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CMS seeks input on potential Stark Law revisions - Healogics settles False Claims allegations, agrees to pay up to $22 million - Fraud fears rise as feds expand access to association health plans - And More

Headlines

CMS seeks input on potential Stark Law revisions

Healogics settles False Claims allegations, agrees to pay up to $22 million

Fraud fears rise as feds expand access to association health plans

Bezos, Buffett, Dimon health venture will be based in Boston

Judge rules in favor of OCR and upholds $4.3M fine for MD Anderson

Radiologist sentenced to 10 years in prison, $250K fine for kickback scheme

Ex-Tenet executive claims kickback charges 'legally flawed'

Waterbury clinician settles CT Medicaid fraud

New Joint Commission advisory on identifying human trafficking victims in health care

Philadelphia personal injury law firm agrees to start compliance program and reimburse US for clients’ Medicare debts

Theranos' Elizabeth Holmes and 'Sunny' Balwani are indicted and accused of fraud schemes

Three more physicians charged in $580M kickback scheme at Pacific Hospital

Nurse admits receiving $50K in kickbacks

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This week’s health care fraud video:

KRGV TV 5, Weslaco, Texas
Valley doctor charged in alleged $240M health care fraud case WATCH IT NOW

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Highlights from The Compliance & Ethics Blog

K is for kindness

In previous articles I have written about fear in the workplace and the use of hotlines to address that and other pressing questions and concerns.  This article falls in the category of an ounce of prevention being worth a pound of cure.  Roughly 80% of calls to hotlines relate in one way or another to Human Resources issues.  And most of those deal with a lack of respect in the workplace (the subject of a future article). READ MORE

Karen Moore on when it’s time to leave your employer [Podcast]

Karen Moore is a compliance officer who has worked both in Europe and in the US. Like most people, in the course of her career she had chosen to leave one job for another. The easy changes are the ones where a great new opportunity comes out of nowhere, and you just can’t say no.  Sometimes, though, there is the opposite situation:  the job grows to be intolerable. You dread coming in and every minute of the day. READ MORE

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Headlines

CMS seeks input on potential Stark Law revisions

On June 21, 2018, HealthLeaders Media reported, “The Centers for Medicare & Medicaid Services is considering revisions to the Stark Law banning physician self-referrals, and they're asking for input from stakeholders.  

“‘In its current form, the physician self-referral law may prohibit some relationships that are designed to enhance care coordination, improve quality, and reduce waste,’ CMS Administrator Seem Verma said Wednesday in a blog post.” READ MORE

Healogics settles False Claims allegations, agrees to pay up to $22 million

On June 21, 2018, Orlando Sentinel reported, “Healogics has agreed to pay up to $22 million to settle allegations that it knowingly billed Medicare for medically unnecessary therapies, the Justice Department announced on Wednesday.”

According to the government press release, “The allegations stem from two whistleblower lawsuits, one filed by a former director for research and quality at Healogics and another filed by several doctors and employees at Healogics-affiliated wound care centers.” READ MORE

Fraud fears rise as feds expand access to association health plans

On June 20, 2018, Modern Healthcare reported, “Regulators and insurance experts worry the Trump administration's new rule expanding association health plans for small businesses and self-employed people will lead to a spike in insurance fraud and insolvencies that plagued consumers and healthcare providers in the past.

“The Labor Department's 198-page final rule, issued Tuesday in response to President Donald Trump's executive order in October, will make it easier for small firms and individuals to band together across state lines in association health plans governed by the Employee Retirement Income Security Act.” READ MORE

Bezos, Buffett, Dimon health venture will be based in Boston

On June 20, 2018, The Boston Globe reported, “Three of the country’s best-known business leaders have turned to Dr. Atul Gawande, a Boston surgeon and best-selling author, to head their new company aimed at reinventing how health care is delivered.” READ MORE

Judge rules in favor of OCR and upholds $4.3M fine for MD Anderson

On June 19, 2018, Healthcare Informatics reported, “Houston-based The University of Texas MD Anderson Cancer Center must pay $4.3 million in fines stemming from three separate breaches involving unencrypted electronic devices that exposed patient data for 33,500 patients, according to an administrative law judge's recent ruling.

“On June 1, U.S. Department of Health and Human Services (HHS) Administrative Law Judge Steven Kessel that MD Anderson violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules for failing to encrypt electronic devices, and granted summary judgment to the HHS Office for Civil Rights (OCR) on all issues, requiring MD Anderson to pay $4,348,000 in civil money penalties imposed by OCR.” READ MORE

Radiologist sentenced to 10 years in prison, $250K fine for kickback scheme

On June 19, 2018, Radiology Business reported, “Radiologist Ronald Grusd, MD, has been sentenced to 10 years in federal prison and ordered to pay a $250,000 fine after being found guilty of fraud and bribery in connection with a detailed kickback scheme back in December 2017.” READ MORE

Ex-Tenet executive claims kickback charges 'legally flawed'

