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Dallas men to plead guilty to roles in two massive health care kickback cases - Psychologist admits to over $6 million in fraudulent Medicaid bills - Former Naples-based hospital chain HMA to pay $260 million to resolve fraud charges - And More

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Dallas men to plead guilty to roles in two massive health care kickback cases

Psychologist admits to over $6 million in fraudulent Medicaid bills

Former Naples-based hospital chain HMA to pay $260 million to resolve fraud charges

MGH study finds major increase in US healthcare data breaches

Virginia health system authority to pay US nearly $4M

Four New Orleans doctors, two others ordered to pay millions in restitution in Medicare fraud case

Whistleblower recovers more than $6.6 million

Queens pharmacy owner bought Porsche with Medicare cash: Feds

Garden City eye doctor to pay nearly $7M settlement in fraud case, feds say

Regulatory News

CMS Update

From the OIG

In the Federal Register

CMS Transmittals

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Dallas men to plead guilty to roles in two massive health care kickback cases

On September 26, 2018, Dallas News reported, “Two key figures who prosecutors say played a role in multiple medical kickback schemes in Dallas in which doctors were paid to steer patients to certain hospitals have agreed to plead guilty in two cases, court records show.

 

“Andrew Hillman, 42, and Semyon Narosov, 54, owned the Next Health network of pharmacies and testing labs that gave people $50 gift cards to urinate in cups at Whataburger bathrooms.”

 

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Psychologist admits to over $6 million in fraudulent Medicaid bills

On September 26, 2018, KIFI/KIDK (WY) reported, “A Cheyenne psychologist and his wife pleaded guilty Tuesday to making false statements to Wyoming Medicaid. Dr. John R. Sink, Jr. and his wife Diane M. Sink appeared before U.S. District Court Judge Alan B. Johnson in federal district court in Cheyenne.”

 

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Former Naples-based hospital chain HMA to pay $260 million to resolve fraud charges

On September 26, 2018, Naples Daily News reported, “Health Management Associates LLC, a former hospital chain based in Naples, has agreed to pay more than $260 million to resolve criminal charges and civil claims relating to a scheme to defraud the federal government.”

 

According to the newspaper report, “The allegations resolved by the settlement stem from eight whistle-blower lawsuits filed under the False Claims Act, which permits private parties to sue on behalf of the government for false claims and to receive a share of any recovery.”

 

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MGH study finds major increase in US healthcare data breaches

On September 26, 2018, HealthIT Security reported, “Since 2010, the total number of healthcare data breaches has increased steadily every year — except in 2015 — from 199 in 2010 to 344 in 2017, according to an analysis of US health care data conducted by two Massachusetts General Hospital (MGH) physicians.

 

“While 70 percent of all breaches took place at health care providers, breaches involving health plans accounted for 63 percent of all breached records.”

 

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Virginia health system authority to pay US nearly $4M

On September 26, 2018, Becker Hospital News reported, “The operator of Virginia Commonwealth University Medical Center and related healthcare facilities in Richmond has agreed to pay the federal government $3,994,151 to resolve inaccurate payments for radiation oncology services, according to the Department of Justice.”

 

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Four New Orleans doctors, two others ordered to pay millions in restitution in Medicare fraud case

On September 26, 2018, NOLA.com reported, “Four New Orleans area doctors, a biller and an office manager were sentenced to prison time and a collective $30 million in restitution payments this week for their roles in a Medicare fraud scheme that involved more than 20 people and netted millions in fraudulent Medicare reimbursements, according to U.S. Attorney Peter G. Strasser's office.”

 

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Whistleblower recovers more than $6.6 million

On September 24, 2018, The Times-News (AL) reported, “East Alabama Medical Center (EAMC) and its subsidiary Aperian Laboratory Solutions, LLC agreed to pay an additional $4,250,000, plus attorney’s fees and litigation expenses, to settle claims they violated the Anti-Kickback Statute and submitted false claims for payment to Medicare in violation of the False Claims Act. This settlement was in addition to earlier settlements in this same case of nearly $2.4 million.”

 

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Queens pharmacy owner bought Porsche with Medicare cash: Feds

On September 24, 2018, Jamaica Patch reported, “The owner of four Queens pharmacies is accused of running a lucrative fraud scheme that bought her jewelry and a fancy car. Aleah Mohammed, 33, was set to be arraigned Monday for allegedly submitting sham Medicare and Medicaid claims that got her Jamaica and Richmond Hill pharmacies nearly $8 million in reimbursements, the Brooklyn U.S. Attorney's Office said.”

 

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Garden City eye doctor to pay nearly $7M settlement in fraud case, feds say

On September 24, 2018, Newsday reported, “A Garden City ophthalmologist will pay nearly $7 million to settle civil fraud claims that he used unapproved drugs purchased overseas on patients and then sought reimbursement by Medicare, federal prosecutors announced Monday.

 

“The agreement calls for Dr. Mark Fleckner, who has offices on Franklin Avenue in Garden City and in Fresh Meadows, Queens, to pay $6.95 million to settle federal False Claims Act violations, according to Richard Donoghue, U.S. attorney for the Eastern District of New York.”

 

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CMS Update

 

Quality Payment Program: Funding for Quality Measure Development

On September 21, CMS awarded seven organizations cooperative agreements to partner with us in developing, improving, updating, or expanding quality measures for Medicare’s Quality Payment Program (QPP). These cooperative agreements, authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), represent the first funding initiative supporting public-private efforts to develop measures for QPP. Through these partnerships, we will work closely with external organizations to develop and implement measures that offer the most promise for improving patient care.

 

For more information: https://www.cms.gov/newsroom/press-releases/cms-awards-funding-quality-measure-development

 

 

Provider Compliance - Improper Payment for Intensity-Modulated Radiation Therapy Planning Services

In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient Intensity-Modulated Radiation Therapy (IMRT) did not comply with Medicare billing requirements. Specifically, hospitals billed separately for complex stimulations when they were performed as part of IMRT planning. Overpayments occurred because hospitals are unfamiliar with or misinterpreted CMS guidance.

Use the following resources to bill correctly:

 

From the OIG

 

 

 

Audit Reports

 

 

OEI Report

 

 

 

In the Federal Register

Current Items

2018 FR Index

 

 

CMS Transmittals

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Acronym Library

Find CMS Acronyms

 

Product Features

 

Investigative Interviewing

 

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The First Information Is Almost Always Wrong

 

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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.