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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.
2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001
Compliance Monitor
Issue 92, December 31, 2008
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NJ physician pleads guilty to Medicare fraud charges
Frederic Feit, owner Modern Pain Therapy in Freehold, NJ, pleaded guilty to charges of third-degree... -
Eight indicted in $1.1 million home healthcare scheme
A federal grand jury in Detroit indicted eight owners and employees of several Michigan home... -
Texas sleep clinic settles false claims suit
HMS Diagnostics Inc., an independent diagnostic testing facility specializing in the treatment of... -
Tip: Reviewing policies and procedures
The HHS-OIG Supplemental Compliance Program Guidance for Hospitals recommends considering the...
Issue 91, December 24, 2008
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Three more sentenced in Miami for Medicare fraud
Ana Alvarez-Jacinto and Sandra Mateos were sentenced to 30 years in prison for their involvement in... -
Former CA physician settles fraud case for $2.2M
Paul Lessler, a former physician in Newport Beach, CA, agreed to pay $2.2 million to settle civil... -
Specifics about the 2009 Physician Quality Reporting Program now available
CMS released specific information about the 2009 Physician Quality Reporting Program (PQRI) on its... -
Q&A: Overhead paging
Q: Is overhead paging of a patient by name back to a clinic or hospital area a HIPAA violation? -
Survey Question: New Year's resolution
Survey Question: New Year’s resolution -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 90, December 17, 2008
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New York Medicaid fraud recoveries top $550M
New York state recovered $551 million in Medicaid fraud and abuse for fiscal year (FY) 2009... -
Former LA hospital CEO pleads guilty to skid row scheme
Former City of Angels Medical Center CEO Rudra Sabaratnam pleaded guilty to charges of paying... -
Nurse sentenced for Medicare fraud
Marie Weller King, registered nurse and owner of King and Associates, will serve 18 months in... -
Tip: How to keep the board of directors updated
The compliance officer must inform the board of directors about the basic responsibilities of... -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 89, December 10, 2008
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Two TN hospitals settle false claims allegations
Jackson Madison General Hospital, in Jackson TN, and Milan General Hospital, in Milan, TN, agreed... -
Clinic and three employees indicted for healthcare fraud
Ashley Collin Walkes, owner of Medic Management, a clinic in Port Arthur, TX, Medic Management... -
Q&A: What is a reportable event?
Q: What is a reportable event? -
Survey Question: Plans for 2009
Survey Question: Plans for 2009 -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 88, December 3, 2008
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Condell Medical Center pays $36M after self-disclosing false claims violations
Condell Medical Center, in Libertyville, IL, will pay the federal government and the state of... -
Manchester Memorial settles false claims allegations
Manchester Memorial Hospital in Manchester, CT agreed to pay the federal government $712,000 to... -
TX cardiologist arrested for healthcare fraud
On December 1, Fabian Aurignac, a cardiologist in McAllen, TX, was arrested in Austin for allegedly... -
Tip: Resources for risk identification
Tip: Resources for risk identification -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 87, November 26, 2008
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Court approves Medicare freeze on payments to Miami home healthcare companies
Medicare will continue to suspend payments to Miami home healthcare agencies suspected of fraud... -
Five more Miami area residents sentenced to prison for Medicare fraud
On November 24, Carlos Contreras and Ramon Pichardo were sentenced to 37 months and 48 months in... -
PA hospital will pay $1.9 million in Medicare fraud settlement
St. Vincent Health System Inc. will pay $1.9 million to settle allegations the company submitted... -
Q: How much does an OIG advisory opinion cost?
