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Two surgeons indicted in $950M kickback scheme in California - AngioDynamics to pay $12.5 million over false claims allegations: U.S. Justice Department - Two consulting companies and nine affiliated skilled nursing facilities to pay $10 million - And More

Headlines

Two surgeons indicted in $950M kickback scheme in California

AngioDynamics to pay $12.5 million over false claims allegations: U.S. Justice Department

Two consulting companies and nine affiliated skilled nursing facilities to pay $10 million

Investigation: Patients' drug options under Medicaid heavily influenced by drugmakers

NextGen Healthcare parent to pay $19M to settle securities fraud allegations

Home health firm to pay $1.5 million in kickback scheme

LabCorp goes down after network breach, putting millions of patient records at risk

Anthem sued by doctors in dispute over emergency-room coverage

Ellsworth (ME) ambulance service agrees to pay feds $17K to settle false

St. Louis County doctor pleads guilty of obstructing FBI investigation

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This week’s health care fraud video:

C-Span: “Combating Medicare Fraud” WATCH IT NOW

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Highlights from The Compliance & Ethics Blog

The junior compliance officer – making waves

Regardless of seniority, compliance professionals have the same overarching responsibility – to ensure the business operates within the regulatory framework through the provision of advice, training, monitoring, relationship management to the business and challenge to senior stakeholders. Looking back on the early days of my compliance career, I didn’t know what to expect and I found it very difficult to make any kind of impact in my role. Now a senior member of the profession, my own struggles as a junior led me to start a blog looking at how junior compliance professionals can make an impact at the early stages of their career. Below, I share two of the hot topics of my blog to date – challenging the business and regulatory interpretation/ communication. READ MORE

Garrett Reisman on learning from the risks of spaceflight [Podcast]

Garrett Reisman has spent 107 days in space.  He is the former Director of Space Flight Operations at SpaceX and is currently a Special Advisor there.  He is also a professor of engineering at USC.

What does that have to do with compliance?  Surprisingly a great deal.  In this podcast, Garrett shows how three of NASA’s catastrophe’s – Apollo 1, the Challenger and Columbia – had several factors in common, and how similar they are to risks every compliance team may someday face. READ MORE

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Headlines

Two surgeons indicted in $950M kickback scheme in California

On July 18, 2018, Becker’s Hospital Review reported, “A federal grand jury indicted two surgeons July 17 for their alleged roles in a kickback scheme that resulted in the submission of more than $950 million in fraudulent claims, mostly to California's worker compensation system, according to the Department of Justice.

“The surgeons, Jacob Tauber, MD, and Serge Obukhoff, MD, were indicted in relation to the government's investigation into kickbacks physicians received for patient referrals for spinal surgeries performed at Pacific Hospital in Long Beach, Calif. They are among dozens of physicians and other medical professionals allegedly involved in the scheme.” READ MORE

AngioDynamics to pay $12.5 million over false claims allegations: U.S. Justice Department

On July 18, 2018, KFGO reported, “AngioDynamics Inc. has agreed to pay the U.S. government $12.5 million to resolve allegations it caused healthcare providers to submit false claims to federal healthcare programs over the use of two medical devices, the Justice Department said on Wednesday.” READ MORE

Two consulting companies and nine affiliated skilled nursing facilities to pay $10 million

On July 18, 2018, the U.S. Department of Justice announced in a press release, “Southern SNF Management, Inc., Rehab Services in Motion d/b/a Dynamic Rehab and nine affiliated skilled nursing facilities in Florida and Alabama have agreed to resolve allegations that they violated the False Claims Act by submitting or causing the submission of false claims to Medicare for medically unnecessary rehabilitation therapy services.  Under the agreement, Southern SNF, Dynamic Rehab and the nine skilled nursing facilities will pay the United States a total of $10 million.”  READ MORE

Investigation: Patients' drug options under Medicaid heavily influenced by drugmakers

On July 18, 2018, NPR reported, “Eight months pregnant, the drug sales representative wore a wire for the FBI around her bulging belly as she recorded conversations with colleagues at a conference in Chicago. Her code name? Pampers.

