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Healthcare Auditing Weekly

This weekly email newsletter offers health care internal auditors and compliance professionals the latest information on setting up and maintaining an effective auditing program.

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Healthcare Auditing Weekly

Issue 60, December 26, 2007

• Editor's note

  Because of the New Year's Day holiday, Healthcare Auditing Weekly will not publish next week. Look...

• Tip: Plan for a paperless panacea

  Somehow, achieving a paperless state remains an elusive goal for approximately one-third of...

• Pay-Per-View: RACs are headed your way

  One rehabilitation hospital in California offers a glimpse of what might be your future: It has two...

• OIG releases audit of AMPs and ASPs

  <p>The OIG identified 22 drug codes with average sales prices (ASP) that exceeded the average...

• OIG reviews claim payment adjustments for QIOs

  The OIG found fiscal intermediaries properly processed the majority of payment adjustments for...

• GAO report: Medicare ineffective at combating fraud

  The Government Accountability Office (GAO) found that Medicare made nearly $90 million in...

Issue 59, December 18, 2007

• Tip: Determine whether your compliance program can withstand an examination

  Here are some questions to ask to determine whether your facility's compliance program can...

• Healthcare Audit Resource Center Audit Plan of the Month

  Looking for a particular audit plan that may help make your job easier? Turn to the "Audit Plans...

• Pay-Per-View: Make smart use of the new OIG Work Plan

  The OIG posted its 92-page plan on October 1 detailing what areas the OIG expects to audit in the...

• Government to end oversight of NJ university

  The government will end its two-year oversight of the University of Medicine and Dentistry of New...

• HealthSouth and physicians agrees to repay $14.9M

  HealthSouth Corporation and two physicians have agreed to repay the government $14.9 million to...

Issue 58, December 11, 2007

• Omnicare Inc. to pay $49.5 million for Medicaid prescription drug fraud

  Omnicare, Inc. will pay the government and 43 states $49.5 million to settle a case initiated by...

• ASC overpayments found through NY audits

  Audits released by the office of New York State show that New York's four largest ambulatory...

• Pay-per-view: Take action to avoid CCAs, CIAs

  When healthcare providers find themselves in legal trouble, they often also find themselves saddled...

• Tip: Preparing a report

  Auditors should prepare written audit reports communicating the results of each audit. Written...

• Healthcare Audit Resource Center Audit Plan of the Month

  Detection and Prevention of Fraudulent Financial Reporting Audit Plan Use this sample audit plan...

• Tired? Need new tools to refresh your compliance program and your career? Tell us about it.

  HCPro Inc., wants to know what we can do to help you wake up your facility's compliance efforts.

Issue 56, December 4, 2007

• Respiratory therapist sentenced for submitting false claims in Georgia

  A respiratory thrapist in Georgia was sentenced to five years in prison, and will pay over $2.7...

• Unfounded pension costs found in audit of Georgia's Blue Cross/Blue Shield

  The OIG found that Georgia did not properly account for the entire unfunded pension costs, because...

• Pay-per-view: Take action to avoid CCAs, CIAs

  When healthcare providers find themselves in legal trouble, they often also find themselves saddled...

• Tip: Planning

  The planning phase of the audit is the first step in the audit process. It includes gaining an...

• Healthcare Audit Resource Center Audit Plan of the Month

  Detection and Prevention of Fraudulent Financial Reporting Audit Plan Use this sample audit plan...

• Tired? Need new tools to refresh your compliance program and your career? Tell us about it.

  HCPro Inc., wants to know what we can do to help you wake up your facility's compliance efforts.

Issue 54, November 26, 2007

• Virginia claimed $5M in unallowable administrative costs for foster care

  In a recent audit, the OIG found the Virginia Department of Social Services claimed Title IV-E...

• Iowa Medicaid payments for targeted case management

  The OIG found that the Iowa Department of Human Services improperly claimed $2,495,948 for targeted...

• Pay-per-view: Take action to avoid CCAs, CIAs

  When healthcare providers find themselves in legal trouble, they often also find themselves saddled...

• Tip: Go/No-go decision

  After the review and analysis of the results of the survey, the audit team meets to determine...

• Healthcare Audit Resource Center Audit Plan of the Month

  Detection and Prevention of Fraudulent Financial Reporting Audit Plan

Issue 52, November 20, 2007

• Inconsistencies in the Medicaid Prescription Drug Program

  The OIG found an estimated $11.8 million in inappropriately claimed Medicaid rebates during the...