Q: How much does it cost to request an OIG advisory opinion? -
Survey Question: Thanksgiving
What is your favorite part of Thanksgiving? -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 86, November 19, 2008
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Another Miami HIV infusion clinic owner sentenced for Medicare fraud
Another Miami HIV infusion clinic owner sentenced for Medicare fraud -
Even more fraud in South Florida
Even more fraud in South Florida -
AR couple sentenced for Medicaid fraud
AR couple sentenced for Medicaid fraud -
Tip: Submission of claims for laboratory services
Tip: Submission of claims for laboratory services -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 85, November 12, 2008
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Miami physician and clinic administrator sentenced for roles in Medicare fraud scheme
Miami physician and clinic administrator sentenced for roles in Medicare fraud scheme -
DOJ recovered $1 billion in FY 2008
DOJ recovered $1 billion in FY 2008 -
Q&A: Defective testing
Q: If a radiology facility provides imaging studies below diagnostic quality in an office/imaging... -
Survey Question: Compliance training update
Survey Question: Compliance training update -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center -
Correction
Correction -
New Jersey assemblyman proposes bill to prevent charging for never events
New Jersey assemblyman proposes bill to prevent charging for never events
Issue 84, November 5, 2008
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CMS releases display copy of CY 2009 MPFS, seeks comments on Stark exception
CMS releases display copy of CY 2009 MPFS, seeks comments on Stark exception -
Louisiana trio indicted for Medicare fraud
Louisiana trio indicted for Medicare fraud -
Tip: Cover all your bases in the ER
Tip: Cover all your bases in the ER -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 83, October 29, 2008
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NJ hospital pays $1.75 million to settle whistleblower claims
NJ hospital pays $1.75 million to settle whistleblower claims -
Delaware doctor indicted for Medicare fraud
Delaware doctor indicted for Medicare fraud -
Q&A: Transfer agreements
Q: The hospital to the south of us has a transfer agreement with a hospital seven miles to our... -
Survey Question: Are you relieved by the new 'Red Flags Rule' implementation date?
Survey Question: Are you relieved by the new ‘Red Flags Rule’ implementation date? -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 82, October 22, 2008
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Louisiana Hospital pays $3.3 million to resolve Medicare fraud charges
Louisiana Hospital pays $3.3 million to resolve Medicare fraud charges -
Six Nevada doctors pay to settle Medicare fraud claims
Six Nevada doctors pay to settle Medicare fraud claims -
Tip: Retention of records
Tip: Retention of records -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 80, October 15, 2008
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Eight indicted in South Florida AIDS/HIV infusion scheme
Eight indicted in South Florida AIDS/HIV infusion scheme -
Peoria podiatrist sentenced to year in prison for Medicare fraud
Peoria podiatrist sentenced to year in prison for Medicare fraud -
Tip: Reporting hotline activity to the board of directors
Tip: Reporting hotline activity to the board of directors -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 78, October 8, 2008
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CMS cracks down on fraud
CMS cracks down on fraud -
McKesson charged with Medicare fraud scheme
McKesson charged with Medicare fraud scheme -
Tip: Guidelines for documenting screening treatment
Tip: Guidelines for documenting screening treatment -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 76, October 1, 2008
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Headlines from the Healthcare Audit Resource Center
This week's headlines include CMS proving updated RAC numbers and also paying billions in... -
NJ Hospital pays $3.85M to settle Medicare fraud charges
NJ Hospital pays $3.85M to settle Medicare fraud charges -
Tip: Create open lines of communication
Tip: Create open lines of communication -
OIG releases supplemental compliance guidance for nursing facilities
OIG releases supplemental compliance guidance for nursing facilities
Issue 74, September 24, 2008
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Jury convicts Los Angeles DME provider of Medicare fraud
Jury convicts Los Angeles DME provider of Medicare fraud -
Federal judge dismisses $15M false claims case
Federal judge dismisses $15M false claims case -
Tip: Exit interview red flags
Tip: Exit interview red flags -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 72, September 17, 2008
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Staten Island University Hospital to pay $89 million to settle fraud claims
Staten Island University Hospital to pay $89 million to settle fraud claims -
