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OCR fines three hospitals nearly $1 million in HIPAA settlements - Springfield gynecologist sentenced for sharing patient files with pharmaceutical company - Federal court orders $1.3 million judgment against toxicology laboratory - And More

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OCR fines three hospitals nearly $1 million in HIPAA settlements

 

Springfield gynecologist sentenced for sharing patient files with pharmaceutical company

Federal court orders $1.3 million judgment against toxicology laboratory

AbbVie hit with lawsuit over alleged $1.2B kickback scheme

Clinic operators, physician found guilty of Medicare fraud

Bridgeville (PA) clinic operator pleads guilty to prescription drug scheme

Windham (NH) nurse practitioner who pleaded guilty to fraud could face more punishment

Physician sentenced to five months in prison for obstructing Medicare audit

Doctor sentenced to prison for selling millions in prescription drugs

Weirton physician sentenced to nearly five years for fraudulent prescription writing

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OCR fines three hospitals nearly $1 million in HIPAA settlements

On September 21, 2018, Health Data Management reported, “Three Boston hospitals have agreed to collectively pay nearly $1 million to the HHS Office for Civil Rights for compromising the privacy of patients’ protected health information during filming of a TV series.”

 

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Springfield gynecologist sentenced for sharing patient files with pharmaceutical company

On September 19, 2018, WWLP reported, “A Springfield gynecologist was sentenced Wednesday for illegally sharing patient medical files and lying to federal investigators.”

According to the government press release, “Rita Luthra, M.D., 67, of Longmeadow, was sentenced by U.S. District Court Judge Mark G. Mastroianni to one year of probation. In April 2018, Luthra was convicted by a federal jury of one count of violation of the Health Information Portability and Accountability Act and one count of obstruction of a criminal health care investigation.”

 

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DOJ Release

 

 

Federal court orders $1.3 million judgment against toxicology laboratory

On September 19, 2018, the U.S. Attorney for the Eastern District of Kentucky announced, “The U.S. District Court has entered a civil judgment of $1,374,058, in favor of the United States and against Calloway Laboratories, Inc. (Calloway), a clinical laboratory based in Woburn, Massachusetts, holding Calloway liable for submitting false claims to federal healthcare programs, including Medicare and TRICARE.”

 

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AbbVie hit with lawsuit over alleged $1.2B kickback scheme

On September 19, 2018, STAT reported, “In a wide-ranging scheme, AbbVie (ABBV) used a combination of old-fashioned kickbacks to doctors and a stealthy network of nurses to illegally boost prescriptions of its best-selling Humira treatment, according to a lawsuit filed on Tuesday by the California insurance commissioner.”

 

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Clinic operators, physician found guilty of Medicare fraud

On September 19, 2018, Pharmacy Times reported, “A federal jury this week found a physician and 2 clinic owners and operators guilty for their roles in a $17 million Medicare fraud scheme.

“John P. Ramirez, MD, 64; Ann Nwoko Shepherd, 62; and Yvette Nwoko, 30, all of Houston, Texas, were convicted of one count of conspiracy to commit health care fraud after a 6-day trial, according to a press release from the US Department of Justice (DOJ). In addition, Nwoko was convicted of 3 counts of health care fraud, Shepherd was convicted of 6 counts of health care fraud and Ramirez was convicted of 3 counts of false statements relating to health care matters.”

 

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Bridgeville (PA) clinic operator pleads guilty to prescription drug scheme

On September 18, 2018, TRIB LIVE reported, “The operator of a drug addiction treatment clinic in Pittsburgh’s South Hills pleaded guilty to unlawfully distributing controlled substances and committing health care fraud, federal prosecutors said Tuesday.

“Terri C. Brown, 53, of Boswell — former owner of the Cherry Way Suboxone clinic in Bridgeville — was convicted on five counts of drug and health care fraud charges, U.S. Attorney Scott W. Brady said.”

