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Vanderbilt's Medicare status threatened after patient death - Two charged in Los Feliz Hospital extortion - Former drug exec pleads guilty to pushing painkiller prescriptions - And More

Headlines

Vanderbilt's Medicare status threatened after patient death

Two charged in Los Feliz Hospital extortion

Former drug exec pleads guilty to pushing painkiller prescriptions

Nevada cardiologist pleads guilty to drug distribution count

Former behavioral health counselor sentenced for Medicaid fraud

Novus co-founder reaches plea deal with prosecutors in $60 million health-care fraud scheme

Nurse practitioner pleads guilty in $65 million prescription fraud involving San Diego Marines

Twelve home health workers indicted for $87M Medicaid fraud

Atrium Health vendor hacked, 2.65M records exposed

Two more premature babies die after N.J. hospital infection outbreak, bringing total to three

Lexington therapy practice fined $200,000 for false Medicare, Medicaid claims

Brothers at South Florida lab ordered to pay $9.6 million for healthcare fraud

Regulatory News

CMS Update

From the OIG

In the Federal Register

CMS Transmittals

Acronym Library

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Building An Ethical Culture: Why It's Vital, How It's Done

501 Ideas for Your Compliance and Ethics Program

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Vanderbilt's Medicare status threatened after patient death

On November 29, 2018, HealthLeaders reported, “Vanderbilt University Medical Center has been told that it will be cut from the Medicare program next week in the wake of a medication error last year that led to a patient's death.”

 

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Two charged in Los Feliz Hospital extortion

On November 28, 2018, Los Feliz Ledger reported, “Two Iranian men are facing federal charges for allegedly masterminding an international computer hacking scheme that used ransomware to extort about $17,000 in Bitcoin from Vermont Avenue’s Hollywood Presbyterian Medical Center and also targeted dozens of other victims, including the Port of San Diego, the U.S. Department of Justice announced Wednesday.”

 

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Former drug exec pleads guilty to pushing painkiller prescriptions

On November 28, The Boston Globe reported, “Alec Burlakoff, former vice president of sales of Chandler, Ariz.-based Insys Therapeutics, pleaded guilty to a count of racketeering conspiracy before US District Court Judge Allison D. Burroughs.”

 

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Nevada cardiologist pleads guilty to drug distribution count

On November 28, 2018, Associated Press reported, “Dr. Devendra Patel of Elko pleaded guilty in federal court in Reno on Monday to one count of a drug distribution crime after being charged last December in a 39-count federal indictment alleging drug offenses and fraud.”

 

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Former behavioral health counselor sentenced for Medicaid fraud

On November 28, 2018, News 4 (OK) reported, “A former behavioral health counselor has been sentenced to a year in prison after being convicted of Medicaid fraud.”

 

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Novus co-founder reaches plea deal with prosecutors in $60 million health-care fraud scheme

On November 28, 2018, Dallas News reported, “The former vice president of marketing and co-founder of a shuttered hospice company has reached a plea deal with federal prosecutors for his role in a $60 million health-care fraud scheme.

“Samuel D. Anderson has agreed to plead guilty to one count of conspiracy to commit health care fraud, according to court documents. Anderson was one of the co-founders for Novus Health Services, and Optim Health Services, which essentially operated as one company with the same employees and an office in Frisco.”

 

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Nurse practitioner pleads guilty in $65 million prescription fraud involving San Diego Marines

On November 27, 2018, The San Diego Union-Tribune reported, “A nurse practitioner pleaded guilty Tuesday in federal court in San Diego to taking part in a kickback scheme that used San Diego County Marines to defraud the military’s health insurance provider out of more than $65 million.

“Candace Michelle Craven, 52, became the fourth of seven defendants charged in the scheme to plead guilty when she admitted to conducting sham ‘telemedicine’ evaluations that resulted in the issuance of pricey prescriptions through the TRICARE system to patients she never saw or examined in person.”

 

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Twelve home health workers indicted for $87M Medicaid fraud

On November 27, 2018, Home Health Care News reported, “Two sisters and 10 of their employees have been indicted after a federal grand jury said they spent years using their home health care companies to defraud the Pennsylvania Medicaid program.

“Home health care companies owned and operated by sisters Arlinda Moriarty and Daynelle Dickens received more than $87 million in Medicaid payments for services that were never performed, according to the 22-count indictment.”

 

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Atrium Health vendor hacked, 2.65M records exposed

On November 27, 2018, HealthLeaders reported, “A third-party vendor providing billing services for Atrium Health was hacked and gave unauthorized users access to about 2.65 million records, Atrium Health announced Tuesday.

“Atrium said the hackers broke into to the databases of billing services contractor AccuDoc Solutions in late September. AccuDoc told Atrium on Oct. 1. A subsequent investigation determined that the information was not removed from AccuDoc's systems.”

 

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Two more premature babies die after N.J. hospital infection outbreak, bringing total to three

On November 27, 2018, NBC News reported, “Two more premature babies who were in the neonatal intensive care unit at a New Jersey hospital died last week, bringing to three the number who have died after a bacterial outbreak at the facility in September, the state Health Department announced Tuesday.

“The two babies, who were infected six weeks ago at University Hospital in Newark, died last week, but the New Jersey Department of Health said it was not notified of the deaths until Monday.”

 

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Lexington therapy practice fined $200,000 for false Medicare, Medicaid claims

On November 26, 2018, WLTX 19 reported, “A Lexington based therapy practice has agreed to pay $200,000 to resolve allegations that it knowingly submitted false claims to Medicare and Medicaid for physical and occupational therapy services.”

 

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Brothers at South Florida lab ordered to pay $9.6 million for healthcare fraud

On November 23, 2018, Miami Herald reported, “The chief executive officer and chief operating officer of a Palm Beach urinalysis lab were sentenced to prison Friday and ordered to pay more than $9.6 million for healthcare fraud.

“The decision Friday by the U.S. District Court for the Southern District of Florida follows guilty pleas in August by Smart Lab’s CEO H. Hamilton Wayne of Palm Beach Gardens and COO Justin Morgan Wayne of Boca Raton. The two are brothers.”

 

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Join us for the Managed Care Compliance Conference | January 27-30 in Lake Buena Vista, FL | Learn More >Join us for the Managed Care Compliance Conference | January 27-30 in Lake Buena Vista, FL | Learn More >

 

CMS Update

 

CMS proposed regulation for Medicare Parts C & D announced

On November 26, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a press release announcing, “proposed polices for 2020 to strengthen and modernize the Medicare Part C and D programs.

According to the press release, “The proposal would ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and the agency is also considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter.”

 

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Provider Compliance - Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities

In a recent report, the Office of the Inspector General (OIG) determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. As a result, beneficiaries were unnecessarily charged outpatient deductibles and coinsurance payments.

 

All items and non-physician services provided during a Medicare Part A inpatient stay must be provided directly by the inpatient hospital or under arrangements with the inpatient hospital and another provider. Use the following resources to bill correctly:

 

 

 

 

In the Federal Register

Current Items

2018 FR Index

 

 

CMS Transmittals

View 2018 Transmittals

 

 

Acronym Library

Find CMS Acronyms

 

Product Features

 

Building An Ethical Culture: Why It's Vital, How It's Done

 

Learn More

 

 

501 Ideas for Your Compliance and Ethics Program

 

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 >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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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.