Two Miami physicians admit to participation in HIV infusion scheme
Two Miami physicians admit to participation in HIV infusion scheme -
Tip: Quality of Care
Tip: Quality of Care -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 70, September 10, 2008
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NY State recovers $269 million in Medicaid fraud and abuse
NY State recovers $269 million in Medicaid fraud and abuse -
New Hampshire ambulance company fined $1M for false claims
New Hampshire ambulance company fined $1M for false claims -
NY's largest Medicaid provider settles fraud case for $35 million
NY’s largest Medicaid provider settles fraud case for $35 million -
Tip: Claims submitted at teaching hospitals
Tip: Claims submitted at teaching hospitals -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 68, September 3, 2008
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Whistleblowers help the government recoup $9.3 billion
Whistleblowers help the government recoup $9.3 billion -
Skid Row recruiter will plead guilty to healthcare fraud conspiracy
Skid Row recruiter will plead guilty to healthcare fraud conspiracy -
Tip: How to handle media requests
Tip: How to handle media requests -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 66, August 27, 2008
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Missouri doctors indicted on healthcare fraud and money laundering
Missouri doctors indicted on healthcare fraud and money laundering -
OIG: Medicare overstated fraud recoveries
OIG: Medicare overstated fraud recoveries -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center -
Tip: Recruitment arrangements
Tip: Recruitment arrangements
Issue 64, August 20, 2008
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Amerigroup pays $225M to settle Medicaid fraud claims
Amerigroup pays $225M to settle Medicaid fraud claims -
Houston occupational therapist gets 15 years for Medicare fraud
Houston occupational therapist gets 15 years for Medicare fraud -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 62, August 13, 2008
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California hospitals pay homeless for participation in Medicare fraud scheme
California hospitals pay homeless for participation in Medicare fraud scheme -
BlueCross BlueShield pays $2.1 M to settle false claims allegations
BlueCross BlueShield pays $2.1 M to settle false claims allegations -
Tip: How to avoid EMTALA violations
Tip: How to avoid EMTALA violations -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center -
We want your tips and stories
We want your tips and stories -
Tip: How to get cooperation from employees and staff during an internal investigation
Tip: How to get cooperation from employees and staff during an internal investigation
Issue 60, August 6, 2008
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Government creates two false DMEPOS to test CMS enrollment process
Government creates two false DMEPOS to test CMS enrollment process -
CMS releases final rule on EMTALA regulations
CMS releases final rule on EMTALA regulations -
Two Miami case managers arrested for Medicaid fraud
Two Miami case managers arrested for Medicaid fraud -
Tips for supporting an audit finding
Tips for supporting an audit finding -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 58, July 30, 2008
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Russian citizen indicted on $1 million Medicare fraud scheme
Russian citizen indicted on $1 million Medicare fraud scheme -
Civil case could mean another $2.4 million in fines for Michigan dermatologist
Civil case could mean another $2.4 million in fines for Michigan dermatologist -
Tip: Choosing an audit sample size
Tip: Choosing an audit sample size -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 56, July 23, 2008
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Another insurer joins the list of those refusing to pay for 'never events'
Another insurer joins the list of those refusing to pay for ‘never events’ -
Missouri health care system to pay $60M to settle False Claims Act allegations
Missouri health care system to pay $60M to settle False Claims Act allegations -
Seattle provider fined for HIPAA violations
Seattle provider fined for HIPAA violations -
Tip: How compliance officers can help mend quality crises
Tip: How compliance officers can help mend quality crises -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 54, July 16, 2008
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Dead doctors bill Medicare for an estimated $92 million
Dead doctors bill Medicare for an estimated $92 million -
CMS releases results of RAC demonstration
CMS releases results of RAC demonstration -
DOJ changes definition of cooperation when investigating organizations
DOJ changes definition of cooperation when investigating organizations -
Tip: Types of investigators/consultants to avoid
Tip: Types of investigators/consultants to avoid -