 

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Windham (NH) nurse practitioner who pleaded guilty to fraud could face more punishment

On September 18, 2018, The Eagle-Tribune reported, “Kristen Khanna, the nurse practitioner who pleaded guilty Monday to federal charges of health care and prescription fraud, could face additional punishment from the state.

“Peter Danles, executive director of the New Hampshire Office of Professional Licensure and Certification, said Khanna, 42, of Windham, could have her nursing license suspended or revoked by the state Board of Nursing.”

 

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Physician sentenced to five months in prison for obstructing Medicare audit

On September 18, 2018, Becker’s Hospital Review reported, “A Florida physician was sentenced to five months in prison for lying to a Medicare program integrity contractor during an audit, according to the Department of Justice.

“John Janick, MD, obstructed an audit of his Janick Medical Group in Port Charlotte, Fla., according to the plea agreement.”

 

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Doctor sentenced to prison for selling millions in prescription drugs

On September 18, 2018, The Telegraph reported, “A doctor who admitted to selling millions in prescription pills at two Middle Georgia clinics for more than a decade was sentenced Tuesday to serve 100 months - or 8.3 years - in prison.

“George Mack Bird III, 59, also was sentenced in U.S. District Court in Dublin to 36 months of supervised release after prison and fined $20,000, according to a news release from the U.S. Attorney’s Office for the Southern District of Georgia.”

 

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Weirton physician sentenced to nearly five years for fraudulent prescription writing

On September 17, 2018, WTOV reported, “Dr. Tod Hagins, of Wintersville, Ohio, was sentenced to 57 months incarceration for writing fraudulent prescriptions to be sold on the streets from his Weirton [clinic].

“‘This case should send a clear message to all those who practice medicine that neither their medical license nor their white lab coat will protect them from enormous consequences of illegal drug distribution and medical fraud. This doctor violated both our laws and his solemn oath as a physician. He will now pay for those violations,’ United States Attorney Bill Powell said.”

 

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CMS Update

 

CMS proposes to lift unnecessary regulations and ease burden on providers

On September 17, the Centers for Medicare and Medicaid Services (CMS) announced that, “a proposed rule to relieve burden on health care providers by removing unnecessary, obsolete, or excessively burdensome Medicare compliance requirements for health care facilities. Collectively, these updates would save health care providers an estimated $1.12 billion annually. Taking into account policies across rules finalized in 2017 and 2018, as well as this and other proposed rules, savings are estimated at $5.2 billion.

“CMS developed the proposed rule in response to President Trump’s charge to federal agencies to ‘cut the red tape’ and reduce burdensome regulations. In addition, feedback from Requests for Information the agency issued seeking stakeholder input on regulatory burdens helped inform this proposed rule.”

Per the CMS press release, the proposed rule includes proposed changes for:

  • Conditions of participation and conditions for coverage
  • Emergency Preparedness policies
  • Hospitals
  • Critical access hospital, rural health centers, and federally qualified health centers
  • Ambulatory surgical centers
  • Transplant centers
  • Hospices
  • Comprehensive outpatient rehabilitation facilities
  • Community mental health centers
  • Portable x-ray services
  • Religious nonmedical health care institutions

For more information, see the complete September 17 Press Release and Fact Sheet.

 

 

MIPS Targeted Review Request: Deadline Extended to October 15

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are available on the Quality Payment Program website. The payment adjustment you receive in 2019 is based on this final score. If you believe there is an error in your 2019 MIPS payment adjustment calculation, request a targeted review until October 15 at 8 pm ET.

 

For More Information:

 

 

Quality Payment Program: MIPS Resources

CMS posted new Merit-based Incentive Payment System (MIPS) resources:

For More Information:

 

 

Provider Compliance — Billing for Stem Cell Transplants — Reminder

In a February 2016 report, the Office of the Inspector General (OIG) determined that Medicare paid for many stem cell transplants incorrectly. The main finding was that providers billed these procedures as inpatient when they should have been submitted as outpatient services.

 

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

 

 

 

 

In the Federal Register

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Questions/Feedback?

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

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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.