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301K patients involved in St. Mary’s paper records data breach - Chattanooga doctor and wife pay fine after Medicare fraud allegations - Lowell (MA) physicians settle drug diversion allegations - And More

Headlines

301K patients involved in St. Mary’s paper records data breach

Chattanooga doctor and wife pay fine after Medicare fraud allegations

Lowell (MA) physicians settle drug diversion allegations

Former drug company official pleads guilty in fraud and kickback scheme that cost Medicare millions

Physician sentenced to prison for role in $30M billing fraud scheme

Quincy-based dentist indicted for Medicaid fraud

Prosecutors charge top figure in $400M-plus pharmacy fraud

Rep. Chris Collins arrested on fraud charges for telling son about failed drug trial

Their company did medical billing. Now, four of them are headed for federal prison

Prime Healthcare, CEO to pay $65M Medicare fraud settlement

Grenada Lake Medical Center to pay more than $1.1 M

Detroit hospital hit with $84.5 million settlement over false claims allegations

Kansas oncologist subject of federal Medicare fraud suit for unnecessary treatments

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Highlights from The Compliance & Ethics Blog

Amii Barnard-Bahn on working with HR [Podcast]

Amii Barnard-Bahn, an executive coach and leadership consultant knows this well from a career which has included extensive work in both HR and compliance.  As she explains in this Compliance Perspectives podcast, one of the challenges in the relationship between compliance and HR is that the two sides often don’t appreciate how alike they are.  They share many of the same challenges in gaining sufficient resources and getting a seat at the table. READ MORE

Three ways to create a more human workplace

As tasks and job details become more based in technology, it can be challenging to cultivate a genuine human connection and foster an organizational culture that other businesses will try to emulate. Whether you’re a Marketing Agency based in London or a Silicon Valley mogul like Google, having a distinctly human element will set you apart from the rest. READ MORE

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Headlines

301K patients involved in St. Mary’s paper records data breach

On August 9, 2018, HealthIT Security reported, “SSM Health St. Mary’s Hospital in Jefferson City, Missouri, reported to OCR on July 30 that an improper disposal of paper medical records may have resulted in a data breach affecting 301,000 individuals.” READ MORE

Chattanooga doctor and wife pay fine after Medicare fraud allegations

On August 8, 2018, CH 9 (TN) reported, “A Chattanooga based doctor and his wife have paid more than $428,000 to resolve state and federal False Claims Act allegations.

“They are Dr. Donald Chamberlain and his wife, Karen Chamberlain.

“In a release, U.S. Attorney J. Douglas Overbey says from January 7, 2009 through May 2, 2012, their medical practice billed Medicare, Tennessee Medicaid (TennCare), and the Federal Employees Health Benefit Program (FEHBP) for foreign-sourced anticancer drugs not approved by the FDA for marketing in the United States.” READ MORE

Lowell (MA) physicians settle drug diversion allegations

On August 8, 2018, U.S. Attorney for Massachusetts Andrew Lelling announced in a press release, “Dr. Hung K. Do and his addiction treatment clinic, H.K.D. Treatment Options, have agreed to pay $23,000 to settle claims of improper billing of medical services under the Controlled Substances Act and the False Claims Act. Dr. Vasumathi Brown, a physician employed by H.K.D., has agreed to pay a $12,500 civil penalty for issuing invalid prescriptions for controlled substances under the Controlled Substances Act.” READ MORE

Former drug company official pleads guilty in fraud and kickback scheme that cost Medicare millions

On August 8, 2018, Hartford Currant reported, “A pharmaceutical sales manager pleaded guilty in U.S. District Court Wednesday to helping organize a kickback scheme that paid thousands of dollars to medical professionals in Connecticut and elsewhere who prescribed a fentanyl-based painkiller his employer manufactured.

“Jeffrey Pearlman, a district sales manager for Arizona-based Insys Therapeutics, is just one of several former Insys employees, including the company’s founder, billionaire John N. Kapoor, 74, of Phoenix, Ariz., to be implicated in the widening bribery and fraud scheme that has cost taxpayers and private insurance companies millions of dollars.” READ MORE

Physician sentenced to prison for role in $30M billing fraud scheme

On August 8, 2018, Becker’s Hospital Review reported, “A physician was sentenced to 18 months in prison Aug. 1 for his role in a $30 million scheme to defraud Medicare and New York's Medicaid program, according to the Department of Justice.

“The sentencing came after Mustak Vaid, MD, previously pleaded guilty to healthcare fraud, conspiracy to commit healthcare fraud, mail fraud and wire fraud. He posed as the owner of a medical clinic in Brooklyn and falsely claimed that he examined and treated hundreds of patients, according to court documents and statements made during his plea proceeding and sentencing.” READ MORE

Quincy-based dentist indicted for Medicaid fraud

On August 8, 2018, The Boston Globe reported, “A Quincy-based dentist, previously banned from the state’s Medicaid program, MassHealth, was indicted Tuesday for allegedly filing more than $200,000 in false claims under another doctor’s name, according to the office of State Attorney General Maura Healey.” READ MORE

Prosecutors charge top figure in $400M-plus pharmacy fraud

On August 8, 2018, Associated Press reported, “Federal prosecutors are filing criminal charges against a pharmacist they say is one of the central figures in a $400 million health care fraud.