• Review of New York temporary assistance payments

  The OIG found that New York State made Temporary Assistance for Needy Families Basic Assistance...

• Pay-per-view: Take action to avoid CCAs, CIAs

  When healthcare providers find themselves in legal trouble, they often also find themselves saddled...

• Tip: Gaining consensus for the appropriate level of investigation

  You've heard the allegation, kicked the tires, and your informal inquiry determined that there is a...

• Healthcare Audit Resource Center Audit Plan of the Month

  Use this sample audit plan to detect and prevent fraudulent financial reporting.

Issue 50, November 13, 2007

• Arizona Heart Hospital settles with DOJ for 5.8 million

  The Arizona Heart Hospital, a Medcath hospital, has agreed to a settlement in which it will pay...

• Arizona Heart Hospital settles with DOJ for 5.8 million

  The Arizona Heart Hospital, a Medcath hospital, has agreed to a settlement in which it will pay...

• Audit of Blue Cross/Blue Shield of South Carolina for Medicare Reimbursement

  The OIG found that Blue Cross/Blue Shield of South Carolina incorrectly billed Medicare for...

• Pay-per-view: Take action to avoid CCAs, CIAs

  When healthcare providers find themselves in legal trouble, they often also find themselves saddled...

• Tip: Five attributes of an audit finding

  Condition: statement that describes the results of the audit Criteria: standards used to measure...

• Healthcare Audit Resource Center Audit Plan of the Week

  Diagnostic testing in the ED plan Use this sample audit plan to ensure your facility documents...

Issue 48, November 6, 2007

• Dianon Systems will pay $1.5 million False Claims Act violation

  Dianon Systems, Inc. will pay $1.5 million for allegedly violating the False Claims Act (FCA) and...

• Dianon Systems will pay $1.5 million False Claims Act violation

  Dianon Systems, Inc. will pay $1.5 million for allegedly violating the False Claims Act (FCA) and...

• OIG audit of refugee medical assistance payments in Florida

  The OIG performed an audit to determine whether the Florida Department of Children and Families...

• Pay-per-view: Incorporate EMTALA into ongoing audits, compliance activities

  Litigation against hospitals relating to patient care often include claims of Emergency Medical...

• Tip: Simple vs. Stratified Sampling

  When determining whether to choose simple random sampling or stratified random sampling, keep the...

• Tip: Simple vs. Stratified Sampling

  When determining whether to choose simple random sampling or stratified random sampling, keep the...

• Healthcare Audit Resource Center Audit Plan of the Week

  Diagnostic testing in the ED plan Use this sample audit plan to ensure your facility documents...

Issue 46, October 30, 2007

• Cardiologist pays $1.8 million for Medicare scheme

  An Ohio cardiologist, Mohammed Aiti, pleaded guilty to ordering cardiology tests that weren't...

• OIG advisory opinion on contracts for emergency ambulance services

  The OIG released an advisory opinion in regard to how three private ambulance companies should...

• Pay-per-view: 2008: The year of Medicaid compliance enforcement

  Healthcare auditing and compliance professionals will be busy next year, says Jim Sheehan. As New...

• Tip: Accessing Communication Effectiveness

  The OIG's Supplemental Guidance recommends considering the following questions when assessing a...

• Tip: Accessing Communication Effectiveness

  The OIG's Supplemental Guidance recommends considering the following questions when assessing a...

• Healthcare Audit Resource Center Audit Plan of the Week

  Use this sample audit plan to ensure your facility documents all diagnostic tests billed out of the...

Issue 44, October 23, 2007

• OIG audits Iowa Foundation for Medical Care

  The OIG posted an audit of the Iowa Foundation for Medical Care (IFMC). The purpose of the audit...

• Medicaid fraud settlement in Kentucky

  Oral surgeon Dr.Peter R. Ciampa will pay more than $270,000 in a settlement after he was accused of...

• Pay-per-view: Stark II Phase III released

  As if the potential Stark changes included in the proposed Medicare Physician Fee Schedule (MFPS...

• Tip: Tests of Evidence

  Evidence should be sufficient, competent, and relevant. Evidence is sufficient if there is...

Issue 42, October 16, 2007

• OIG releases 2006 report on CMS's prevention of fraud and abuse

  The OIG released CMS's Implementation of Safeguards During Fiscal Year 2006 To Prevent and Detect...

• Million dollar Medicare scheme in Southern California

  Four people involved in a million dollar Medicare fraud scheme were given sentences ranging from...