Headlines from the Healthcare Auditing Resource Center
Headlines from the Healthcare Auditing Resource Center
Issue 52, July 9, 2008
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Tip: Scheduling employee interviews
Tip: Scheduling employee interviews -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center -
AMA members call some CMS no-pay events unrealistic
AMA members call some CMS no-pay events unrealistic -
Owner of Miami medical equipment company sentenced to 130 months in prison
Owner of Miami medical equipment company sentenced to 130 months in prison -
Two defendants plead guilty to Medicare fraud
Two defendants plead guilty to Medicare fraud
Issue 50, July 2, 2008
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Tip: Questions to ask before you begin training
Tip: Questions to ask before you begin training -
DOJ chases Medicare fraud suspects to Dominican Republic
DOJ chases Medicare fraud suspects to Dominican Republic -
Eleven indicted in alleged $6.1 million Medicaid scheme
Eleven indicted in alleged $6.1 million Medicaid scheme -
Mother and daughters get prison time for Medicare fraud
Mother and daughters get prison time for Medicare fraud -
New group formed to track medical fraud
New group formed to track medical fraud
Issue 48, June 25, 2008
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Tip: Avoid legal trouble with self-disclosure
Tip: Avoid legal trouble with self-disclosure -
CA Health Clinic will pay $4.96 million in false Medicaid claims settlement
CA Health Clinic will pay $4.96 million in false Medicaid claims settlement -
MA will no longer pay for certain 'never events'
MA will no longer pay for certain ‘never events’ -
Settlement prohibits PA personal care provider from doing business
Settlement prohibits PA personal care provider from doing business -
Physicians and clinic owner arrested in HIV/AIDS infusion scheme
Physicians and clinic owner arrested in HIV/AIDS infusion scheme -
Headlines from the Health Care Auditing Resource Center
Headlines from the Health Care Auditing Resource Center
Issue 46, June 17, 2008
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U.S. Supreme Court rules on False Claims Act case
U.S. Supreme Court rules on False Claims Act case -
OIG reports more than $2 billion in recoveries this year
OIG reports more than $2 billion in recoveries this year -
Florida Health Care Agency paid $3.7 million to ineligible Medicaid recipients
Florida Health Care Agency paid $3.7 million to ineligible Medicaid recipients -
AHA says hospitals are not ready for new CMS rules
AHA says hospitals are not ready for new CMS rules -
Tip: Keep compliance messages simple
Tip: Keep compliance messages simple -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 44, June 11, 2008
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Maine healthcare provider settles false claims allegations
Maine healthcare provider settles false claims allegations -
New York State Medicaid will no longer reimburse for certain 'never events'
New York State Medicaid will no longer reimburse for certain ‘never events’ -
Walgreens to pay $35 million to settle fraud claims
Walgreens to pay $35 million to settle fraud claims -
Three ex-hospital workers charged in kickback lawsuit
Three ex-hospital workers charged in kickback lawsuit -
Tip: Reviewing your auditing and monitoring functions
Tip: Reviewing your auditing and monitoring functions
Issue 42, June 4, 2008
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Headlines from the Healthcare Audit Resource Center
Department of Justice fights healthcare fraud OIG recommends consistency for Medicare’s... -
Tip: Policies to encourage compliance, reporting, and cooperation
Employees should be required to report all known suspicions of improper conduct in the... -
DOJ reports on efforts to combat fraud
During fiscal year 2007, the Department of Justice (DOJ) won or negotiated approximately $1.8... -
Express Scripts to pay $9.3 million to settle switching allegations
Pharmaceutical benefits manager Express Scripts allegedly engaged in deceptive business practices... -
More Medicare fraud uncovered in South Florida
South Florida remains a hotbed of Medicare fraud activity if the South Florida Medicare Fraud...
Issue 40, May 28, 2008
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Headlines from the Healthcare Audit Resource Center
OIG OKs nursing program for Medicare eligibility OIG recommends training, repayment in Texas... -
Tip: Risk assessments for False Claims Act purposes
To help guarantee accurate claims are submitted, healthcare providers must understand common... -
Miami residents charged with Medicare fraud
Leonardo Lozada, Eliades Diaz, Jimmy A. Soto, and Jose D. Claro, all of Miami, are charged with... -
Virginia woman pleads guilty to Medicaid fraud
Sharon M. Honeycutt, of Portsmouth, VA, pleaded guilty to healthcare fraud, according to a... -
FBI releases healthcare fraud information
The FBI investigated 2,493 cases of healthcare fraud in fiscal year 2007, leading to 635...
