/15/2015) (PDF) For more
  • Medicare Compliance Review of Saint Anthony's Medical Center for 2011 and 2012 (A-07-14-05059) (05/14/2015) (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 2014 (A-17-15-52000) (05/18/2015) (PDF) For more

***top***

Acronym Library

MED-ED Medical Education
MEDAL Medicare/Medicaid Eligibility Data Linkage
MEDB Manage the EDB System
MEDB Medicare Part B
MEDIBAPS Medicare Budget Allocation Process System

Click here for more from CMS Acronyms

***top***

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.

***top***

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

To subscribe to TWCC, click here


This Week’s HCCA Corporate Members

CCI maintains a dedicated hotline reporting service, ComplianceLine®, which was established in 1998 and is the standard in the healthcare industry. 
DLA Piper

Click here to see more