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A shattering breach of trust: What happens to patients when their doctor is not who he claimed to be? - Hackers breach data of 4,300 Missouri patients for 3 months - Stiff penalties under the False Claims Act can paralyze healthcare providers - And More

 

 

A shattering breach of trust: What happens to patients when their doctor is not who he claimed to be?

On January 3, 2019, STAT reported, “In Yvette Hansberry’s home, a small, soft teddy bear sits on the mantel above the fireplace. Its beady eyes survey the small family room; its face always smiles. The bear is in a prime location because it contains the remains of the worst day of her life.

“A week before that fateful day, Hansberry had been six months pregnant. She had begun leaking a clear-looking fluid — enough for her to wear a pad when she went to work. Her OB-GYN, Dr. Charles Akoda, examined her, but dismissed her concerns, she said, pronouncing her ‘fine,’ just as he had when she experienced light bleeding three months into her term.”

 

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Hackers breach data of 4,300 Missouri Patients for 3 months

On January 3, 2019, Health IT Security reported, “Missouri-based Choice Rehabilitation Center is notifying 4,309 patients that their data was breached in a months-long hack on a corporate email account.

“On November 7, Choice discovered that one of its email accounts was hacked. According to officials, the cybercriminals forwarded the provider’s emails to their personal account.”

 

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Stiff penalties under the False Claims Act can paralyze healthcare providers

On January 3, 2019, Insurance Business reported, “In 2017, the US government recovered $2.4 billion from the healthcare industry as a result of actions under the False Claims Act (FCA), a law that originated in the 1800s with the intent of imposing liability on those that defraud government programs. Over recent decades, healthcare and procurement fraud cases have made up the majority of all FCA actions, according to reporting in Today’s Wound Clinic.

 

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GA Attorney General announces lawsuit against opioid manufacturers and distributors

On January 3, 2019, Georgia Attorney General Chris Carr announced in a press release, he’d “filed a lawsuit in the Superior Court of Gwinnett County against opioid manufacturers and distributors* to seek justice for their alleged role in fueling the opioid crisis and its catastrophic effects on Georgia citizens.”

 

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Chandler woman allegedly tried to fraudulently obtain nursing license

On December 30, 2018, KTAR News reported, "Arizona Attorney General Mark Brnovich announced Friday that Laura Lynn Bell of Chandler was indicted for allegedly trying to fraudulently obtain a new nursing identity."

 

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Dearborn entrepreneur charged in $1M health care fraud

On December 31, The Detroit News reported, “A Dearborn pharmacist, hailed earlier this year for opening the nation's first halal-certified Sonic Drive-In restaurant, cheated Medicare and Medicaid by charging for medication prescribed to dead people, according to federal prosecutors.”

 

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HHS releases best practice healthcare cybersecurity guidelines

On December 31, 2018, Health IT Security reported, “The Department of Health and Human Services issued cybersecurity guidelines for the healthcare sector on Friday, focused on voluntary cybersecurity practices to reduce security risks and bolster cybersecurity programs across the industry.”

 

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Privacy breach at Family Physicians Group may have affected 8,400 Orlando patients

On December 29, 2018, Orlando Sentinel reported, “Family Physicians Group, a large practice in Orlando that was recently acquired by Humana, is notifying more than 8,000 patients about a privacy breach that may have compromised their personal health information.”

 

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Get the knowledge and tools you need for compliance oversight, regulatory risk, and audit & investigations | Join us for the Board & Audit Committee Compliance Conference | Learn More >Get the knowledge and tools you need for compliance oversight, regulatory risk, and audit & investigations | Join us for the Board & Audit Committee Compliance Conference | Learn More >

 

CMS Update

 

Laboratory Date of Service Exception Policy: Enforcement Discretion Exercised until July 1

CMS will exercise enforcement discretion until July 1, 2019, for the laboratory date of service exception policy for advanced diagnostic laboratory tests and molecular pathology tests excluded from the Medicare hospital outpatient prospective payment system packaging policy. Visit the Laboratory Date of Service Policy webpage for more information.

 

 

Antipsychotic Drug Use in Nursing Homes: Trend Update

CMS is tracking the progress of the National Partnership to Improve Dementia Care in Nursing Homes by reviewing publicly reported measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who receive antipsychotic medication, excluding residents diagnosed with schizophrenia, Huntington's disease, or Tourette’s syndrome. In the fourth quarter of 2011, 23.9 percent of residents received an antipsychotic medication; since then there has been a decrease of 38.9 percent to a national prevalence of 14.6 percent in the second quarter of 2018. Success varies by state and CMS region; some states and regions have a reduction greater than 40 percent. A four-quarter average of this measure is posted on the Nursing Home Compare website.

 

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Provider Compliance – Coding for Specimen Validity Testing Billed in Combination with Urine Drug Testing — Reminder

In a February 2018 report, the Office of the Inspector General (OIG) determined that Medicare payments to clinical laboratories and providers for specimen validity tests did not comply with Medicare billing requirements. A recent MLN Matters® Special Edition Article reminds laboratories and other providers about proper billing for specimen validity testing done in conjunction with drug testing; this article contains no policy changes.

Current coding for testing for drugs of abuse relies on a structure of presumptive and definitive testing that identifies the specific drug and quantity in the patient. This article includes descriptors for:

 

 

 

 

In the Federal Register

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2019 FR Index

 

 

CMS Transmittals

2018 Transmittals

2019 Transmittals

 

 

Acronym Library

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HIPAA Rules and Compliance

 

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Investigative Interviewing

 

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Compliance strategies, industry connections, professional development | Join us for the Compliance Institute | Register by Jan. 7 to save >Compliance strategies, industry connections, professional development | Join us for the Compliance Institute | Register by Jan. 7 to save >

 

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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.