Issue 38, May 21, 2008
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Tip: Implied false certification
Prosecutors have alleged medical fraud in cases where the defendant has not made an express false... -
Florida physician to pay $6.7M to settle fraud allegations
A variety of healthcare fraud allegations will cost Aleyda Borge, MD, and the operators of a... -
Greenwich Hospital settles fraud allegations
Greenwich Hospital will pay $605,274 to resolve allegations it submitted false claims to Medicare... -
Excessive compensation costs Baptist Health $7.77M
Baptist Health South Florida will pay $7.77 million to settle charges it paid an oncology group too... -
Eleven people indicted for Medicare fraud in LA
The Los Angeles Medicare Strike Force is bringing charges against individuals and organizations...
Issue 36, May 14, 2008
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Headlines from the Healthcare Audit Resource Center
Comparison of ASP and AMP for Medicare Part B Review of excessive payments by TrailBlazer... -
Tip: Limiting qui tam liability
One of the key features of the federal False Claims Act is the qui tam provision, which allows... -
Maryland social worker pleads guilty to healthcare fraud
Melvin Shandler, 61, of Chevy Chase, MD, faces up to 10 years in prison after pleading guilty to... -
Owners of healthcare facility agree to Medicaid settlement
The owners of a North Natomas, CA, adult healthcare facility will pay $455,000 to resolve... -
CoxHealth facing potential $60M settlement
Resolution to claims of Medicare fraud and False Claims Act violations could cost CoxHealth some...
Issue 34, May 7, 2008
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Tip: Conduct regular self-assessments
The OIG recommends hospitals complete an annual review of specific components of their compliance... -
Headlines from the Healthcare Audit Resource Center
California incorrectly paid Arizona Medicaid beneficiaries North Dakota procedure development... -
Report: Antifraud compliance becoming more complex
Complying with federal statutes and regulations aimed at eliminating fraud is becoming more complex... -
Texas physician settles false claims allegations
Daniel Andrew Maynard, D.O., of Dallas, will pay $253,000 to resolve allegations he submitted... -
More Medicare fraud convictions in Miami
Score two more convictions for the Florida Medicare Fraud Strike Force. -
More Medicare fraud convictions in Miami
Score two more convictions for the Florida Medicare Fraud Strike Force.
Issue 32, April 30, 2008
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Headlines from the Healthcare Audit Resource Center
Audit reveals overpayments for inpatient services Nebraska’s Medicaid drug rebate program... -
Tip: Examples of False Claims Act violations
A wide range of activities are illegal under the False Claims Act. The diverse situations that have... -
Virginia women indicted for Medicaid fraud
A federal grand jury indicted Annette Fleming-McClatchey, of Woodbridge, VA, on 24 counts of... -
Louisiana hospital settles false claim allegations
Touro Infirmary, a New Orleans Hospital, will pay $1.75 million to settle allegations it submitted... -
CIGNA to stop paying for 'never events'
Add health insurer CIGNA to the list of those who won’t bill or pay for preventable medical...
Issue 30, April 23, 2008
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Headlines from the Healthcare Audit Resource Center
Washington incorporated some, but not all, audit recommendations Nine additional conditions... -
Tip: Deciding what to target during an audit
Successful audit programs are based on identifiable risks. Assess your internal processes in light... -
Washington says 'no' to anti-data mining law
Another attempt to ban data mining ended unsuccessfully when a bill in Washington state failed to... -
DOJ joins whistleblower suit against radiology clinic
A Beverly Hills-based diagnostic clinic fraudulently billed Medicare for unnecessary tests... -
Medicare may stop paying for more 'never events'
Medicare is considering expand the list of preventable medical errors, known as “never... -
OIG issues draft compliance guidance for nursing facilities
The OIG released its Draft OIG Supplemental Compliance Program Guidance (CPG) for Nursing... -
Self-reporting compliance violations could eliminate CIA
Healthcare providers who voluntarily report possible compliance violations will have to submit...
