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NJ fines vendor behind Virtua healthcare data breach $200K - Four charged in $87M home health care scheme - Co-owners of Miami pain management clinic and patient recruiter sentenced - And More



NJ fines vendor behind Virtua healthcare data breach $200K

On November 7, 2018, Health IT Security reported, “New Jersey is slapping a $200,000 fine on a defunct Georgia-based medical transcription company that caused the Virtua Medical Group breach impacting more than 1,650 individuals in 2016.”


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Four charged in $87M home health care scheme

On November 7, 2018, Home Health Care News reported, “Federal investigators had a busy month of October shining a light on major fraud schemes throughout the home health industry — and November appears to be more of the same.

“A federal jury on Friday found a patient recruiter guilty for her role in a scheme involving roughly $1.1 million in fraudulent Medicare claims for home health care services procured through kickbacks.”


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Co-owners of Miami pain management clinic and patient recruiter sentenced

On November 7, 2018, Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division announced, “The husband and wife co-owners of a Miami, Florida pain management clinic and a patient recruiter who doubled as a drug diverter were sentenced to prison today for their participation in a scheme to unlawfully distribute thousands of pills of oxycodone.”


According to the government press release, “David Bosch, 46, and Tania Sanchez, 47, both of Hialeah, Florida, and Odalys Abreu, 45, of Miami, were sentenced by Chief U.S. District Judge K. Michael Moore of the Southern District of Florida. Bosch, Sanchez and Abreu were sentenced to serve 108, 97 and 57 months in prison followed by three years of supervised release, respectively.”


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Maryland Treatment Centers agrees to pay $500,000

On November 7, 2018, U.S. Attorney for Maryland Robert K. Hur announced, “Maryland Treatment Centers has agreed to pay the United States $500,000 to settle allegations under the False Claims Act that it submitted false claims to the United States for mental health and substance abuse services that were undocumented or not provided. Maryland Treatment Centers, including its affiliate Mountain Manor Treatment Centers, offers mental health and substance abuse services to children and adults in outpatient and inpatient locations in Maryland, including Baltimore and Rockville.”


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Indiana AG, US attorney in Kentucky settle with dental firms

On November 5, 2018, The Telegraph reported, “Indiana's attorney general and a federal prosecutor in Kentucky have reached a nearly $5.2 million settlement with two dental firms accused of Medicaid fraud.”


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New York eye doctor agrees to pay $2M

On November 2, 2018, Reuters reported, “A New York eye doctor and his medical practice have agreed to pay $2 million to settle civil fraud claims over Medicare and Medicaid reimbursement they received for procedures that were either poorly executed or not performed at all.”


According to a government press release, the U.S. Attorney for the Southern District of New York Geoffrey S. Berman announced, “a settlement of a civil fraud lawsuit against Dr. Kenneth S. Felder (Felder) And Metropolitan Retina Associates, Inc. (Metropolitan Retina). The settlement resolves claims under the False Claims Act alleging that Felder and Metropolitan Retina billed Medicare and Medicaid for (1) substandard fluorescein angiography tests that were of such poor quality that they lacked all diagnostic value and were effectively worthless; and (2) ophthalmic ultrasounds that were either not performed or lacked any supporting documentation.”


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DOJ Press Release



Dublin (OH) doctor latest to be charged in insurance fraud scheme

On November 2, 2018, The Columbus Dispatch reported, “A Blacklick man who practiced medicine in Dublin has been charged in federal court with prescribing medications that weren’t necessary.


“Dr. Bernard Oppong, 60, was charged in United States District Court with seven counts related to insurance fraud.”


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Managed Care Compliance Conference | January 27-30, 2019 | Lake Buena Vista, FL | Learn More >Managed Care Compliance Conference | January 27-30, 2019 | Lake Buena Vista, FL | Learn More >


CMS Update


SNF Provider Preview Reports: Review Your Data by November 30

Skilled Nursing Facility (SNF) Provider Preview Reports are available on quality measures based on second quarter 2017 through first quarter 2018 data. Review your performance data by November 30, prior to public display on Nursing Home Compare in January 2019. Corrections to the underlying data are not permitted during this time; request a CMS review if you believe that your data is inaccurate. For more information and directions to access your report, visit the SNF Quality Public Reporting webpage.




Provider Compliance - Reporting Changes in Ownership — Reminder

A 2016 Office of the Inspector General (OIG) report noted that providers may not be informing CMS of ownership changes. Providers must update their enrollment information to reflect changes in ownership within 30 days. Owners are individuals or corporations with a 5 percent or more ownership or controlling interest. Failure to comply could result in revocation of your Medicare billing privileges.






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Are you and your board compliance ready? | Get the knowledge and tools you need at the Board & Audit Committee Compliance Conference | Learn more >Are you and your board compliance ready? | Get the knowledge and tools you need at the Board & Audit Committee Compliance Conference | Learn more >


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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.