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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 44, November 4, 2009

• Texas Hospital group pays U.S. $27.5 million in false claims settlement

  A Texas hospital group will pay the United States $27.5 million to resolve allegations that it...

• Detroit clinic owner faces 10 years in prison for Medicare fraud scheme

  On October 30, Daisy Martinez pled guilty in Detroit’s U.S. District Court to one count of...

• Medical equipment owner pleads guilty to fraudulently billing Medicare

  Noel Wayne Jhagroo, owner and operator of Trucare Medical Equipment Services, a Houston-area...

• Tip: Conducting a limited investigation

  Internal investigations will not always lead to a million dollar settlement conducted in an...

• HCCA survey: Impact of economy on compliance

  In 2008, the Health Care Compliance Association (HCCA) conducted a survey with members of the...

Issue 43, October 28, 2009

• Los Angeles Medicare Fraud Strike Force lands 20 on trial

  The Los Angeles Medicare Fraud Strike Force arrested 20 California residents for their involvement...

• Three pharmacies and their employees indicted on Medicaid fraud charges

  New Jersey Attorney General Anne Milgram announced the indictments of four pharmacists, three...

• Florida woman defrauds Medicare of 5.7 million

  A U.S. district judge sentenced a Florida woman to 57 months in prison for her role in defrauding...

• Q&A: Notification of compliance breach

  Q: Is a business associate (BA) that discovers a breach ever responsible for notifying the...

• Survey: "Red Flags" rule

  Survey: "Red Flags" rule

• Video: "60 Minutes" reports on Medicare fraud

  “60 Minutes” recently featured a report on how criminals are defrauding Medicare out of...

Issue 42, October 21, 2009

• Four pharmaceuticals to pay $124 million for submission of false claims to Medicaid

  AstraZeneca, Mylan Pharmaceuticals, Ortho McNeil Pharmaceutical, and UDL Laboratories, have agreed...

• Small healthcare entities may avoid Red Flags Rule

  Healthcare facilities that employ fewer than 20 people will be exempt from the Federal Trade...

• Boston man to serve 10 years in prison for several counts of healthcare and insurance fraud

  Former health clinics owner, Tu Quy Mai, will serve 10 years in prison for committing several...

• Tip: Identifying risk factors through documentation

  All healthcare facilities should perform a risk assessment to identify the internal and external...

Issue 41, October 14, 2009

• Harborside Healthcare to pay $1.375 million for kickbacks and false claims

  Harborside Healthcare and HHC Nutrition Services will pay the United States $1.375 million to...

• OB/GYN indicted on Medicaid fraud

  A federal grand jury indicted Arkansas OB/GYN, Kelly Dean Shrum, 41, on healthcare fraud and money...

• Mafia turns to Medicare fraud

  The Medicare crime collar is changing from white to red. Lured by greater sums of money for less...

• Q&A: HIPAA certification compliance

   Q: Are we required to “certify” our organization’s compliance with the...

• Survey: CDI physician queries

  Survey: CDI physician queries

Issue 40, October 7, 2009

• OIG releases Fiscal Year 2010 Work Plan

  The 2010 OIG Work Plan details various target areas including hospital readmissions, adverse...

• A New Jersey university to pay $8.3 million in Medicare fraud

  The University of Medicine and Dentistry of New Jersey (UMDNJ) will pay the government $8.3 million...

• Five Detroit residents plead guilty to healthcare fraud

  Five Detroit residents, Dierdre Teagan, Robert Wynn, Ernest Neal, James Harris, and Steve Sherman...

• Tip: Avoid anti-kickback statues from exclusive contracts

  According to the Supplemental Compliance Program Guidance for Hospitals (Supplemental Guidance...

Issue 39, September 30, 2009

• New Stark law regulations loom over healthcare professionals

  Significant changes to the federal Physician Self-Referral Law, or Stark Law, will take effect...

• Rehab facility owner pleads guilty to submitting false claims

  Suresh Chand, a Detroit rehabilitation facility owner, pleaded guilty to one count of conspiracy...

• Pharmacy owner defrauds Medicaid of $3 million

  A New York U.S District Judge sentenced Yefry Burgos, 33, to 78 months in prison for illegally...

