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Governor Parson creates Medicaid Fraud and Abuse Task Force - 14 Home health care workers face charges of fraud in St. Louis - Top five healthcare sector fraud settlements for 2018 - And More

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Governor Parson creates Medicaid Fraud and Abuse Task Force

14 home health care workers face charges of fraud in St. Louis

Top five healthcare sector fraud settlements for 2018

Federal government sues Lenexa chiropractic clinic for Medicare fraud

Advancement of artificial intelligence opens health data privacy to attack

Federal government joins lawsuit against Wheeling Hospital

Justice Department recovers over $2.8 B from False Claims Act cases in FY 2018

Conn. initiates lawsuit against Stamford-based Purdue Pharma, executives and board for company's role in opioid crisis

Fort Myers doctor to pay $1.7 M for medical fraud

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CMS Update

From the OIG

In the Federal Register

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Governor Parson creates Medicaid Fraud and Abuse Task Force

On December 27, 2018, The Leader reported, “Missouri Gov. Mike Parson recently announced the formation of the Medicaid Fraud and Abuse Task Force with the goal of making Missouri a national leader in Medicaid fraud prevention. To prepare coordination for the task force, Governor Parson brought together members of the departments of Social Services, Health and Senior Services, and Mental Health, as well as the Office of the Attorney General, Missouri Health Care Association leaders, and partners from the Health and Human Services Office of the Inspector General.”

 

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14 home health care workers face charges of fraud in St. Louis

On December 26, 2018, HomeCareDaily.com reported, “14 residents of the St. Louis area have been indicted by a federal grand jury. They are accused of defrauding Medicare and Medicaid of approximately $1.3 million for home health care services that were never provided. Prosecutors allege that 13 out of the 14 people indicted were not even in the United States at the time when services were reported to have been provided.”

 

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Top five healthcare sector fraud settlements for 2018

On December 26, 2018, HealthLeaders reported, “Healthcare fraud accounted for $2.5 billion in fraud recoveries for the federal government in 2018.” The following are the top five according to the HealthLeaders report: AmerisourceBergen Corp., Actelion Pharmaceuticals US, Inc., a DaVita Inc. subsidiary, Health Management Associates, and Detroit-based William Beaumont Hospital.

 

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Federal government sues Lenexa chiropractic clinic for Medicare fraud

On December 24, 2018, KCUR reported, “A Lenexa chiropractic clinic and its two owner-operators are being sued by the federal government for defrauding Medicare.

"The lawsuit, filed Friday in federal court in Kansas City, Kansas, names Kansas City Health & Wellness Clinic, Ryan Schell and Tyler Schell. It seeks triple damages under the federal False Claims Act.”

 

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Advancement of artificial intelligence opens health data privacy to attack

On December 21, 2018, Berkley News reported, “Advances in artificial intelligence have created new threats to the privacy of health data, a new UC Berkeley study shows.

 

“The study, led by professor Anil Aswani of the Industrial Engineering & Operations Research Department (IEOR) in the College of Engineering and his team, suggests current laws and regulations are nowhere near sufficient to keep an individual’s health status private in the face of AI development. The research was released today on JAMA Network Open.”

 

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Federal government joins lawsuit against Wheeling Hospital

On December 21, 2018, WTOV9 (WV) reported, “The federal government is joining a lawsuit against Wheeling Hospital, according to a press release issued by the Department of Justice on Friday.

 

“The suit is based on alleged improper payments and kickbacks to physicians.

 

“Under the False Claims Act, the government is going after the hospital, R & V Associates, Ltd., and Ronald Violi in the U.S. District Court for the Western District of Pennsylvania.”

 

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Justice Department recovers over $2.8 B from False Claims Act cases in FY 2018

On December 21, 2018, Principal Deputy Associate Attorney General Jesse Panuccio and Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division announced, “The Department of Justice obtained more than $2.8 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30, 2018.”

 

According to the announcement, “Of the $2.8 billion in settlements and judgments recovered by the Department of Justice this past fiscal year, $2.5 billion involved the health care industry, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. This is the ninth consecutive year that the Department’s civil health care fraud settlements and judgments have exceeded $2 billion. The recoveries included in the $2.5 billion reflect only federal losses but, in many of these cases, the Department was instrumental in recovering additional millions of dollars for state Medicaid programs.”

 

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Conn. initiates lawsuit against Stamford-based Purdue Pharma, executives and board for company's role in opioid crisis

On December 20, 2018, Connecticut Attorney General George Jepsen announced in a press release, “the state has initiated a lawsuit against Stamford, Conn.-based Purdue Pharma L.P., Purdue Pharma Inc., and several current and former members of Purdue's management and board of directors alleging that they designed, financed and waged a pervasive and aggressive campaign to mislead doctors and patients, claiming that prescription opioid medications manufactured and marketed by the company were safe and effective and strategically downplaying risks of addiction that they knew were inherent in their opioid products.”

 

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Fort Myers doctor to pay $1.7 M for medical fraud

On December 20, 2018, WINK news reported, “A Fort Myers doctor will be paying $1.7 million to resolve allegations of fraud, according to the Department of Justice.

“Dr. Jonathan Daitch, M.D. has agreed to a civil settlement that will pay $1.718 million to the United States to resolve allegations that he violated the False Claims Act by receiving illegal kickbacks associated with the provision of anesthesia services and by causing the submission of medically unnecessary urine tests.”

 

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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

 

Hybrid Hospital-Wide Readmission Measure: Voluntary Reporting Extended to January 4

The deadline for the voluntary reporting of Hybrid Hospital-Wide Readmission (HWR) measure data under the Hospital Inpatient Quality Reporting Program is extended to January 4 at 11:59 pm PT. For more information, visit the Voluntary Hybrid HWR Measure Overview webpage.

 

 

 

LTCH Compare Refresh

The December 2018 quarterly Long-term Care Hospital (LTCH) Compare refresh is available, including quality measure results based on data from the first to fourth quarter of 2017. Visit LTCH Compare to view the data. For more information, visit the LTCH Quality Public Reporting webpage.

 

 

 

IRF Compare Refresh

The December 2018 quarterly Inpatient Rehabilitation Facility (IRF) Compare refresh is available, including quality measure results based on data from the first to fourth quarter of 2017. Visit IRF Compare to view the data. For more information, visit the IRF Quality Public Reporting webpages.

 

 

 

 

 

In the Federal Register

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2018 FR Index

 

 

CMS Transmittals

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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.