• Pay-per-view: Continuum Health makes HIPAA awareness a top compliance concern

  Few principles in medicine are more sacred than keeping patient information private. The legal...

• Tip: Analyzing Samples

  To get the most out of your audit results, segregate and analyze your data. Segregate the results...

Issue 39, October 9, 2007

• Featured audit plan: Medical necessity monitoring plan

  Looking for a particular audit plan that may help make your job easier? Turn to the "Audit Plans...

• Tip: Know deficiencies in internal control

  The following are examples of deficiencies that may be reportable conditions:

• Pay-per-view: Audit physicians for E/M missteps

  Physicians are overloaded with tasks-from staying on top of the latest medical advances to breaking...

• Florida Doctor to spend 18 months in prison for Medicare fraud

  Dr. Orestes Alvarez-Jacinto was sentenced to 18 months in prison for his involvement in a $7...

• Bristol-Meyers Squibb settles with DOJ for $515 million

  Bristol-Meyers Squibb (BMS) will pay more than $515 million for a wide assortment of illegal drug...

Issue 38, October 2, 2007

• Medical equipment company owner to spend 10 years in prison

  The owner of a Florida home care company will pay $1.7 million to Medicare and spend 10 years in...

• False claims for Medicaid reimbursement found in Missouri

  The OIG found that Missouri's State agency claims for Medicaid reimbursement of graduate medical...

• Pay-per-view: Kaiser to Complete Compliance Makeover

  Kaiser Permanente is confronting a high-profile, high-stakes overhaul of some of its auditing and...

• Tip: Gather Appropriate Documentation

  For a successful audit, develop a set of working papers-either hard copy or electronic-that support...

Issue 36, September 25, 2007

• Adventis pays more than $190 million in settlement

  Adventis Pharmaceuticals, Inc. has agreed to pay more than $190 million to settle FCA allegations...

• OIG finds irregular number of claims for HIV/AIDS patients

  The OIG found an irregular number of claims for infusion therapy for patients with HIV/AIDS in...

• Pay-per-view: CMS to close loopholes in Stark Law

  On July 2, CMS proposed potentially far-reaching changes to the Stark regulations as part of its...

• Tip: Follow CMS fraud alerts

  CMS issues a fraud alert when it has identified an apparent Medicare scam or fraudulent scheme that...

Issue 35, September 18, 2007

• Audit cites overpaid Medicare insurers

  An audit by the Government Accountability Office found the Bush administration did not properly...

• Handle Stark problems proactively

  Stark may not have been high on a hospital's risk assessment chart in the past, but it should be...

• Pay-per-view Proceduralists ensure compliance with specialized surgeries

  Practice makes perfect. This is the commonsense concept behind the increasingly popular strategy of...

• Tip: Formal vs. informal audits

  Formal reviews and audits involve carefully selected areas, outcomes, and samples. Informal reviews...

• Featured audit plan: Medical necessity monitoring plan

  Looking for a particular audit plan that may help make your job easier? Turn to the "Audit Plans...

Issue 34, September 11, 2007

• OIG audit finds overpayment by Medicaid intermediary

  A high-dollar Medicaid payment made by Chisholm Administrative Services (Chisholm), a Medicare Part...

• Rhode Island Quality Improvement Organization accurately documents costs

  An OIG audit of six fiscal integrity areas for the Rhode Island Quality Improvement Organization...

• Tip: Procedural due process

  Although the hospital has the authority and obligation to evaluate medical staff members and...

• Pay-per-view: Learn from CMS’ mistakes to guarantee outlier compliance

  It’s time to pay attention to outpatient outlier payments. CMS didn’t, and it became...

• Featured audit plan: Ambulatory payment classification monitoring

  Looking for a particular audit plan that may help make your job easier? Turn to the "Audit Plans...

Issue 33, September 4, 2007

• OIG reviews vendor rebate to Illinois hospital

  The OIG is continuing its review of vendor rebates paid to hospitals that it outlined in the 2007...

• Audit finds Florida therapist not in compliance

  Of 100 sampled physical therapy claims from Florida, 96 did not meet Medicare's reimbursement...

• Pay-per-view: Top reasons to target E/M coding

  Evaluation and management (E/M) coding continues to be a top compliance priority. But an E/M audit...

• Tip of the week: Use COSO to identify risks, assess controls

  Identifying potential barriers to your organization's success should be your top priority to ensure...