• Q&A: Releasing information to non-care family member physicians

  Q: A patient admitted to the hospital has a close family member who is a physician with privileges...

• Survey: Obama's healthcare reform plans

  Survey: Obama’s healthcare reform plans

Issue 38, September 23, 2009

• Three arrested for $112,000 Medicaid fraud scheme

  The Medicaid Fraud Control Unit arrested three Florida residents for allegedly conspiring to...

• Assisted living home owner bills Medicaid from unlicensed facility

  Authorities arrested an adult family care home owner for concealing an unregistered family...

• Pfizer fraud money funds Florida whistleblower plan

  Florida’s state Legislature has created a program that will reward whistleblowers up to 25...

• Tip: Build trust with the Notice of Privacy Practices

  Noncompliance with HIPAA regulations can result in several steep penalties. Misuse of patient...

Issue 37, September 16, 2009

• Utah doctor to pay $1.5 million for illegally prescribing pills

  A U.S. district judge sentenced Utah doctor, Warren R. Stack to pay $1.5 million in restitution for...

• Three more convictions tied to New Orleans Medicaid fraud

  Three women were convicted of Medicaid fraud by a federal judge in New Orleans according to a...

• Texas couple faces a combined 40 years in prison for healthcare fraud

  An Eastern Texas couple has been found guilty by a federal court jury of one count of conspiracy to...

• Q&A: Small providers and HIPAA

  Q&A: What defines a small provider and are they exempt from HIPAA?

• Survey: Internal investigations

  How many internal investigations do you perform each year?

• Survey: Internal investigations

  How many internal investigations do you perform each year?

Issue 36, September 9, 2009

• Pfizer to pay $2.3 billion for largest healthcare fraud settlement in history

  Pharmaceutical giant Pfizer Inc. and its subsidiary Pharmacia & Upjohn Company Inc. will pay...

• Former NJ State Senator sentenced for defrauding hospital

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• Michigan woman pleads guilty to $6.5M Medicare fraud scheme

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• Tip: Support your audit finding

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Issue 35, September 2, 2009

• IA medical center settles false claims case for $4.5 million

  Covenant Medical Center in Waterloo, IA, agreed to pay $4.5 million to settle claims that it had...

• Detroit physical therapist admits to falsifying Medicare claims worth $1.68M

  On August 26, Jay Jha, a Detroit-area physical therapist, admitted his involvement in a conspiracy...

• NY hospital agrees to repay $255,000 to Medicaid for billing mistakes

  Ira Davenport Memorial Hospital in Bath, NY, agreed to repay $255,000 to the Medicaid program...

• Q&A: Who enforces the Health Insurance Portability and Accountability Act (HIPAA)?

  Q: Who enforces the Health Insurance Portability and Accountability Act (HIPAA)?

Issue 34, August 26, 2009

• Miami residents open clinic in Detroit, defraud Medicare of $15M

  On August 18, Jose and Arnaldo Rosario pleaded guilty to participating in a conspiracy to defraud...

• Miami residents open clinic in Detroit, defraud Medicare of $15M

  On August 18, Jose and Arnaldo Rosario pleaded guilty to participating in a conspiracy to defraud...

• Audit reveals Utah's vulnerability to Medicaid fraud, waste, and abuse

  The Utah Medicaid program has significant room for improvement when it comes to program integrity...

• Two Detroit healthcare agency owners plead guilty to Medicare fraud

  On August 19, Kevin Watson and Jaqueline Jackson pleaded guilty to soliciting and paying kickbacks...

• Tip: Review EMTALA policies

  The Office of Inspector General (OIG) Supplemental Compliance Program Guidance for Hospital advises...

Issue 33, August 19, 2009

• Whistleblower files $90M fraud lawsuit against TN hospital corporation

  Community Health Systems Inc., a Tennessee-based heathcare corporation, allegedly made illegal...

• Miami man pleads guilty to $123M Medicare fraud scheme

  Reinaldo Guerra, owner and operator of 11 durable medical equipment (DME) companies, pled guilty to...

• Johnson & Johnson kickback case is back on

  A federal appeals court revived the kickback portion of the case against Johnson & Johnson...

• Q&A: Documenting HIPAA compliance

  Q: What auditing and documentation is necessary to demonstrate HIPAA compliance?

