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OIG excludes company and owner from federal health care programs - Local doctor admits to falsely prescribing opioids to girlfriends - Doctor, wife plead not guilty to new charges in healthcare fraud case - And More

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OIG excludes company and owner from federal health care programs

Local doctor admits to falsely prescribing opioids to girlfriends

Doctor, wife plead not guilty to new charges in healthcare fraud case

Justice Department takes first-of-its-kind legal action to reduce opioid over-prescription

HOPE Clinic nurse pleads guilty

LI doctor sentenced to 1 year, 1 day in clinic scam, officials say

South Carolina becomes a leader in federal health care fraud cases, with millions at stake

Physicians underreport conflicts of interest from devicemakers, study suggests

Nurse pleads guilty to fraud related to Fulton man's death

Texas ambulance company owner convicted

Genesee County (MI) physician, two others charged with health care fraud

Lincare pays $5.25M to resolve False Claims Act allegations

Regulatory News

CMS Update

From the OIG

From the Federal Register

CMS Transmittals

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HIPAA Training Handbook, 3rd Edition

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OIG excludes company and owner from federal health care programs

On August 23, 2018, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) announced, “On August 17, 2018, Administrative Law Judge (ALJ) Bill Thomas upheld OIG's 15-year exclusion of Karim Maghareh, Ph.D. and BestCare Laboratory Services, LLC from participation in all Federal health care programs under section 1128(b)(7) of the Social Security Act.

 

“‘The decision reached in this case illustrates how OIG will use its administrative exclusion authority to protect the Federal health care programs from untrustworthy individuals and entities who engage in Medicare fraud,’ said Gregory E. Demske, Chief Counsel to the HHS Inspector General.”

 

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Local doctor admits to falsely prescribing opioids to girlfriends

On August 23, 2018, KMOX reported, “A Warren County Doctor admits to writing opioid prescriptions for three girlfriends.

“Dr. Phillip Dean pleads guilty in federal court to charges of prescribing very powerful drugs including Oxycodone, Hydrocodone, Codeine and other narcotics for the women over a period of three years.”

 

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Doctor, wife plead not guilty to new charges in healthcare fraud case

On August 22, 2018, The Brownsville Herald reported, “A doctor and his wife pleaded not guilty to new federal charges related to a healthcare fraud case.

“Dr. Jorge Zamora-Quezada, a local rheumatologist, and his wife Meisy Angelica Zamora appeared before U.S. Magistrate Judge J. Scott Hacker Tuesday morning in connection with new federal charges levied against them by the federal government.”

 

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Justice Department takes first-of-its-kind legal action to reduce opioid over-prescription

On August 22, 2018, U.S. Department of Justice announced, “The Justice Department filed a complaint to bar two Ohio doctors from prescribing medications after an investigation revealed they recklessly and unnecessarily distributed painkillers and other drugs. Temporary restraining orders—a first-of-its-kind against doctors allegedly prescribing opioids illegally under the Controlled Substances Act (CSA)—were served this week that forbid Michael P. Tricaso, D.O., of Akron, and Gregory J. Gerber, M.D., of Sandusky, from writing prescriptions.”

 

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HOPE Clinic nurse pleads guilty

On August 21, 2018, WV MetroNews reported, “A Bristol, Virginia nurse practitioner pleaded guilty Tuesday for her alleged involvement at a clinic described as a pill mill.

“According to U.S. Attorney Mike Stuart, Teresa Emerson, 59, admitted to aiding and abetting obtaining a controlled substance by fraud.”

 

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LI doctor sentenced to 1 year, 1 day in clinic scam, officials say

On August 21, 2018, Newsday reported, “A doctor from Valley Stream was sentenced Tuesday to one year and a day for posing as the owner of two Brooklyn clinics in a scam that cheated Medicaid and Medicare out of $30 million, according to the U.S. Attorney's office in Manhattan."

 

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South Carolina becomes a leader in federal health care fraud cases, with millions at stake

On August 20, 2018, The Post and Courier reported, “For years, the only person Dr. Michael Mayes could confide in about the fraud he was witnessing was his wife.

