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Compliance Monitor

This HTML e-mail newsletter delivers news on Medicare and Medicaid fraud and abuse, as well as recent documents and targets of the Office of Inspector General, CMS, and the Department of Justice each week. A second e-mail newsletter, Compliance Monitor Q&A, answers compliance questions from your peers.

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Compliance Monitor

Issue 5, February 1, 2012

• Physician referral patterns ripe for scrutiny

  When is a general practitioner's referral of a patient to a specialist an appropriate one that will...

• Nurse pleads guilty to Medicare fraud

  Jorge Pineiro, a registered nurse in Miami who worked for ABC Home Health Care Inc. and Florida...

• Dealing with data breaches

  The following is adapted from an article authored by Greg Freeman that originally appeared in the...

• HIPAA Q&A: HIPAA-compliant phone messages

  Q: What do you recommend for HIPAA-compliant phone messages regarding copay due at time of service...

• Survey: Do you have a plan for incorporating the Medicaid Recovery Audit Program into your existing Medicare Recovery Audit Program?

  Survey: Do you have a plan for incorporating the Medicaid Recovery Audit Program into your existing...

Issue 4, January 25, 2012

• Cape Fear Valley Medical Center averts Medicare defunding

  Cape Fear Valley Medical Center (CFVMC) in Fayetteville, NC has entered into a systems improvement...

• Ten arrested for Medicare fraud in Puerto Rico

  A federal grand jury in the District of Puerto Rico indicted 10 individuals on 39 counts of...

• Atlanta man gets jail time for stealing PHI

  A federal judge sentenced an Atlanta man to 13 months in prison January 10 for intentionally...

• HIPAA Q&A: Maintenance of medical records after physician death

  Q: If a sole family practice physician suddenly dies, what should happen to the patients&rsquo...

Issue 3, January 18, 2012

• Third immediate jeopardy for Cape Fear Valley Medical Center

  Cape Fear Valley Medical Center (CFVMC) in Fayetteville, NC has received notification from the CMS...

• Louisiana DME owner and patient recruiter sentenced to prison for Medicare fraud

  A patient recruiter and a DME company owner were sentenced to federal prison for soliciting...

• Study: HIPAA breaches on the rise

  Patient information data breaches climbed 32% in 2011, according to the Ponemon Institute’s...

• Compliance Q&A: Annual log of data breaches

  Q: I would like some direction on the annual log of breaches affecting fewer than 500 individuals...

• Survey: RAC audit trending

  Does your facility have a system in place for studying RAC trends? Yes We are in the...

Issue 2, January 11, 2012

• OIG to CMS, AHRQ: Help hospitals determine incident reports

  The OIG found that hospital incident reporting systems only capture an estimated 14% of adverse...

• Sneak peek: Put the focus on clinical documentation

  Contractors in the Recovery Audit Program are focusing on documentation issues and, in response...

• Compliance Q&A: Potential breach from medical records

  Q. We found medical records about one of our patients in our parking lot. Is this a breach? What...

• Tip: Use nontechnical controls to assess individuals who may pose a risk

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Issue 1, January 4, 2012

• CMS to delay two out of three new demonstration projects aimed at reducing improper payments

  On December 29, CMS issued a notice announcing the delay of the recovery audit prepayment review...

• DME company owner sentenced for Medicaid fraud scheme

  U.S. District Judge Grey Miller of the Southern District of Texas sentenced the former owner of two...

• HIPAA Q&A: Leaving PHI on voicemail

  Q. A health plan representative told our clinic that she could not include PHI in a voicemail...

• Tip: Improve quality at your facility

  Compliance officers don’t treat patients, but they can do much to improve their care. The...

• Survey: Does your facility have specific guidelines for providers and their use of mobile devices?

  Survey: Does your facility have specific guidelines for providers and their use of mobile...