Issue 32, August 21, 2007

• OIG: New York, Nevada’s false claims acts meet DRA incentive

  The OIG has posted two new state false claims act review letters for New York and Nevada. According...

• Featured audit plan: Ambulatory payment classification monitoring

  Looking for a particular audit plan that may help make your job easier? Turn to the "Audit Plans...

• Tip: Make sure audits are objective

  Tip: Make sure audits are objective

• Medicare ends coverage for hospital errors

  Beginning next year, Medicare will no longer pay to treat infections patients pick up in the...

• Two trainers of home health aides admit fraud

  The former owners of two unrelated schools that trained home health aides in New York admitted to...

• Featured Audit Plan: Self-administered take-home drugs

  Featured Audit Plan: Self-administered take-home drugs Looking for a particular audit plan that...

• Tip of the week: Ask why

  During an audit, identifying the root cause of a good or bad performance is key. The auditors...

• Pay-per-view: Proceduralists ensure compliance with specialized surgeries

  Practice makes perfect. This is the commonsense concept behind the increasingly popular strategy of...

Issue 31, August 14, 2007

• New Orleans hospitals drowning under financial burdens

  When Hurricane Katrina flooded, and closed, Charity Hospital in 2005, New Orleans lost a major...

• New York, New Jersey asked to refund millions after OIG audits

  New York and New Jersey each improperly received millions of dollars in Federal Medicaid...

• Aussie pharmas must publicly disclose gifts to docs online

  Australian pharma companies that manufacture and market prescriptions will have to report the type...

• Nebraska Hospitals provide family and friends with real-time electronic updates

  Omaha’s Methodist Hospital is yet another Nebraska hospital adopting technology in order to...

• Pay-per-view: Protect your quality of care

  Pay-per-view: Protect your quality of care

• Tip: Avoid OSHA citations

  Tip: Avoid OSHA citations

Issue 30, August 7, 2007

• OIG issues advisory opinion regarding subsidizing costs for the needy

  The OIG recently released an advisory opinion regarding a charitable organization’s...

• Hospital nurse charged with stealing drugs, falsifying records

  A Mineola, FL nurse was arrested and charged last week with stealing narcotics--including powerful...

• OIG: Mutual of Omaha overpaid claims by $370,000

  An audit of a Midwest intermediary’s payments for long-term care hospitals (LTCH) claims...

• Pay-per-view: Review your community benefit policy

  A number of policymakers in recent years have intimated that the community benefit standard is...

• Tip: Review your E/M guidelines in light of new CMS guidance

  Section IX, part C of the recent OPPS proposed rule ("Proposed Visit Reporting Guidelines...

Issue 29, July 31, 2007

• Pay-per-view: Health system’s new vendor policy stands its ground

  Pay-per-view: Health system’s new vendor policy stands its ground

• Tip: Make the proposed revised CC list more manageable for coders

  Tip: Make the proposed revised CC list more manageable for coders

• Featured audit plan: Ambulatory payment classification monitoring

  Featured audit plan: Ambulatory payment classification monitoring

• Audit: UMDNJ's DSH payments exceed limit by more than $20 million

  In one of its most recent audits, the OIG set out to review Medicaid disproportionate share...

• Medical school faculties worry over reducing resident hours

  Despite reports of medical interns suffering from extremely long shifts at academic medical...

Issue 28, July 24, 2007

• OIG: Medicare Program Safeguard Contractors have

  An OIG audit of Medicare's program safeguard contractors (PSCs) found a substantial difference...

• Clinic system suspends 100 employees for snooping through medical records

  Park Nicollet Health Services, a chain of more than two dozen health clinics, have suspended more...

• Miami surgeon ignores suspension, keeps operating

  A legal dispute involving a 69-year-old Miami heart surgeon has revealed that he has been suspended...

• New OPPS proposed rule pushes wholesale packaging

  The outpatient prospective payment system (OPPS) has seen its fair share of changes every year...

• Featured audit plan: EMTALA

  Featured audit plan: EMTALA

Issue 27, July 17, 2007

• Illinois hospital must prove community benefit or face consequences

  Mokena, IL-based Provena Health, a Catholic hospital chain, is fighting to keep its state property...

• CMS proposes extensive Stark changes

  Earlier this month, CMS released a number of proposed and potentially far-reaching changes to the...

• FBI arrests millionaire doctor on fraud, kickback charges

  Dr. Patrick Chan of Little Rock, AR is under house arrest and is required to wear an ankle bracelet...