Issue 28, April 16, 2008
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Headlines from the Healthcare Audit Resource Center
Questions raised about discharges in long-term care hospitals New York QIO asked to refund $77K -
Tip: Conducting effective training and education
As part of its compliance program, a hospital should provide training on government regulations and... -
Missouri psychiatrist heading to jail
Ajit Trikha will spend 30 months in prison after pleading guilty to defrauding Medicare and... -
Two Florida men sent to jail for Medicaid fraud
Michael Labrada and Miguel Castillo, both of Miami, will spend a combined 154 months in prison for... -
Dental center pays $10M to resolve false claims allegations
Allegedly billing for unnecessary dental services performed on indigent children cost Medicaid...
Issue 26, April 9, 2008
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Headlines from the Healthcare Audit Resource Center
WellPoint to stop payments for ‘never events’ Oregon state agency failed to implement... -
Tip: Designate a compliance officer
The OIG recommends every hospital designate a compliance officer to carry out and enforce... -
Whistleblower suit against Iasis dismissed
U.S. District Judge James Teilborg dismissed a private whistleblower lawsuit against Iasis... -
Clinic owner sent to prison for largest individual case of Medicare fraud
A Miami woman will spend 10 years in prison for her role in the largest known individual case of... -
Miami residents charged with fraud for HIV infusion billing
Seven Miami-area residents were indicted for allegedly paying kickbacks, submitting false claims... -
False Claims Act Corrections Act moves out of committee
The Senate could soon be taking up the question of whether the courts have misinterpreted the... -
DOJ joins whistleblower suit against Cincinnati hospital
The Department of Justice (DOJ) has joined a whistleblower lawsuit accusing Christ Hospital, The...
Issue 24, April 2, 2008
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Cleveland psychiatrist to pay $1.1M to settle false claims case
A Cleveland psychiatrist submitted more than 6,000 false claims to Medicare and TennCare programs... -
Florida physician arrested for healthcare fraud
A Florida physician faces a 54-count indictment, including 14 counts of healthcare fraud, according... -
Medicare fraud lands two Florida men in jail
Two Florida men will spend time in jail for their roles in separate Medicare fraud schemes... -
Tip: Effective Lines of Communication
Maintaining effective communications channels between employees and the hospital's compliance... -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center -
Survey
Survey
Issue 22, March 26, 2008
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CVS Caremark to pay $36.7M to settle fraud allegations
CVS Caremark will pay $36.7 million to settle claims it increased Medicare reimbursement by... -
Man sentenced to federal prison for healthcare fraud
A Florida man will spend 39 months in federal prison for his role in a multimillion dollar Medicare... -
Medical equipment suppliers in Texas sent to prison for fraud
Two Texas men will spend time in federal prison after pleading guilty to defrauding Medicare and... -
Tip: Standards of Conduct
The OIG Compliance Program Guidance advises hospitals to develop standards of conduct for all... -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 20, March 19, 2008
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HCPro, Inc. launches new logo and tagline as part of its new corporate branding initiative
HCPro, Inc. launches new logo and tagline as part of its new corporate branding initiative -
Hospitals to receive $666M in back Medicare benefits
Suing the federal government paid off in a big way for 667 hospitals. -
Yale-New Haven Hospital to pay $3.78M for false claims violations
Yale-New Haven Hospital agreed to pay just under $3.8 million to settle allegations of Medicare... -
Tip: Medical staff credentialing
Certain medical staff credentialing practices may implicate the anti-kickback statute. -
Survey
Survey -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 18, March 12, 2008
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Oregon hospitals to stop charging for never events
Oregon is the latest state to decide to stop charging for preventable medical errors, according to... -
NJ companies settle Medicare fraud allegations
Two New Jersey-based companies agreed to million-dollar settlements to resolve allegations they... -
Four convicted of Medicare fraud in Miami
Miami-Dade County's Medicare Strike Force earned another victory this week when a Miami jury... -