“Her company, drugmaker Warner Chilcott, was using payments and perks to get doctors to prescribe its drugs. Then its sales representatives gave nurses hot tips about what kind of symptoms would get Medicaid to pay for the drugs. The representatives also violated privacy laws by going through patient files and kept fax machines in their cars to fill out the paperwork meant for doctors.”
READ MORE

NextGen Healthcare parent to pay $19M to settle securities fraud allegations

On July 18, 2018, FierceHealthcare reported, “The parent company of EHR vendor NextGen Healthcare has agreed to pay $19 million to settle a class-action complaint that senior executives defrauded investors by misrepresenting the company’s financial projections.

“The settlement ends five years of litigation and suspends a request to the Supreme Court to review the case.” READ MORE

Home health firm to pay $1.5 million in kickback scheme

On July 18, 2018, WLRN (FL) reported, “The owners of a Palm Beach Gardens home-health agency have agreed to pay $1.5 million to the federal government to settle allegations that the company illegally paid kickbacks to marketers to lead to patient referrals, federal officials announced Tuesday.” READ MORE

LabCorp goes down after network breach, putting millions of patient records at risk

On July 17, 2018, HealthcareITNews reported, “Over the weekend of July 14, hackers got into LabCorp’s network. Officials immediately took certain systems offline as part of its breach response policy to contain the hack. As a result, test processing and customer access to test results was temporarily impacted.

“According to its site, LabCorp services more than 115 million patient encounters annually, which potentially put all of those patient records at risk if they were located on the impacted network. LabCorp did not respond to a request for comment.” READ MORE

Anthem sued by doctors in dispute over emergency-room coverage

On July 17, 2018, Bloomberg reported, “The American College of Emergency Physicians and the Medical Association of Georgia filed suit on Tuesday in U.S. District Court in Atlanta against Anthem’s Blue Cross and Blue Shield of Georgia unit over the denied payments. The doctors asked the court to require Anthem to halt its policy and cover the claims.” READ MORE

Ellsworth ambulance service agrees to pay feds $17K to settle false reimbursement case

On July 17, 2018, Bangor Daily News reported, “An Ellsworth-area ambulance service has settled a civil suit brought by prosecutors who charged it with filing false reimbursement claims.

“County Ambulance, Inc., has agreed to pay $16,776.74 to resolve allegations that it submitted false claims to Medicare and MaineCare from January 2015 through April 2016, the U.S. Attorney’s Office wrote Tuesday in a prepared statement. About two-thirds of all claims submitted to MaineCare, which is Maine’s Medicaid program, are paid for by the federal government.” READ MORE

St. Louis County doctor pleads guilty of obstructing FBI investigation

On July 13, 2018, St. Louis Business Journal reported, “A St. Louis County doctor has pleaded guilty to obstructing an FBI investigation regarding Medicare billing.

“Dr. Vidal Sheen, 58, who operated a medical office in St. Louis County, pleaded guilty Friday to obstructing an investigation by the FBI regarding whether he billed the Medicare program and private insurers for ‘face to face’ office visits with patients, during times when he was traveling outside the state of Missouri, and in some cases outside the U.S., according to a release from the U.S. Attorney's Office.” READ MORE

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Regulatory News

CMS Update

PEPPERs for Home Health Agencies, Partial Hospitalization Programs
Fourth quarter CY 2017 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available for Home Health Agencies (HHAs) and Partial Hospitalization Programs (PHPs). These reports summarize provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities.

  • HHAs and Community Mental Health Center PHPs: For instructions on obtaining your PEPPER, see the Secure PEPPER Access Guide 
  • PHPs operated by short-term acute care hospitals or inpatient psychiatric facilities: Your PEPPER was distributed via the QualityNet secure portal

For More Information:

Provider Compliance
Cardiac device credits: Medicare billing
A 2018 Office of the Inspector General (OIG) Report noted that payments reviewed for recalled cardiac medical devices did not comply with Medicare requirements for reporting manufacturer credits. Medicare incorrectly paid hospitals $7.7 million for cardiac device replacement claims, resulting in potential overpayments of $4.4 million. Manufacturers issued reportable credits to hospitals for recalled cardiac medical devices, but the hospitals did not adjust the claims with the proper condition codes, value codes, or modifiers to reduce payment as required.

CMS developed the Medicare Billing for Cardiac Device Credits Fact Sheet to ensure that hospitals properly report manufacturer credits for cardiac devices and avoid overpayment recoveries. Additional resources:

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

Reports

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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.