• Tip: Contact payers when designing your contingency plan

  Tip: Contact payers when designing your contingency plan

• Pay-per-view: SEC approves new guidance for SOX compliance

  Pay-per-view: SEC approves new guidance designed to make SOX compliance more feasible

• Featured audit plan: Medical necessity monitoring plan

  Featured audit plan: Medical necessity monitoring plan

Issue 26, July 10, 2007

• CMS targets equipment vendors in Florida, Los Angeles

  CMS Administrator Leslie Norwalk has "had enough," and in a move to stamp out Medicare fraud in...

• Florida, Texas successfully improve false claim laws

  Two states have moved forward with their individual false claims acts: Texas and...

• Featured audit plan: Lifetime reserve days

  Featured audit plan: Lifetime reserve days

• Pay-per-view: OIG targets hospitals for accurate vendor-rebate reporting

  Pay-per-view: OIG targets hospitals for accurate vendor-rebate reporting

• Tip: Ensure that your staff is properly reporting modifier -59

  Tip: Ensure that your staff is properly reporting modifier -59

Issue 25, July 3, 2007

• OIG: Missouri QIO successfully passes audit

  A Missouri quality improvement organization (QIO) passed a government-ordered audit with flying...

• WellPoint named a defendant in sexual-battery suit

  One month after it booted Chief Financial Officer David Colby, WellPoint is finding itself in more...

• Scrushy slapped with fine, jail time

  Former HealthSouth Corp. chief executive Richard Scrushy -- cleared in a landmark corporate fraud...

• Featured audit plan: Ambulance transports

  Featured audit plan: Ambulance transports

• Pay-per-view: Baby boomers headed your way

  Pay-per-view: Baby boomers headed your way

Issue 24, June 19, 2007

• Ambulance co. agrees to pay millions to settle

  Scottsdale, AZ-based Rural/ Metro Corp. has agreed to pay the federal government more than $2.5...

• ERs labeled 'biggest crisis in heathcare,' congressman says HHS ignoring problem

  The nation's emergency departments are overwhelmed, understaffed, underfunded and unready to take...

• OIG cracks down on fraud in new criminal enforcement actions

  The OIG handed out years in jail time and thousands of dollars in fines as punishments for several...

• Texas doctor blows whistle on improper care, poorly supervised surgeries

  A former department chair at UT Southwestern Medical Center in Dallas is claiming he was demoted...

• Controversial medical school places another executive on

  A top administrator at the University of Medicine and Dentistry of New Jersey (UMDNJ) has been...

• OIG releases another vendor rebate audit

  The number of hospitals audited for vendor rebate reporting continues to increase with the release...

• Featured audit plan: Vendor gratuities

  Featured audit plan: Vendor gratuities

• Featured audit plan: Same-day readmissions

  Featured audit plan: Same-day readmissions

• Evaluating quality of care

  Evaluating quality of care

• Healthcare Humor

  Healthcare Humor

Issue 23, June 12, 2007

• West Coast company blaimed for online data breach at NH hospital

  The personal health information of more than 9,000 Concord Hospital patients was exposed on the...

• JCAHO sends inspectors to DC facility

  The Joint Commission, a national hospital accrediting organization, sent inspectors to Greater...

• Hospital warns of fraudulent door-to-door fundraising

  The Phoenix, AZ Children’s Hospital Foundation is warning residents of fundraising scams...

• Pay-per-view: RAC program to go national by 2010

  CMS has announced that the recovery audit contractor (RAC) program will expand nationwide in two...

• Tip: Conduct an audit to verify cash deposits

  Tip: Conduct an audit to verify cash deposits

Issue 22, June 5, 2007

• WellPoint ousts chief financial officer for 'misconduct'

  David C. Colby, chief financial officer of WellPoint, Inc., the operator of a large network of Blue...

• Iraq spending bill eases burden on teaching hospitals

  President George W. Bush's approval of the Iraq war spending bill not only affected the military...

• New York subpoenas Amgen's sales, marketing documents

  Amgen Inc. received a subpoena last week from the New York state attorney general, who is seeking...

• Pay-per-view: Take ’medically unnecessary’ out of your facility’s vocabulary

  Pay-per-view: Take ’medically unnecessary’ out of your facility’s vocabulary

• Tip: Be aware of medical identity theft

  Tip: Be aware of medical identity theft

Issue 21, May 28, 2007

• OIG: Massachusetts hospital should return overpayments

  The OIG recommends a Massachusetts hospital repay $15,738 to the state's Medicaid program following...