• Survey: Internal HIPAA sanctions

  Do you have an internal HIPAA sanctions policy?

Issue 32, August 12, 2009

• State Medicaid Fraud Control Units recovered $1.3 billion in 2008

  State Medicaid Fraud Control Units (MFCU) recovered $1.3 billion in court-ordered restitution...

• Miami doctor and assistants sentenced for $10.9M fraud scheme

  A federal judge sentenced Miami physician Keith Russell and physician’s assistant Jorge Luis...

• Surprise! Voluntary refunds don’t protect against RACs

  For many providers, self-auditing has become an important RAC preparation tool. Certainly, internal...

• Tip: Designate a compliance committee

  One way to strengthen your compliance department is to designate a compliance committee. A...

• Check out our new HIPAA Update blog!

  Since HIPAA first took effect in 2003, HCPro, Inc. has been an industry leader in privacy and...

Issue 31, August 5, 2009

• Feds arrest dozens nationwide for Medicare fraud scheme

  Continuing the trend of increased fraud enforcement, the Medicare Fraud Strike Force arrested 32...

• Boston laboratory agrees to pay $629,000 in fraud settlement

  Boston Clinical Laboratories reached a settlement with authorities and agreed to pay $615,000 to...

• HIPAA Security Rule enforcement now falls under Civil Rights office

  By Dom Nicastro, for HealthLeaders Media   The secretary of HHS shifted enforcement of the...

• Q&A: Notifying patients after a faxing mistake

  Q: A secretary in our pathology department faxed a report to a physician’s office. After...

• Survey: Risk analysis

  How much preparation has your RAC team done in terms of conducting a risk analysis?

Issue 30, July 29, 2009

• New York state and New York City to pay record False Claims settlement

  New York state and New York City will pay the federal government $540 million to settle allegations...

• NY doctor charged with Medicare fraud scheme

  Federal prosecutors allege Simon Levich MD billed Medicare for services he never provided, billed...

• Health reform could mean more fraud enforcement--and more fraud

  The Obama administration has made it clear that cracking down on healthcare fraud and abuse is a...

• Tip: Safeguard quality of care in your organization

  Although you don’t directly treat patients, you can do a lot to improve their care...

Issue 29, July 22, 2009

• NJ surgeon, manager, and treatment center charged in $8.5M fraud case

  On July 13, a New Jersey grand jury indicted Khashayar Salartash M.D., his office manager, Farah...

• Endoscopic Technologies settles Medicare fraud case

  Endoscopic Technologies Inc., a medical device manufacturer, agreed to pay the United States $1.4...

• Tampa Bay doctor to pay $1.7M to resolve fraud allegations

  Gabriel DeCandido MD agreed to pay the United States $1.7 million to settle charges that the...

• Q&A: Amendments to records generated prior to April 2003

  Q: I’ve been receiving requests for amendments resulting from records generated prior to...

• Survey: RAC appeals

  Does your facility have a program in place to handle RAC appeals?

Issue 28, July 15, 2009

• Massive insurance fraud scheme yields several indictments

  On July 8, New York Attorney General Andrew Cuomo announced the takedown of an elaborate fraud...

• CA authorities take down largest Medi-Cal fraud scheme in state history

  On July 9, California authorities arrested 20 individiuals believed to be involved in a Medicaid...

• CT Pharmacist pleads guilty to fraud charges

  Joby George pleaded guilty to one count of healthcare fraud and entered into a civil agreement...

• Tip: Steps for Red Flags Rule compliance

  John C. Parmigiani, HIPAA security and privacy consultant and president of John C. Parmigiani &...

• Have you had an experience with Medicaid Integrity Contractors?

  If you’ve had experience with Medicaid Integrity Contractors (MIC), we want to hear from you!

Issue 27, July 8, 2009

• LSU healthcare center settles false claims charges

  The Louisiana State University Health Sciences Center-Shreveport (LSUHSC) will pay $706,000 to...

• Two Miami men indicted for $179M Medicare fraud scheme

  Jose Luis Perez, of Golden Beach, FL, and Reinaldo Guerra, of Miami, FL, will face charges of...

• Healthcare fraud affects public and private insurance alike

  A report published by the George Washington University Medical Center, Health Insurance Fraud: An...

