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Eight pharmacy owners, marketers charged in alleged $9.1 million Dallas-area kickback scheme - CMS probes hospital accrediting panel for conflict of interest - Email hack on Vermont provider breaches 32,000 patient records - And More

Headlines

Eight pharmacy owners, marketers charged in alleged $9.1 million Dallas-area kickback scheme

 

CMS probes hospital accrediting panel for conflict of interest

 

Email hack on Vermont provider breaches 32,000 patient records

 

Role and place of compliance officers in life sciences companies addressed in Seton Hall Law white paper

 

Medicare, Medicaid exclude 200% more docs for healthcare fraud

 

Former employees sue health care fraud suspects

 

Murfreesboro psychologist faces federal health care fraud charges

 

Miami-area woman sentenced to over six years in prison

 

Nashville CEO forged signatures for fake therapy, U.S. Attorney says

 

Jury convicts ex-employees of pharmacy in U.S. meningitis outbreak

Regulatory News

CMS Update

From the OIG

In the Federal Register

CMS Transmittals

Acronym Library

Product Features

Health Care Privacy Compliance Handbook, Second Edition

Building a Career in Compliance and Ethics

HCCA's Premium Newsletter: Report on Patient Privacy | Subscribe Today >

 

 

Grow your healthcare compliance career | Join HCCA | Learn More >

 

 

Eight pharmacy owners, marketers charged in alleged $9.1 million Dallas-area kickback scheme

On December 19, 2018, Dallas News reported, “Eight pharmacy owners and marketers have been charged in what authorities allege was a Dallas-area scheme in which kickbacks were paid after doctors prescribed compounded drugs covered by federal insurance, according to a federal indictment unsealed Wednesday.

 

“The scheme, the indictment alleges, involved $92 million in claims and $9.1 million in kickbacks.”

 

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CMS probes hospital accrediting panel for conflict of interest

On December 19, 2018, Crain’s Chicago Business reported, “The Centers for Medicare & Medicaid Services issued a request for information yesterday from accrediting organizations like the Joint Commission to understand how they establish and disclose relationships with providers they both accredit for participation in Medicare as well as consult for.”

 

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Email hack on Vermont provider breaches 32,000 patient records

On December 18, 2018, Health IT Security reported, “Elizabethtown Community Hospital, part of the University of Vermont Health Network, notified about 32,000 patients that their personal health information was breached during an email hack.”

 

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Role and place of compliance officers in life sciences companies addressed in Seton Hall Law white paper

On December 18, 2018, Seton Hall Law School’s Center for Health & Pharmaceutical law & Policy announced the release of a new white paper, “The Role and Place of Compliance Within Life Sciences: The Imperative of Chief Ethics and Compliance Officer Independence,” that, “offers a fresh perspective on this hotly contested issue.”

 

According to the announcement, “Drawing on available evidence, the relevant scholarship, and the feedback from many experts and stakeholders, the Paper offers unique insights, including identifying ten basic ingredients of CECO independence. It also suggests that the debate over the relationship between corporate counsel and the CECO will wane as their respective skill sets evolve, largely because of CECOs’ increasing reliance on predictive analytics. Finally, the paper encourages ethics and compliance officers to be more forward thinking and to broaden their function to encompass emerging ethical issues not yet addressed by law.”

 

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White Paper

 

 

Medicare, Medicaid exclude 200% more docs for healthcare fraud

On December 18, 2018, Revcycle Intelligence reported, “Efforts to combat healthcare fraud, waste, abuse by Medicare, Medicaid, and public insurance programs may be paying off, according to a new study from the University of Southern California and Harvard Medical School.

 

“The study recently published in JAMA Network Open revealed that the number of physicians excluded from Medicare, Medicaid, and other public healthcare programs increased by about 200 percent from 2007 to 2017. The physicians had to exit the programs because of healthcare fraud schemes, health crimes, or unlawful prescribing of controlled substances.”

 

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Former employees sue health care fraud suspects

On December 17, 2018, The Brownsville Herald (TX) reported, “Two home health care companies that closed after a federal grand jury indicted executives at the businesses on multiple charges of defrauding Medicare out of $150 million are now being sued by nine employees alleging that they were fired without notice and not paid.

 

“The Waco-based employees filed the lawsuit on Dec. 14 in Brownsville alleging BRM Home Health and Merida Health Care violated the Wages and Fair Labor Standards Act and the Worker Adjustment and Retraining Notification Act, which are laws protecting employees facing mass layoffs and establishing minimum wage and overtime pay.”

 

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Murfreesboro psychologist faces federal health care fraud charges

On December 17, 2018, Daily News Journal reported, “A Murfreesboro psychologist was arrested Friday and charged with two counts of health care fraud, according to a news release issued Monday by the Department of Justice.

 

“Donald Martin McCoy, 52, was a licensed psychologist and an authorized TennCare provider who led individual and family psychotherapy sessions with patients.”

 

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Miami-area woman sentenced to over six years in prison

On December 17, 2018, Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division announced, “A Miami, Florida-area woman was sentenced to 78 months in prison to be followed by three years of supervised release today for her role in a $4.65 million health care fraud scheme involving three home health agencies that purported to provide home health services to Medicare patients.”

 

According to the government press release, “Margarita Palomino, 54, of Homestead, Florida, was sentenced by U.S. District Judge Jose E. Martinez of the Southern District of Florida. Judge Martinez also ordered Palomino to pay $4,658,241.00 in restitution and to forfeit $186,650.50. Palomino pleaded guilty on Oct. 10, 2018 to one count of conspiracy to commit health care fraud and wire fraud.”

 

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Nashville CEO forged signatures for fake therapy, U.S. Attorney says

On December 14, 2018, The Tennessean reported, “A former Nashville CEO was arrested in North Dakota this week after investigators say she stole more than $1 million from Medicare and Medicaid.

 

“Margaret Fisher, 60, used to be the CEO of Fishield Behavioral Medical Services, Inc. in Madison.”

 

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Jury convicts ex-employees of pharmacy in U.S. meningitis outbreak

On December 13, 2018, Reuters reported, “A co-owner and four ex-employees of a Massachusetts compounding pharmacy were convicted on Thursday of committing frauds and other illegal activities that helped boost its business before a deadly 2012 fungal meningitis outbreak linked to drugs it made.”

 

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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

 

Opioids Training Modules

The Centers for Disease Control & Prevention (CDC) launched two new opioid trainings that support providers in safer prescribing of opioids for chronic pain. The modules are part of a series of interactive online trainings that feature recommendations from the CDC Guideline for Prescribing Opioids for Chronic Pain, clinical scenarios, tools, and resource libraries to enhance learning. The modules offer free continuing education.

View additional modules in the series on the CDC Interactive Training Series webpage.

 

 

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:

 

 

New from Medicare Learning Network: Physician Supervision of Diagnostic Procedures, Telehealth Services MLN Matters Article

Revision of Definition of the Physician Supervision of Diagnostic Procedures, Clarification of DSMT Telehealth Services, and Establishing a Modifier for Expanding the Use of Telehealth for Individuals with Stroke is available. Learn about updated policies.

 

 

 

 

In the Federal Register

Current Items

2018 FR Index

 

 

CMS Transmittals

View 2018 Transmittals

 

 

Acronym Library

Find CMS Acronyms

 

Product Features

 

Health Care Privacy Compliance Handbook, Second Edition

 

Learn More

 

 

Building a Career in Compliance and Ethics

 

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.