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Third doctor agrees to plead guilty in massive kickback scheme at Forest Park Medical Center - Houston psychiatrist sentenced to more than 12 years in prison for role in $155 million Medicare fraud scheme - Owners of assisted living home where worker was murdered convicted of Medicaid fraud - And More

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Third doctor agrees to plead guilty in massive kickback scheme at Forest Park Medical Center

Houston psychiatrist sentenced to more than 12 years in prison for role in $155 million Medicare fraud scheme

Owners of assisted living home where worker was murdered convicted of Medicaid fraud

Bay area medical professionals indicted in kickback scheme for Medicare referrals

Ex-nurse admits diluting Valium endangered young patients

Johnstown addiction clinic doctor pleads guilty to doling out prescriptions for cash

Four indicted in $80M Medicare insurance fraud scheme

Assisted living doctors agree to pay $4 million in False Claims Act settlement

Owners of Gardens lab plead guilty to health care fraud charges

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CMS Update

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Third doctor agrees to plead guilty in massive kickback scheme at Forest Park Medical Center

On September 4, 2018, Dallas News reported, “An eighth defendant, a Colleyville surgeon, has agreed to plead guilty to accepting kickbacks in exchange for referring his patients to Forest Park Medical Center, federal court records show.

 

“Dr. David Daesung Kim, 55, will plead guilty to soliciting or receiving illegal remuneration, court records show. A judge has to accept his plea before it becomes official.”

 

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Houston psychiatrist sentenced to more than 12 years in prison for role in $155 million Medicare fraud scheme

On September 4, 2018, MDLinx reported, “A Houston psychiatrist was sentenced today to 150 months in prison for his role in a $155 million Medicare fraud scheme involving false and fraudulent claims for psychiatric services.”

 

According to the report, “Riyaz Mazcuri, 67, a former attending psychiatrist at Riverside General Hospital (Riverside) of Houston, was sentenced by US District Judge Vanessa D. Gilmore of the Southern District of Texas. Judge Gilmore also ordered Mazcuri to pay $20,607,410.22 in restitution to Medicare and $2,250,789.69 in restitution to Medicaid.”

 

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Owners of assisted living home where worker was murdered convicted of Medicaid fraud

On September 4, 2018, Anchorage Daily News reported, “The owners of an Anchorage company that ran assisted living homes for people with disabilities were convicted Thursday of fraudulently billing Medicaid for services that were never provided, bilking state taxpayers of hundreds of thousands of dollars, prosecutors said.

 

“The company, Flamingo Eye LLC, came under scrutiny by state investigators in 2015 after a resident at one of the homes killed his caregiver.”

 

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Bay area medical professionals indicted in kickback scheme for Medicare referrals

On September 4, 2018, The Mercury News reported, “Three Bay Area doctors and three other health care professionals were indicted last month by a federal grand jury in a kickback scheme related to the referral of Medicare patients to a home health care agency in Milpitas, United States Attorney Alex G. Tse announced Thursday.

 

“Federal prosecutors allege three Bay Area doctors received money in exchange for referrals to Medics Choice Home Health, Inc. Prosecutors say Medics Choice Home Health received $4.2 million from Medicare for the care of patients referred by the doctors.”

 

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Ex-nurse admits diluting Valium endangered young patients

On August 31, 2018, MLive reported, “A former nurse who diluted Valium intended for disabled patients pleaded guilty to two charges of tampering with a consumer product.

 

“Kristie Ann Mollohan of Kalamazoo entered the pleas Thursday, Aug. 30, in U.S. District Court in Grand Rapids. A third tampering charge will be dismissed.”

 

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Johnstown addiction clinic doctor pleads guilty to doling out prescriptions for cash

On August 31, 2018, Pittsburgh Post-Gazette reported, “Patients arriving at SKS Associates, an addiction treatment clinic in Johnstown, often left their cars idling in the parking lot when they came in.”

 

According to the report, “Dr. Michael Cash, 50, was doling out those prescriptions to addicts, according to federal agents, and on Friday he admitted to distributing a total of 32,000 doses without any medical need from 2016 until this past March.”

 

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Four indicted in $80M Medicare insurance fraud scheme

On August 31, 2018, Mid Hudson Valley Patch reported, “Four people have been charged in a widespread scheme to defraud Medicare and other medical insurance providers resulting in $80 million in losses. Geoffrey S. Berman, the U.S. Attorney for the Southern District of New York, said Thursday that an indictment was unsealed charging James Spina, 59, of Middletown, Jeffrey Spina, 56, of Middletown, Andrea Grossman, 59, of Loch Sheldrake, and Kimberly Spina, 54, of Woodbourne, with participating in a health-care fraud scheme through their fraudulent operation of Dolson Avenue Medical, a multi-disciplinary medical clinic in Middletown.”

 

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Assisted living doctors agree to pay $4 million in False Claims Act settlement

On August 31, 2018, McKnight’s Senior Living reported, “A Tampa, FL, dermatology practice that cares for senior living residents has agreed to pay $4 million to settle allegations that it submitted false claims to obtain Medicare and Medicaid reimbursements for the treatment of non-melanoma skin cancer with superficial radiation therapy, the Justice Department announced this week.”

 

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Owners of Gardens lab plead guilty to health care fraud charges

On August 30, 2018, Palm Beach Post reported, “Two brothers who owned a Palm Beach Gardens lab on Thursday pleaded guilty to health care fraud charges, admitting they worked with notorious sober home operator Kenny Chatman to bilk insurers out of nearly $3 million.”

 

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Corporate Compliance & Ethics Week. Photo Contest September 4-17 | Submit a Photo >

 

CMS Update

 

PEPPERs for Short-term Acute Care Hospitals

Second quarter FY 2018 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available for short-term acute care hospitals. 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. The PEPPER files were recently distributed through a QualityNet secure file exchange to hospital QualityNet Administrators and user accounts with the PEPPER recipient role.

For More Information:

 

 

CMS Provider Minute Video: The Importance of Proper Documentation — Reminder

Why is proper documentation important to you and your patients? Find out how it affects items/services, claim payment, and medical review in the Provider Minute: The Importance of Proper Documentation video.

Learn about:

  • Top five documentation errors
  • How to submit documentation for a Comprehensive Error Rate Testing review
  • How your Medicare Administrative Contractor can help

 

Watch the Video

 

From the OIG

 

Testimony of Ruth Ann Dorrill

Testimony of Ruth Ann Dorrill, Regional Inspector General, Office of Inspector General, U.S. Department of Health and Human Services: House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations: Examining Federal Efforts to Ensure Quality of Care and Resident Safety in Nursing Homes.

 

See Details

 

 

Updated Provider Self-Disclosure Settlements

 

See Details

 

 

 

From the Federal Register

Current Items

2018 FR Index

 

 

CMS Transmittals

View 2018 Transmittals

 

 

Acronym Library

Find CMS Acronyms

 

Product Features

 

501 Ideas for Your Compliance and Ethics Program

 

Learn More

 

 

Compliance 101, Fourth Edition

 

Learn More

 

Register for the 4th Annual Healthcare Enforcement Compliance Conference | Nov 4-7 in DC | Learn more >Register for the 4th Annual Healthcare Enforcement Compliance Conference | Nov 4-7 in DC | 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.