• OIG continues review of hospital rebates

  The OIG continues to review rebates paid to hospitals. In its most recently released audit report...

• Report: Public facilities should announce changes in auditors

  If your facility is a publicly-traded company, it should have to inform the public when it switches...

• Tip: Audit your compliance hotline

  Audit your compliance hotline to make sure the compliance department investigates calls in a timely...

Issue 20, May 22, 2007

• California doctors arrested in $30 million surgery scam

  Three doctors were charged with billing insurers for $30 million of unnecessary surgery performed...

• UnitedHealthCare to pay Nebraska $650,000 in settlement

  The Nebraska Department of Insurance and UnitedHealthCare have settled complaints about the...

• Insurer makes changes to payment, reimbursement procedures

  Aetna is changing its reimbursement procedures to expand on its transparency initiatives and to...

• Tip: Use these strategies to integrate coders

  Getting new inpatient coders to become productive members of your facility is a challenge...

• Pay-per-view: Alert--OIG auditing HIPAA security

  Pay-per-view: Alert: OIG auditing HIPAA security

Issue 19, May 15, 2007

• OIG continues rebate audits

  The OIG is continuing its review of vendor rebates paid to hospitals with the release of two audits...

• Dozens arrested as feds target Medicare fraud in Florida

  The federal government has already made multiple arrests as it cracks down on Medicare fraud in...

• AHA: Healthcare industry should prepare now for baby boomers

  The over-65 population will nearly triple between 1980 and 2030 as a result of the aging baby...

• Pay-per-view: Follow these tips to comply with the Deficit Reduction Act

  Pay-per-view: Follow these tips to comply with the Deficit Reduction Act

• Tip: Add warnings to printed materials

  Tip: Add warnings to printed materials

Issue 18, May 8, 2007

• Tip: Establish a process for employees to access their own medical records

  Tip: Establish a process for employees to access their own medical records

• Pay-per-view: OIG auditing HIPAA security

  Pay-per-view: OIG auditing HIPAA security

• OIG: Hospital fails to accurately report vendor rebates

  OIG: Hospital fails to accurately report vendor rebates

• States push new false claims legislation

  States push new false claims legislation

• Delaware AG probes pharma-hospital pricing contracts

  Delaware AG probes pharma-hospital pricing contracts

Issue 17, May 1, 2007

• CMS issues guidance on hospital emergency services

  CMS released new guidance last week clarifying the responsibility of hospitals that provide...

• Tip: Motivate employees with small gestures

  Look for ways to enhance the work experience for both surgeons and staff at your facility. Even the...

• HHS gives Office of Civil Rights subpoena authority

  The secretary of Health and Human Services (HHS) has delegated to the director of the Office for...

• Pay-per-view: Whistleblower laws cause states to scramble for their own

  Pay-per-view: Whistleblower laws cause states to scramble for their own

• OIG: $718 million inappropriately paid out for mental health services in 2003

  The OIG released a report last week that determines the extent to which Medicare Part B mental...

• Survey of the Week

  Survey of the Week

Issue 16, April 24, 2007

• Pay-Per-View: Audit your ambulance rates to prevent inappropriate discounts

  Pay-Per-View: Audit your facility's ambulance rates to prevent inappropriate discounts

• Tip: Five ways to prevent would-be whislteblowers

  Tip: Five ways to prevent would-be whislteblowers

• Georgia passes qui tam whistleblower law

  Georgia passes qui tam whistleblower law

• Report finds fraud, waste in state-run charity program

  Report finds fraud, waste in state-run charity program

• New York hospitals continue lawsuits against HMOs

  New York hospitals continue lawsuits against HMOs

Issue 15, April 17, 2007

• State appoints head to Medicaid fraud fighting team

  State appoints head to Medicaid fraud fighting team

• OIG: Free drugs outside of Part D benefit not allowed

  OIG: Free drugs outside of Part D benefit not allowed

• Report: OIG assesses PECOS implementation

  Report: OIG assesses PECOS implementation

• CMS announces IPPS proposed changes

  CMS announces IPPS proposed changes

• Tip: How to audit credentialing and privileging practices

  Tip: How to audit credentialing and privileging practices

Issue 14, April 11, 2007

• Government Audit Insider

  A nursing home may pass on "rewards" from its company credit cards to employees, according to a...

• Tip: Auditing procedures pertaining to anti-kickback and Stark

  Hospitals should have policies and procedures in place to address state and federal anti-kickback...