Tip: Benefits of a compliance program
The OIG will consider the existence of an effective compliance program that pre-dated any... -
Survey
Survey -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 16, March 5, 2008
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Senate panel reviewing False Claims Act Correction Act
Healthcare companies may find themselves in the odd position of siding with the Department of... -
Third defendant pleads guilty to Medicare fraud in Texas
A third defendant pleaded guilty to one count of healthcare fraud and one count of conspiracy in... -
Government joins fraud suit against SC hospital
The federal government has joined a South Carolina physician's lawsuit against Tuomey Regional... -
Tip: Areas to audit
The OIG recommends hospitals conduct regular audits. Either internal or external auditors with... -
Physician Provider Audits: The latest tools to analyze risk and benchmark compliance
Physicians rarely list coding and documentation among their top priorities. Many believe that such... -
Survey
Survey -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 14, February 27, 2008
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AstraZeneca to appeal $215M verdict
AstraZeneca plans to appeal a jury's decision to award $215 million to Alabama in a Medicaid... -
Virginia couple charged with Medicaid fraud
A Virginia couple allegedly defrauded the state's Medicaid agency of $14 million, according to a... -
Provider charged with Medicaid fraud
A Virginia woman has been charged with 27 counts of healthcare fraud and making false statements... -
Tip: Assessing internal disciplinary effectiveness
Tip: Assessing internal disciplinary effectiveness -
Physician Provider Audits: The latest tools to analyze risk and benchmark compliance
Physician Provider Audits: The latest tools to analyze risk and benchmark compliance -
Survey
Survey -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 12, February 20, 2008
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Tennessee man to repay $1.3M for Medicare fraud
A Tennessee man will pay the federal government $1.3 million to settle civil and criminal Medicare... -
NJ man sentenced to jail for Medicare fraud
The vice president of adult daycare centers in New Jersey will spend 55 months in jail for... -
Government collects $2.2B in settlements, judgments in fiscal year 2006
During fiscal year 2006, the federal government won or negotiated approximately $2.2 billion in... -
Tip: Claim development and submission process
To prove your facility has a strong compliance program, make sure your hospital maintains written... -
Physician Provider Audits: The latest tools to analyze risk and benchmark compliance
Physicians rarely list coding and documentation among their top priorities. Many believe that such... -
Need new tools to refresh your compliance program? Tell us about it.
How can we help you wake up your facility's compliance efforts? -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 7, February 12, 2008
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Supreme Court hears argument on scope of False Claims Act
Senator Charles Grassley (R-IA) and the Solicitor General are among those weighing in on a Supreme... -
Bayonne Hospital settles fraud case
The buyers of Bayonne Medical Center have agreed to settle allegations of Medicare fraud for $2.5... -
Pay-Per-View: Protect data, even data at rest
State laws requiring notification of a security breach to patients whose protected health... -
Tip: Handle a security breach with a solid plan
A healthcare entity's best defense against the fallout from a security breach is a two-tiered... -
Crafting a compliance program that falls just short of tired-and-true? 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. -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 6, February 6, 2008
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DOJ joins investigation of NJ hospitals
The Department of Justice (DOJ) announced it is joining the investigation into alleged False Claims... -
Washington state hospitals won't charge for 'never events'
Add Washington state hospitals to the growing list of facilities that won't charge for preventable... -
NJ man pleads guilty to healthcare fraud
A New Jersey man admitted to defrauding insurance companies of more than $2.5 million through a... -
Pay-Per-View: OIG/AHLA team up to address lab quality
Healthcare administrators and compliance officers have new guidance to help them comply with... -
Tip: Best practices for better success in HIPAA training