On June 19, 2018, Becker’s ASC Review reported,” A former Dallas-based Tenet Healthcare executive — who the U.S. Department of Justice alleged was involved in a $400 million kickback scheme — filed a motion calling his indictment ‘legally flawed,’ Reuters reports.” READ MORE

Waterbury clinician settles CT Medicaid fraud

On June 19, 2018, Hartford Business.com reported, “A Waterbury private social worker must repay Connecticut $200,000 and accept a 10-year ban to settle civil claims he abused the state's Medicaid program, authorities say.” READ MORE

New Joint Commission advisory on identifying human trafficking victims in health care

On June 19, 2018, the Joint Commission released an advisory to highlight how health care organizations can help to identify Human Trafficking Victims. Per the advisory, “Human trafficking is the fastest growing criminal industry in the world and the second-largest source of income for organized crime. Knowing how to identify victims, when to involve law enforcement, and what community resources are available is important information for all health care professionals to know—and is the focus of a new Quick Safety advisory from The Joint Commission.” READ MORE

Philadelphia personal injury law firm agrees to start compliance program and reimburse US for clients’ Medicare debts

On June 18, 2018, U.S. Attorney for the Eastern District of Pennsylvania William M. McSwain announced, “Philadelphia personal injury law firm, Rosenbaum & Associates, and its principal, Jeffrey Rosenbaum, Esq., have entered into a settlement agreement with the United States to resolve allegations that they failed to reimburse the United States for certain Medicare payments the government had previously made to medical providers on behalf of firm clients who sought medical care.”

According to the government press release, “…Rosenbaum agreed to pay a lump sum of $28,000. Rosenbaum also agreed to (1) designate a person at the firm responsible for paying Medicare secondary payer debts; (2) train the designated employee to ensure that the firm pays these debts on a timely basis; and (3) review any outstanding debts with the designated employee at least every six months to ensure compliance. In addition, Rosenbaum acknowledged that any failure to submit timely repayment of Medicare secondary payer debt may result in liability for the wrongful retention of a government overpayment under the False Claims Act.” READ MORE

Theranos' Elizabeth Holmes and 'Sunny' Balwani are indicted and accused of fraud schemes

On June 15, 2018, Los Angeles Times reported, “Theranos Inc. founder Elizabeth Holmes and former company President and Chief Operating Officer Ramesh ‘Sunny’ Balwani have been charged by a federal grand jury of wire fraud and conspiracy to commit wire fraud, the Justice Department said Friday.” READ MORE

Three more physicians charged in $580M kickback scheme at Pacific Hospital

On June 15, 2018, Los Angeles Business Journal reported, “Three more doctors were charged in connection to an alleged $580 million kickback scheme linked to spinal surgeries at the defunct Pacific Hospital in Long Beach.” READ MORE

Nurse admits receiving $50K in kickbacks

On June 15, 2018, Sun Herald (MS) reported, “A nurse practitioner has pleaded guilty in the same health care fraud conspiracy that snared longtime Biloxi doctor Albert Diaz Jr.

“Susan K. Perry, 58, who had a family clinic in Biloxi, pleaded guilty Friday to one charge of conspiracy to commit health care fraud, a news release from the U.S. Attorney's Office says.” READ MORE

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Regulatory News

Office of Civil Rights issues new guidance on HIPAA and individual authorization of uses and disclosures of PHI for research

OCR has issued new guidance on HIPAA and individual authorization of uses and disclosures of protected health information (PHI) for research.  This guidance explains certain requirements for an authorization to use or disclose PHI for future research.  The guidance also clarifies aspects of the individual’s right to revoke an authorization for research uses and disclosures of PHI.  You can find a direct link to the guidance here:  READ MORE

CMS Update

Provider Compliance
Payment for outpatient services provided to beneficiaries who are inpatients of other facilities — Reminder
In a recent report, the Office of the Inspector General (OIG) determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. As a result, beneficiaries were unnecessarily charged outpatient deductibles and coinsurance payments.

All items and non-physician services provided during a Medicare Part A inpatient stay must be provided directly by the inpatient hospital or under arrangements with the inpatient hospital and another provider. Use the following resources to bill correctly:

 

In the Federal Register

2018 Federal Register items per day: READ MORE

FR Index 2018 READ MORE

CMS Transmittals

2018: READ MORE

From the OIG

Updated Corporate Integrity Agreement List

Updated Civil Monetary Penalties and Affirmative Exclusions

Updated: Work Plan

Advisory Opinion 18-04

OIG Podcast
Pain management doctor was a "one-man crime wave"
https://oig.hhs.gov/newsroom/podcasts/hhsoig.asp#gott

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Health Care Compliance Library
HCCA offers members and registered guests access to an extensive library of articles. Information provided covers topics in corporate compliance and ethics in healthcare organizations. Contributing authors include attorneys, chief compliance officers, providers of auditing, monitoring, coding, billing and technology services, and other members of our compliance community.