• Healthcare fraud effects public and private insurance alike

  A report published by the George Washington University Medical Center, Health Insurance Fraud: An...

• CMS releases 2010 OPPS proposed rule

  Outpatient facilities and pharmacies hoping to see an increase in reimbursement for separately...

• Q&A: Appropriate subjects for OIG advisory opinions

  Q: What are appropriate subject matters for an Office of Inspector General (OIG) advisory opinion...

• Survey: PQRI participation

  Are you participating in the physician quality reporting initiative (PQRI) this year? 

Issue 26, July 1, 2009

• Strike Force arrests 53 individuals in Medicare fraud scheme

  On June 24, the Medicare Fraud Strike Force in Detroit arrested 53 people on Medicare fraud...

• $20 million Florida fraud scheme ends in eight arrests

  The Medicare Fraud Strike Force in Florida arrested eight Miami-Dade County, FL residents June 26...

• Complex reviews to arrive as soon as August

  by Andrea Kraynak, CPC-A CMS released further information June 24 on its RAC Web site letting...

• Tip: Report non-compliance promptly

  If the compliance officer or committee discovers evidence of misconduct or noncompliance and has...

Issue 25, June 24, 2009

• CMS warns industry about fax scam

  On June 18, many providers received an alert message from CMS informing them that scammers are...

• Former CA hospital executive pleads guilty to 'Skid Row' fraud scheme

  Robert Bourseau, former board member and co-owner of City of Angels Medical Center in Los Angeles...

• Former home health company owner sentenced to prison for healthcare fraud

  Judge Robert G. James sentenced Janice Davis, former owner of Aging Care Home Health Care (ACHHC...

• Q&A: How would you construct a letter to inform patients about stolen PHI?

  Q: How would you construct a letter to inform patients about stolen Protected Health Information?

• Survey: Snooping in patient records

  Do you trust your staff members not to snoop at patient records?

Issue 24, June 17, 2009

• Double-billing settlement highlights whistleblower concerns

  Earlier this week, the University of Medicine and Dentistry of New Jersey agreed to pay the...

• TN healthcare company agrees to pay $1.3 million to settle false claims case

  Kindred Healthcare, Inc. and its successor PharMerica Healthcare Pharmacy, LLC, agreed to pay $1.3...

• Two TN women plead guilty to $1.1M healthcare fraud scheme

  Glenesha Moye and Tabitha Jones, owners and operators of EBC Healthcare, pleaded guilty to charges...

• Tip: What to include in compliance reports

  The OIG believes an ongoing evaluation process is critical to a successful compliance program. An...

Issue 23, June 10, 2009

• Business illegally obtains OxyContin perscriptions, bills Medicare

  On June 4, the U.S. Deaprtment of Justice (DOJ) unsealed the grand jury indictment that charges a...

• Houston man received $680,000 from Medicaid in diaper fraud scheme

  Ene Etim Hogan pleaded guilty June 5 to three counts of healthcare fraud, according to a Department...

• Man admits to billing Medicaid for bail money

  Christopher Long, of Jefferson City, MO, pleaded guilty June 3 to billing Medicaid for home-health...

• Q&A: HIPAA and cell phones

  Q: I keep hearing rumors that the Department of Health and Human Services (HHS) will modify HIPAA...

• Survey: Corporate integrity agreements

  Is your facility currently under a corporate integrity agreement (CIA)?

Issue 22, June 3, 2009

• OIG lists recommendations not fully implemented by HHS

  The Department of Health and Human Services (HHS) failed to fully implement recommendations made by...

• Three TN imaging centers charged with Medicare fraud

  MedQuest Associates Inc. and three of its companies allegedly submitted false claims to Medicare...

• WV physician seeks new fraud trial

  John Sharp M.D., of Marlington, WV, will appear before U.S. District Judge Irene Keeley to request...

• Tip: Create unique user identification

  To ensure only authorized personnel have access to ePHI, assign a unique name or number to identify...

Issue 21, May 27, 2009

• Obama signs fraud bill into law

  On May 20, President Barack Obama signed the Fraud Enforcement and Recovery Act of 2009 (FERA...

• Sebelius: New fraud prevention team will turn up heat

  On May 20, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced the...

• Three MN hospitals agree to pay $2.28M to settle false claims case

  St. Joseph’s Hospital, St. John’s Hospital, and Woodwinds Hospital—all based in...