When the HIPAA privacy rule went into effect in early 2003, it provided the first measure of... -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 4, January 23, 2008
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Headlines from the Healthcare Audit Resource Center
OIG reviews relationship between Medicare Part D payments and drug acquisition costs -
Tip: Decipher acronyms with this helpful list
The National Alliance for Health Information Technology is spearheading the effort to develop a... -
Pay-Per-View: Updated sepsis, pain management coding
ICD-9 guidelines Although there are not any surprising changes to the new ICD-9-CM coding... -
New Jersey governor signs False Claims Act
New Jersey became the 20th state to pass its own version of the federal False Claims Act when... -
Texas medical equipment supplier convicted of fraud
A Texas medical equipment supplier was convicted on four counts of healthcare fraud and two counts... -
HHS approves gainsharing arrangements
The Department of Health and Human Services (HHS) approved gainsharing arrangements between a... -
Nine Miami defendants sentenced for Medicare fraud
Owners of nine separate Miami-based healthcare corporations have been sentenced to prison for... -
Pennsylvania Medicaid won't pay hospitals for preventable errors
Pennsylvania hospitals that treat low-income Medicaid patients covered under fee-for-service... -
Pay-Per-View: Oregon creates NPI and provider authentication data repository
Healthcare organizations in Oregon have found their own approach to remedy the quality... -
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... -
Headlines from the Healthcare Audit Resource Center
Headlines from the Healthcare Audit Resource Center
Issue 3, January 16, 2008
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Headlines from the Healthcare Audit Resource Center
Physician-owned specialty hospitals not ready for emergencies -
Tip: Improvie patient-centered care
All the technology in the world won't help your practice if the data quality is poor. Here are some... -
Pay-Per-View: Be aware of minors’ privacy rights regarding HIPAA
When divulging protected health information (PHI) to patients' family members, it is well known... -
Medical center to pay $1.9M to settle fraud claims
Lafayette General Medical Center (LGMC), located in Lafayette, LA, will pay $1.9 million to settle... -
Three accused in a healthcare fraud ring arrested in Florida
Three men accused of taking part in a healthcare fraud ring were arrested last week in Florida on... -
Former owner of healthcare business pleads guilty to Medicaid fraud
The former owner of Complete Care of America pleaded guilty to healthcare fraud, failing to pay...
Issue 2, January 9, 2008
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Headlines from the Healthcare Audit Resource Center
OIG releases audit of Missouri Medicaid disproportionate share hospital payments -
Tip: Monitor the health of your HIPAA security compliance
Healthcare providers encourage routine health checkups, knowing that they are effective for... -
Pay-Per-View: Oregon creates NPI and provider authentication data repository
Healthcare organizations in Oregon have found their own approach to remedy the quality... -
Four Oregon surgeons settle Medicare fraud claims
Four heart surgeons in Eugene, OR, agreed to pay $2.5 million to settle allegations they... -
CMS delays implementing parts of the anti-markup provision
CMS will delay implementation of parts of the anti-markup provision until January 1, 2009... -
St. Joseph's Hospital of Atlanta to pay $26M to settle FCA allegations
St. Joseph's Hospital of Atlanta and St. Joseph's Health System will pay the federal government $26...
Issue 1, January 2, 2008
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Headlines from the Healthcare Audit Resource Center
GAO report: Medicare ineffective at combating fraud -
Headlines from the Healthcare Audit Resource Center
GAO report: Medicare ineffective at combating fraud -
Tip: Promoting hand hygiene compliance
Three main issues can help ensure compliance with any evidence-based recommendation, including hand... -
Pay-Per-View: An increasing focus on patient-centered care
The healthcare environment is being altered by a movement toward patient empowerment. Consumers are... -
OIG posts Solicitation of New Safe Harbors and Special Fraud Alerts
The OIG posted its annual Solicitation of New Safe Harbors and Special Fraud Alerts in the Federal... -
OIG releases final Semiannual Report to Congress for 2007
The OIG reported a total of $43 billion in savings and expected recoveries in its final Semiannual...