• CMS to hold NPI contingency roundtable

  CMS to hold NPI contingency roundtable

• Tenet reaches $10 million settlement in fraud case

  Tenet reaches $10 million settlement in fraud case

• Audit: New York DOH overpaid millions in benefits

  New York's Department of Health (DOH) overpaid medical providers $25.7 million between 2001 and...

Issue 13, April 3, 2007

• Drug, device ties capped at $50K for docs on FDA ad boards

  The FDA has proposed stricter conflict of interest rules that set a grant or fee cap of $50,000 for...

• Texas Web site provides price transparency

  Texas Web site provides price transparency

• Tip: Develop a plan now for NPI exchange

  Tip: Develop a plan now for NPI exchange

• Government Audit Insider: OIG issues report on suppliers’ compliance

  The OIG announced last week that it has issued a report on compliance of suppliers of durable...

• Hospital fined $100,000 for patient's death

  Hospital fined $100,000 for patient's death

Issue 12, March 27, 2007

• CMS releases additional guidance on new DRA requirements

  CMS issued a letter to state Medicaid directors that includes additional guidance on employee...

• GAO: Medicare doctors, suppliers owe back taxes

  A new report out of the Government Accountability Office says the federal government has failed to...

• OIG approves two states’ whistleblower laws

  The OIG announced it approved both Hawaii and Virginia’s new whistleblower laws last week.

• Tip: Resolving past coding errors

  Did you attend a conference recently and find out that someone in your organization has been coding...

• Government Audit Insider: Florida handled Medicaid payments appropriately

  The state of Florida made accurate and appropriate Medicaid payments on behalf of beneficiaries in...

Issue 11, March 20, 2007

• UnitedHealthcare supports program to reduce racial disparities

  Insurer UnitedHealthcare is supporting a government program aimed at reducing racial and ethnic...

• Government Audit Insider: OIG releases new advisory opinion

  The OIG focused its most recent advisory opinion on whether hospitals could subsidize the cost of...

• Tip: Create a training compliance plan

  A plan for compliance training can help ensure that every employee in your organization is trained...

Issue 10, March 13, 2007

• Attorney pleads guilty to Medicare fraud conspiracy

  South Florida attorney Benjamin Metsch pleaded guilty to charges that he defrauded Medicare between...

• Hospital worker sues doctor for reading her personal medical information

  A Massachusetts hospital employee is suing a colleague for accessing her medical chart in order to...

• Kaiser Permanente maintains struggling EMR system ’spectacular’

  While California regulators investigate problems with the installation of Kaiser Permanente’s...

• Tips for identifying risks

  The process of identifying compliance risks does not have to be costly--one often can identify risk...

• Government Audit Insider: Health plan administrator makes positive changes

  Peoples Health Network, the administrator of Tenet Choices, Inc.’s Tenet Choices 65 health...

Issue 9, March 6, 2007

• Seimens executives plead guilty in hospital fraud case

  Two former Siemens executives pled guilty last week to "fixing" a $49-million contract to provide...

• CMS proposes to substantially revise advanced beneficiary notification forms

  CMS published in the February 23 Federal Register a request for comments on its proposal to revise...

• Attorney General proposes pharmaceutical gift disclosure legislation

  Marketing drugs in Connecticut may hinge on a requirement for pharmaceutical companies to disclose...

• Tip: Four commonly used audit tools

  Use these four common audit tools to make your job easier:

• Government Audit Insider: Covenant improperly billed Medicare

  The Lubbock, TX-based Covenant Health System improperly billed Medicare for air ambulance services...

Issue 8, February 26, 2007

• UnitedHealth to fine physicians if patients go to ’wrong’ lab

  Effective March 1, the UnitedHealth Group will fine a physician $50 if a patient goes outside the...

• Update to coverage of inpatient hospital therapeutic services

  On February 16, CMS released an MLN Matters article relating to a January 26 transmittal on the...

• Tip: Ensure integrity of electronic information

  HIPAA includes an integrity standard to ensure that electronic protected health information is...

• Government Audit Insider: Medicaid fraud referral process lacks standards

  CMS lacks adequate criteria to measure state Medicaid agency performance in controlling Medicaid...

Issue 7, February 13, 2007

• New York hospitals sue UnitedHealth for racketeering

  Two New York hospitals have filed a Racketeer Influenced and Corrupt Organizations (RICO) suit...