“Thomas E. Spell Jr. of Ridgeland was charged Wednesday with one count of attempt and conspiracy to commit health care fraud.” READ MORE

Rep. Chris Collins arrested on fraud charges for telling son about failed drug trial

On August 8, 2018, Market Watch reported, “Rep. Christopher Collins of New York was arrested on federal charges relating to securities fraud Wednesday, in a case involving an Australian biotech company.”
READ MORE

Their company did medical billing. Now, four of them are headed for federal prison

On August 7, 2018, Miami Herald reported, “Little Havana’s Billing USA offered a comprehensive menu of services for its medical business clients, from basic billing to complete financial falsehoods that made multimillion-dollar healthcare fraud almost cut-and-paste easy.

“Friday’s conviction of Billing USA office manager Francel Rodriguez on one count of conspiracy to commit healthcare fraud is only part of the story.” READ MORE

Prime Healthcare, CEO to pay $65M Medicare fraud settlement

On August 6, 2018, Becker’s Hospital Review reported, “Ontario, Calif.-based Prime Healthcare Services, as well as its nonprofit arm, consulting subsidiary and CEO, agreed to pay $65 million to the federal government to resolve allegations hospitals submitted false Medicare claims and admitted patients who only needed cheaper, outpatient care, according to the Justice Department.

“As part of the settlement, Prime Healthcare founder and CEO Prem Reddy, MD, will pay $3.25 million, while Prime Healthcare, Prime Healthcare Foundation and Prime Healthcare Management will pay $61.75 million.” READ MORE

Grenada Lake Medical Center to pay more than $1.1 M

On August 6, 2018, U.S. Department of Justice announced in a press release, “Grenada Lakes Medical Center (GLMC), a publicly-owned hospital which at various times has been operated by the University of Mississippi Medical Center and by the Grenada Lake Medical Center Board of Trustees, has agreed to pay more than $1.1 million to resolve False Claims Act allegations that the hospital sought and received reimbursement from Medicare for services that were not medically reasonable or necessary. 

“The settlement resolves allegations that, beginning in January 2005 and continuing until April 2013, the hospital submitted claims for Intensive Outpatient Psychotherapy (IOP) services that did not qualify for Medicare reimbursement.  The IOP services in question were performed on GLMC’s behalf by Allegiance Health Management (Allegiance), a post-acute healthcare management company based in Shreveport, Louisiana, but billed to Medicare by GLMC directly.” READ MORE

Detroit hospital hit with $84.5 million settlement over false claims allegations

On August 6, 2018, Healthcare Finance News reported, “Detroit-based William Beaumont Hospital has agreed to pay $84.5 million to resolve allegations the system maintained improper relationships with eight referring physicians, which resulted in the submission of false claims to the Medicare, Medicaid and TRICARE programs, the Justice Department announced.” READ MORE

Kansas oncologist subject of federal Medicare fraud suit for unnecessary treatments

On August 3, 2018, Kansas City Star reported, “The federal government plans to sue a Kansas oncologist for allegedly submitting fraudulent claims to government insurers — including Medicare, Medicaid and TRICARE — for cancer treatments that were medically unnecessary.

“Mark Fesen, who was the subject of an investigation four years ago by The Wichita Eagle, worked for the Hutchinson Clinic from 1993 to 2011, until he left to work for Central Care Cancer Center, which has offices across the state. The center’s website says Fesen currently works at its offices in Wichita and Great Bend.” READ MORE

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Regulatory News

CMS Update

Provider Compliance

Reporting Changes in Ownership — Reminder
A 2016 Office of the Inspector General (OIG) report noted that providers may not be informing CMS of ownership changes. Providers must update their enrollment information to reflect changes in ownership within 30 days. Owners are individuals or corporations with a 5 percent or more ownership or controlling interest. Failure to comply could result in revocation of your Medicare billing privileges.
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

Advisory Opinion 18-07 READ MORE

Updated Corporate Integrity Agreement List
READ MORE

Updated Civil Monetary Penalties and Affirmative Exclusions READ MORE

Updated Provider Self-Disclosure Settlements READ MORE

Audit Reports
Medicare Compliance Review of WakeMed Raleigh Campus (A-04-17-04057) READ MORE

OEI Reports
Questionable Billing for Compounded Topical Drugs in Medicare Part D (OEI-02-16-00440) READ MORE

Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2016 Average Sales Prices (OEI-03-18-00120) READ MORE

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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.