• Q&A: Processing PHI at home

  Q: Is taking PHI home to process it legal?

• Survey: Government contractors

  Which government integrity contractor worries you the most?

Issue 20, May 20, 2009

• NY hospital contractor accused of bribing a DSS employee

  New York Attorney General Andrew M. Cuomo recently announced an indictment that alleges Deborah...

• DOJ and 16 states join whistleblower lawsuit against Wyeth

  The United States, along with 16 states, is joining two whistleblower cases filed against...

• TX ambulance company owners sentenced in fraud case

  United States District Judge Lee H. Rosenthal sentenced Mazen Abdallah and Wesam Abdallah, owners...

• Tip: Consider method of delivery when developing training

  An important aspect to consider early in the compliance training development process is the...

Issue 19, May 13, 2009

• NJ hospital fails in attempt to have whistleblower case dismissed

  On May 11, the United States District Court in New Jersey denied Robert Wood Johnson University...

• Florida health plan company enters $80M agreement to avoid fraud charges

  On May 5, Tampa-based WellCare Health Plans, Inc. agreed to enter a deferred prosecution agreement...

• NY Medicaid fraud unit is nation's best

  The U.S. Department of Health and Human Services (HHS) has selected New York’s Medicaid Fraud...

• Q&A: Are all hospital acquired conditions (HACs) also 'never-events'?

  Q: Are all hospital acquired conditions (HACs) also “never-events”?

• Survey: Delayed Red Flags Rule

  Are you relieved the Federal Trade Commission decided to delay the implementation of the Red Flags...

Issue 18, May 6, 2009

• NY releases work plan, fraud unit annual report

  The New York State Office of the Medicaid Inspector General (OMIG) released its second annual work...

• Former HealthEssentials Solutions manager indicted for healthcare fraud

  A federal grand jury indicted Karen Stone, former business manager of Kentucky-based...

• Wheelchair dealer and physician indicted for healthcare fraud

  On April 30, a federal grand jury indicted Jeffrey McElveen and Robert Cleveland M.D. on charges of...

• Tip: Determining whether a service is medically necessary

  Facilities must be able to screen for the medical necessity of a service before rendering it to...

• Headlines from the Healthcare Audit Resource Center

  The following are this week's headlines: CMS proposes historically low inpatient payment increases...

Issue 17, April 29, 2009

• Florida House passes bill to fight Medicaid fraud

  Florida legislators took a big step towards curbing healthcare abuse this week when the state House...

• Senate approves Fraud Enforcement and Recovery Act

  On April 28 the Senate approved the Fraud Enforcement and Recovery Act of 2009, a bill designed to...

• Three convicted in $36M healthcare fraud scheme

  A Huston jury convicted Houston area residents, Rhonda Fleming, Bose Ebhamen, and King Arthur, of...

• Q&A: What is an invasive procedure?

  Q: What is an invasive procedure?

• Survey: Offsite employees

  What percentage of your facility’s staff who use a computer as part of their job works...

• Headlines from the Healthcare Audit Resource Center

  This week the Healthcare Audit Resource Center reported on Quest Diagnostics' $302 million...

Issue 16, April 22, 2009

• IA senator wants CMS to respond to DMEPOS problem

  On April 17, Senator Chuck Grassley issued a public letter to CMS calling for the agency to respond...

• Nine LA residents arrested for Medicaid fraud

  Former and current personal care attendants at First Thessalonians Community Programs were arrested...

• Business associates: HIPAA survey

  We want to hear from business associates about their need for HIPAA training. Business associates...

• Medical testing company will pay $302M to settle false marketing case

  Quest Diagnostics will pay $302 million to settle civil charges of misleading marketing and...

• Tip: Include compliance in a performance evaluation

  When evaluating the performance of managers and supervisors, factor in adherence to the elements of...

• Headlines from the Healthcare Audit Resource Center

  This week the Healthcare Audit resource Center reported on the following items: "Part B...

Issue 15, April 15, 2009

• Clinic owner received over $1M for fraudulent hyperbaric chamber services

  On April 7, Chaunsay Beckwith, owner and operator of International Alternative Medicine Inc...

