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LivaNova settles medical device kickback case for $1.9 million - Doctor and offices to pay $213,000 to resolve allegations of false claims - Medtronic to pay $51 million to resolve U.S. medical device probes - And More

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LivaNova settles medical device kickback case for $1.9 million

Doctor and offices to pay $213,000 to resolve allegations of false claims

Medtronic to pay $51 million to resolve U.S. medical device probes

Florida home health services company owner and co-conspirator plead guilty

DOJ announces changes to the Yates Memo policy on individual accountability

Fayetteville (NY) doctors fined $811,000 over false insurance claims

Cheyenne couple gets 37 months

OIG touts nearly $3B in Medicare, Medicaid fraud recoveries in fiscal 2018

Colorado Springs-area speech pathologist sentenced in $1.2 million Medicaid fraud

Regulatory News

CMS Update

From the OIG

In the Federal Register

CMS Transmittals

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501 Ideas for Your Compliance and Ethics Program

The First Information Is Almost Always Wrong

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LivaNova settles medical device kickback case for $1.9 million

On December 5, 2018, Reuters reported, “A unit of medical device manufacturer LivaNova PLC will pay $1.87 million to resolve allegations it paid kickbacks to doctors in Georgia in exchange for patient referrals for its epilepsy treatment.”

 

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DOJ Press Release

 

 

Doctor and offices to pay $213,000 to resolve allegations of false claims

On December 5, 2018, The Citizens (GA) reported, “Anil J. Desai, M.D., East Metro Internal Medicine, L.L.C. and Rockdale-Newton Hematology-Oncology (the ‘Desai Parties’), based in Conyers and Covington, have agreed to pay $213,000 to resolve allegations that they violated the False Claims Act by submitting claims to Medicare and Medicaid for drugs that were never provided to their patients, and for drugs that had not received final marketing approval by the U.S. Food and Drug Administration (FDA).”

 

According to the report, “The government alleges that between Nov. 1, 2008 and Aug. 13, 2012, the Desai Parties submitted claims to Medicare and Medicaid for Procrit even though there was no record that they purchased enough Procrit to cover the amount that they billed. Moreover, the Government alleges that during that same time period, the Desai Parties submitted claims to Medicare and Medicaid for Eloxitan that had been purchased from a Canadian company, Quality Specialty Products, and had not received final marketing approval by the FDA. The civil settlement resolves the government’s investigation into these allegations.”

 

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Medtronic to pay $51 million to resolve U.S. medical device probes

On December 4, 2018, Reuters reported, “Medtronic Plc said on Tuesday it would pay $50.9 million to resolve U.S. Justice Department probes into how companies it later acquired marketed medical devices, including one meant to treat a vascular defect in the brain.”

 

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Florida home health services company owner and co-conspirator plead guilty

On December 4, 2018, Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division announced in a press release, “Alexander Ros Lazo, 54, an owner and operator of T.L.C. Health Services Inc., a home health agency, pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Jose E. Martinez of the Southern District of Florida. Misleidy Ibarra, 46, also of Miami, a licensed massage therapist, pleaded guilty before Judge Martinez to one count of conspiracy to commit health care fraud. Sentencing has been scheduled for Feb. 5, 2019 before Judge Martinez.

 

“As part of his guilty plea, Ros Lazo admitted that he paid kickbacks and bribes to his co-conspirators in exchange for home health services prescriptions and the referral of Medicare beneficiaries to T.L.C. Health Services, a company based in Miami.”

 

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DOJ announces changes to the Yates Memo policy on individual accountability

On December 4, 2018, The National Law Review reported, “On Thursday, November 29th, the U.S. Department of Justice (DOJ) announced changes to its policy known as the ‘Yates Memo.’ That policy, established in 2015 by then-Deputy Attorney General Sally Yates, had required companies to provide DOJ with all relevant information about any individuals involved in misconduct to be eligible to receive any cooperation credit in resolving corporate investigations.

 

“Under the revised policy, to be eligible to receive cooperation credit, companies must provide relevant information about ‘all individuals substantially involved in or responsible for the misconduct.’”

 

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Fayetteville (NY) doctors fined $811,000 over false insurance claims

On December 4, 2018, Syracuse.com reported, “A Fayetteville dermatology practice has agreed to pay more than $811,000 for submitting false claims to state and federal health insurance programs.

 

“The U.S. Attorney's Office said Dermatology Associates of Central New York submitted thousands of false insurance claims for services provided by nurse practitioners that were billed as if they had been provided by or under the supervision of the practice's owners.”

 

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Cheyenne couple gets 37 months

On December 4, 2018, KGAB reported, “A Cheyenne psychologist and his wife have been sentenced to 37 months in federal prison for making false statements as part of a scheme to fraudulently bill Wyoming Medicaid for mental health services, which were never provided.

 

“John Robert Sink, Jr., 68, and Diane Marie Sink, 63, were indicted in March 2018 by a federal grand jury for health care fraud, making false statements and money laundering.”

 

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OIG touts nearly $3B in Medicare, Medicaid fraud recoveries in fiscal 2018

On December 3, 2018, Skilled Nursing News reported, “The Department of Health and Human Services’ top fraud watchdog recovered nearly $3 billion from providers in fiscal 2018, a figure that included more than $18 million in improper payments at nursing homes.

 

“The HHS Office of the Inspector General (OIG) touted its $2.91 billion haul in its most recent semiannual report to Congress, released at the end of last week, tallying 764 criminal actions and the removal of more than 2,700 providers from the approved Medicare and Medicaid rolls.”

 

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Colorado Springs-area speech pathologist sentenced in $1.2 million Medicaid fraud

On November 29, 2018, The Gazette reported, “An El Paso County speech pathologist drained nearly $1.3 million from Medicaid under a six-year scheme in which she billed the state for phony patients and exaggerated the services she provided.”

 

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CMS Update

 

CMS strengthens nursing home oversight and safety to ensure adequate staffing

According to a November 30 Centers for Medicare and Medicaid Services (CMS) press release, the agency “announced actions that will bolster nursing home oversight and improve transparency in order to ensure that facilities are staffed adequately to provide high-quality care. These actions include sharing data with states when potential issues arise regarding staffing levels and the availability of onsite registered nurses; clarifying how facilities should report hours and deduct time for staff meal breaks; and providing facilities with new tools to help ensure their resident census is accurate.”

 

See the Details

 

 

PEPPERs for Short-term Acute Care Hospitals

Third 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:

 

 

Provider Compliance - Cardiac Device Credits: Medicare Billing — Reminder

A 2018 Office of the Inspector General (OIG) Report noted that payments reviewed for recalled cardiac medical devices did not comply with Medicare requirements for reporting manufacturer credits. Medicare incorrectly paid hospitals $7.7 million for cardiac device replacement claims, resulting in potential overpayments of $4.4 million. Manufacturers issued reportable credits to hospitals for recalled cardiac medical devices, but the hospitals did not adjust the claims with the proper condition codes, value codes, or modifiers to reduce payment as required.

 

CMS developed the Medicare Billing for Cardiac Device Credits Fact Sheet to ensure that hospitals properly report manufacturer credits for cardiac devices and avoid overpayment recoveries.

 

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501 Ideas for Your Compliance and Ethics Program

 

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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.