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Post Acute Medical agrees to pay more than $13M - DOJ, HHS continue war on Medicare fraud with formation of new regional fraud strike force - HIPAA through the years: 5 biggest fines since 2008 - And More

 

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KFVS 12 TV: Red Bud, IL pharmacy owner pleads guilty to fraudulent charges

 

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Post Acute Medical agrees to pay more than $13M

 

DOJ, HHS continue war on Medicare fraud with formation of new regional fraud strike force

 

HIPAA through the years: 5 biggest fines since 2008

 

Miami judge tosses key evidence, accuses feds of ‘misconduct’ in Medicare fraud case

 

Former Merced-area executive pleads guilty to health care fraud

 

Boston-based home health care provider is sentenced for Medicaid fraud

 

Grand jury indicts physician for illegal remuneration for health care referrals

 

Pharmacist pleads guilty in health care fraud scheme

 

Regulatory News

CMS Update

 

From the OIG

 

From the Federal Register

 

CMS Transmittals

 

Acronym Library

 

Product Features

HIPAA Training Handbook, 3rd Edition

 

Research Compliance Professional's Handbook, 2nd Edition

Subscribe to Report on Medicare Compliance | Learn more >

 

 

Grow your healthcare compliance career. Join HCCA! Learn More >

 

 

 

Post Acute Medical agrees to pay more than $13M

On August 15, 2018, U. S. Department of Justice announced, “Post Acute Medical, LLC, a Pennsylvania-based operator of long‑term care and rehabilitation hospitals across the country, and certain affiliated entities through which the company operates its facilities (collectively, PAM), have agreed to pay the United States, Texas, and Louisiana a total of $13,168,000 to resolve claims that they violated the False Claims Act, and the Texas and Louisiana false claims statutes, by knowingly submitting claims to the Medicare and Medicaid programs that resulted from violations of the Anti‑Kickback Statute and the Physician Self‑Referral Law.”

 

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DOJ, HHS continue war on Medicare fraud with formation of new regional fraud strike force

On August 14, 2018, Healthcare Finance News reported, “The Department of Justice has announced a new regional Medicare fraud strike force for the Newark, NJ and Philadelphia, Pennsylvania region.

 

“The new force, which will be known as the Newark/Philadelphia Regional Medicare Fraud Strike Force, is a joint law enforcement effort combining the resources and expertise of the Health Care Fraud Unit in the Criminal Division's Fraud Section, the U.S. Attorney's Offices for the District of New Jersey and the Eastern District of Pennsylvania, as well as law enforcement partners at the FBI, U.S. Department of Health and Human Services Office of the Inspector General and U.S. Drug Enforcement Administration.”

 

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HIPAA through the years: 5 biggest fines since 2008

On August 14, 2018, Becker’s Health IT & CIO Report reported, “Civil monetary penalties issued by OCR for HIPAA violations can reach up to $50,000 per violation, with an annual maximum of $1.5 million. The U.S. Justice Department may impose fines up to $250,000 and imprisonment up to 10 years for HIPAA violations, depending on the circumstances of the breach.”

 

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Miami judge tosses key evidence, accuses feds of ‘misconduct’ in Medicare fraud case

On August 13, 2018, Miami Herald reported, “Federal prosecutors have lost a major battle in the nation’s biggest Medicare criminal case as a judge threw out key evidence in the $1 billion fraud indictment against wealthy Miami Beach businessman Philip Esformes while finding ‘misconduct’ by the Justice Department’s investigative team.”

 

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Former Merced-area executive pleads guilty to health care fraud

On August 13, 2018 Merced Sun-Star reported, “The former executive of several Merced-area health clinics pleaded guilty on Monday to health care fraud and receiving kickbacks in connection with a years-long, multimillion-dollar scheme, the California Department of Justice announced.

 

“Sandra Haar, 57, was the founder and chief executive officer of Horisons Unlimited, a nonprofit chain of clinics that provided health and dental services to thousands of low-income patients in Merced and other parts of the San Joaquin Valley.”

 

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Boston-based home health care provider is sentenced for Medicaid fraud

On August 13, 2018, The Boston Globe reported, “The owner of a Boston home health care agency was sentenced on Friday to two to three years in state prison.”

 

A press release from Massachusetts Attorney General Maura Healey noted, “Suffolk Superior Court Judge Douglas Wilkins sentenced Elena Kurbatzky, age 45, of Boston to two to three years in state prison, with three years of probation to serve upon her release. Kurbatzky must also provide restitution up to $1.8 million and is forbidden from contracting with federal and state health care programs while on probation.”

 

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Grand jury indicts physician for illegal remuneration for health care referrals

On August 10, 2018, U.S. Attorney for the Northern District of Oklahoma Trent Shores announced in a press release, “that a federal grand jury returned an indictment against Adam Gallardo Arrendondo, 56, of Waxahachie, Texas, charging him with Illegal Remuneration for Health Care Referrals.”

 

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Pharmacist pleads guilty in health care fraud scheme

On August 9, 2018, WDAM (MS) reported, “A Ridgeland pharmacist pleaded guilty Thursday for his role in a scheme to defraud TRICARE and other health care benefit programs out of more than $240 million.

 

"Thomas Edward Spell Jr., 50, pleaded guilty before U.S. District Judge Keith Starrett in Hattiesburg to a criminal complaint outlining his role in the scheme, according to a Department of Justice news release.”

 

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Clinical Practice Compliance Conference | Register by Aug 28 to save $300 | Learn more >Clinical Practice Compliance Conference | Register by Aug 28 to save $300 | Learn more >

 

 

CMS Update

 

Pathways to success for the Medicare Shared Savings Program proposed - CMS Fact Sheet

On August 9, 2018, the Centers for Medicare and Medicaid Services (CMS) “issued a proposed rule that would set a new direction for the Medicare Shared Savings Program (Shared Savings Program). Referred to as ‘Pathways to Success,’ this proposed new direction for the Shared Savings Program would redesign the participation options available under the program to encourage Accountable Care Organizations (ACOs) to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses), increase savings for the Trust Funds and mitigate losses, reduce gaming opportunity and increase program integrity, and promote regulatory flexibility and free-market principles. This proposed rule would also strengthen beneficiary engagement, ensure rigorous benchmarking, and help improve care for Medicare beneficiaries, with an emphasis on combatting opioid addiction and expanding the use of interoperable electronic health record technology among ACO providers/suppliers. The proposed policies also include changes to address the additional tools and flexibilities for ACOs established by the Bipartisan Budget Act of 2018 (BBA of 2018), specifically in the areas of new beneficiary incentives, telehealth services, choice of beneficiary assignment methodology, and voluntary alignment refinements.”

 

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From the OIG

 

Updated: Work Plan

 

See Details

 

 

Advisory Opinion 18-08

 

See Details

 

 

Audit Reports

Maryland Did Not Adequately Secure Its Medicaid Data and Information Systems

 

See Report

 

 

CMS Did Not Always Accurately Authorize Financial Assistance Payments to Qualified Health Plan Issuers in Accordance With Federal Requirements During the 2014 Benefit Year

 

See Report

 

 

 

From the Federal Register

View FR Index 2018

 

 

CMS Transmittals

View 2018 Transmittals

 

 

Acronym Library

Find CMS Acronyms

 

Product Features

 

HIPAA Training Handbook, 3rd Edition

 

Learn More

 

 

Research Compliance Professional's Handbook, 2nd Edition

 

Learn More

 

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Questions/Feedback?

Please feel free to contact Margaret Dragon, editor of Compliance Weekly News.

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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.