• GAO criticizes HHS’ progress on privacy

  HHS should address "key privacy principles" to ensure success in nationwide health information...

• California doctors indicted in multi-million dollar Medicare fraud scheme

  A group of Los Angeles-area doctors, healthcare administrators and associates have been indicted on...

• State regulators to audit mental health treatment

  The state of North Carolina will audit companies that provide basic assistance to mental health and...

• Congressional panel digs into drug pricing

  Federal prosecutors have a backlog of more than 150 cases of alleged pharmaceutical fraud...

• State balks at Medicaid billing costs

  A $50-million computer system initially created to update Maine’s Medicaid billing program is...

• Organizations push for conflicts of interest limitations

  Healthcare consumer group Community Catalyst and the Institute on Medicine as a Profession, a...

• TIP: Conduct a worthwhile internal coding/billing audit

  You can’t afford to lose revenue, especially when you have done the work to earn it. So how...

• Tip: Conduct a worthwhile internal billing/coding audit

  Last week we covered four reasons to get your team involved in annual billing and coding...

• OIG monitors nursing home fraud

  As part of a requirement mandated by Congress, the OIG has begun reviewing potentially excessive or...

• OIG posts new corporate integrity agreements

  The OIG released its updated list corporate integrity agreements to its Web site.

Issue 6, February 5, 2007

• Group urges adjustments to HHS’ NPI implementation plan

  HHS should permit contingency plans and consider extending the national provider identifier (NPI...

• Bayer to pay $8 million in settlement with state AGs

  Bayer Corporation will pay $8 million in a 30-state settlement regarding the marketing of its...

• State auditor to probe hospital’s IT services

  Iowa state Auditor David Vaudt will investigate access to the University of Iowa (UI) Hospitals and...

• Tip: Auditing common EMTALA pitfalls

  The Emergency Medical Treatment and Labor Act (EMTALA) ensures that all emergency room patients...

• Government Audit Insider: CIGNA submitted unallowable claims

  The OIG reviewed pension costs claimed by CIGNA for Medicare reimbursement between 1991 and 2004 as...

Issue 4, January 23, 2007

• Misys CEO bows out

  Misys Healthcare Systems Chief Executive Officer Tom Skelton stepped down from his post last week.

• Drugstore executives indicted on bribery charges

  Two suspended executives of CVS were indicted last week on federal charges of fraud and bribery of...

• Lying to doctors puts patients’ health at risk

  Patients put their own health at risk when they lie to their doctors, the Associated Press (AP...

• Tip: Conducting an IRB audit

  It’s a good idea to conduct an audit of your organization’s institutional review board...

• Government Audit Insider: Medicare contractor makes inappropriate payments

  Associated Hospital Service (AHS), a Medicare contractor based in Maine, made inaccurate payments...

Issue 3, January 16, 2007

• Hospital debt sees increase in 2007

  Citing rising costs from uninsured and underinsured patients, healthcare analysts say bad debt is...

• USC attempts to rectify transplant program problems

  The University of Southern California's University Hospital will change the way it selects its...

• Hospital takes new approach to cutting costs

  In an effort to save money, Seattle-based Virginia Mason Medical Center is working with insurers...

• TIP: Formal vs. informal audits

  When designing an audit, you need to know whether you will conduct a formal review/audit or an...

• Government Audit Insider

  The Nevada Division of Health Care Financing and Policy inappropriately claimed nearly $6 million...

Issue 1, January 2, 2007

• Step-by-step review of one-day stays

  Auditing one-day stays can be easy with the help of a step-by-step guide. This is the first of a...

• Hospital fails to maintain controlled substance standards

  Lawton Indian Hospital in Lawton, OK has not complied with requirements to secure and account for...

Issue 19, June 5, 2007

• Other CMS Developments

  Other CMS Developments

Issue 1, January 29, 2007

• Medicare payment demonstration makes strides in patient care

  Second-year results from CMS’ hospital value-based purchasing demonstration project show...

• Schering Sales Corporation sentenced to criminal fine

  Schering-Plough subsidiary Schering Sales Corporation was sentenced in federal court last week in...

• Healthcare research group shuts its doors

  The Florida-based Healthcare Research and Development Institute (HRDI), a consulting group owned by...

• Determining the effectiveness of your compliance hotline

  A compliance hotline allows employees, vendors, and physicians to anonymously report compliance...

• Government Audit Insider

  Results from a recent OIG audit of additional reimbursement for distinct-part nursing facilities of...