“He noticed that a blood testing lab was paying doctors he worked with at a private practice in Hilton Head extra fees for every test they ordered. Each one amounted to relatively small payments, from $10 to $17, but collectively, the doctors were raking in a lot of money.”

 

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Physicians underreport conflicts of interest from devicemakers, study suggests

On August 20, 2018, Becker’s Hospital Review reported, “Physicians don't always disclose relevant payments from medical device vendors, even when it's relevant to their research, according to a study published in JAMA Surgery.

“Using 2015 general payments data from the Open Payments Database, researchers from UC Irvine School of Medicine's department of surgery identified 100 physicians who received the highest compensation from 10 popular surgical and medical device manufacturers.”

 

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Nurse pleads guilty to fraud related to Fulton man's death

On August 20, 2018, Herald-WHIG reported, “A nurse has admitted that she did not provide health care services to a developmentally disabled Missouri man for months before his body was found encased in concrete in 2017.

“Forty-nine-year-year-old Melissa Denise DeLap, of Columbia, pleaded guilty Monday to health care fraud.”

 

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Texas ambulance company owner convicted

On August 20, 2018, U.S. Attorney for the Southern District of Texas Ryan K. Patrick announced in a press release, “Anthony Chukwudi Nwosah is the owner of Tonieann EMS and Rosenberg EMS. Today, he admitted he conspired to submit more than $3 million in false and fraudulent claims to Medicare for ambulance transport services that were not provided and not medically necessary. Nwosah received approximately $1,094,260 as payment for those claims.”

 

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Genesee County physician, two others charged with health care fraud

On August 18, 2018, WJRT MI reported, “A grand jury indictment was unsealed today (Thursday) charging Patrick Wittbrodt, Dr. April Tyler and Jeffrey Fillmore of Genesee County with health care fraud and Patrick Wittbrodt with money laundering, United States Attorney Matthew Schneider announced.”

According to the news report, “The Indictment charges the defendants with a conspiracy to commit health care fraud and 17 counts of health care fraud. The Indictment specifically charges that between 2014 and 2017, the defendants would attend meetings of the United Auto Workers (UAW) union.”

 

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Lincare pays $5.25M to resolve False Claims Act allegations

On August 17, 2018, Effingham Daily News reported, “Lincare Inc., has paid $5.25 million to resolve allegations that it violated the federal False Claims Act and the Anti-Kickback Statute by offering illegal price reductions to Medicare beneficiaries, U.S. Attorney Steven D. Weinhoeft announced today. Headquartered in Clearwater, Florida, Lincare is one of the nation’s largest providers of oxygen and other respiratory therapy services to patients in the home, with approximately 1,000 locations across the United States, including Effingham.”

 

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CMS Update

 

Provider Compliance

Medicare Hospital Claims: Avoid Coding Errors — Reminder

In two recent reports, the Office of Inspector General (OIG) cited significant issues leading to coding errors on Medicare hospital claims:

Use the following resources to bill correctly and avoid overpayment recoveries:

 

From the OIG

 

OIG Advisory Opinion No 18-09

 

See Details

 

 

Updated Corporate Integrity Agreement List

 

See Details

 

 

Audit Reports

Liberty Medical, LLC, Received Unallowable Medicare Payments for Inhalation Drugs (A-09-17-03019)

 

See Report

 

 

Virginia Did Not Claim Some Medicaid Administrative Costs for Its Medallion 3.0 Waiver Program In Accordance With Federal Requirements (A-03-17-00200)

 

See Report

 

 

Medicare Improperly Paid Hospitals Millions of Dollars for Intensity-Modulated Radiation Therapy Planning Services (A-09-16-02033)

 

See Report

 

 

Medicare Made Improper and Potentially Improper Payments for Emergency Ambulance Transports to Destinations Other Than Hospitals or Skilled Nursing Facilities (A-09-17-03017)

 

See Report

 

 

 

From the Federal Register

Current Items

2018 FR Index

 

 

CMS Transmittals

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Acronym Library

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Product Features

 

HIPAA Training Handbook, 3rd Edition

 

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Research Compliance Professional's Handbook, 2nd Edition

 

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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.