• California therapy company settles whistleblower case

  The owners of Interstate Rehabilitation LLC, a physical therapy company located in Glendale, CA...

• DME company owner sentenced to over 5 years in prison

  On April 8, U.S. District Judge Ursula Ungaro sentenced Eduardo Batista Barquin, of Miami, to...

• Q&A: Transporting original medical records

  Q: The Department of Defense allows some active duty service members moving to a new base to...

• Survey: Red Flags Rule training

  Which of the following departments do you think would benefit most from training on the Federal...

• Headlines from the Healthcare Audit Resource Center

  This week the Healthcare Audit Resource Center reported on an HIV infusion scheme in South Florida...

Issue 14, April 8, 2009

• Florida senators propose Medicaid reform bill

  The Florida Senate’s Health Regulation Committee approved a plan that would put stricter...

• Missouri podiatrist pleads guilty to creating fake medical records

  Bic Chau Stafford MD, of St. Louis, pleaded guilty to federal charges of obstructing a federal...

• Virginia oncologist accused of healthcare fraud

  A Norfolk, VA, grand jury charged Ronald Poulin MD with a 45-count indictment that includes...

• Tip: Compare your facility to others when performing an E/M audit

  To begin an evaluation and management (E/M) services audit, compare your facility with others in...

• Headlines from the Healthcare Audit Resource Center

  This week the Healthcare Audit Resource Center reported on a new OIG Web page for Recovery Act...

Issue 13, April 1, 2009

• Houston hospital to pay $9.9M to settle inflated outlier charges

  Houston’s Methodist Hospital agreed to pay $9.9 million to settle allegations that it...

• Miami doctor and chemist altered blood samples to justify billing for HIV infusions

  Carmen Del Cueto, MD, andAlexis Dagnesses each pleaded guilty to one count of conspiracy to commit...

• OIG refines self-disclosure protocol in open letter

  The OIG released an open letter to healthcare providers March 24, explaining changes to its...

• Q&A: Physician Quality Reporting Initiative

  Q: If I have questions regarding the Physician Quality Reporting Initiative (PQRI), whom should I...

• Survey: What concerns you most about Medicare Recovery Audit Contractors (RAC)?

  What concerns you most about Medicare Recovery Audit Contractors (RAC)?

• Headlines from the Healthcare Audit Resource Center

  The Healthcare Audit Resource Center features stories about a quality of care roundtable report and...

Issue 12, March 25, 2009

• Seven California companies indicted in 'massive' Medicaid fraud scheme

  On March 20, California Attorney General Jerry Brown joined a whistleblower suit that alleges seven...

• U.S. files case against Las Vegas medical practice; alleges unnecessary testing

  The U.S. attorney's office filed a lawsuit which alleges Miller Medical Group Chtd., a Las Vegas...

• Hospital employee lost patient information on a subway train

  A Massachusetts General Hospital employee left paperwork that contained protected health...

• Tip: Discounts to uninsured or underinsured patients

  Hospitals may discount services to uninsured and underinsured patients who are unable to pay their...

• Headlines from the Healthcare Audit Resource Center

  The OIG reveals a CMS edit failed to catch improper transfer claims and a Medicare fraud case...

Issue 11, March 18, 2009

• We want your case studies

  HCPro is looking for compliance case studies for use in our elearning library, and we want to hear...

• San Mateo County agrees to pay $6.8 million to settle false claims allegations

  San Mateo county reached a settlement March 12 with the federal government in a whistleblower case...

• Victory Memorial hospital settles whistleblower case for at least $2.3 million

  The United States has reached a $2.3 million settlement with Victory Memorial, a not-for-profit...

• Cornerstone hospital pays $690,000 to settle false claims case

  Cornerstone Hospital, of Huntington, WV, has agreed to pay the United States $690,000 to end an...

• Q&A: Physician-owned lithotripsy partnership contracts

  Q: When a physician-owned lithotripsy partnership contracts with a hospital to provide a...

• Survey: Updating compliance policies

  How often does your facility update compliance policies?

• Headlines from the Healthcare Audit Resource Center

  In this week's headlines, the New York State Medicaid Agency publishes self-disclosure guidance and...

Issue 10, March 11, 2009

• US joins whistleblower case against Community Health Systems Inc.

  The United States has gotten involved in a whistleblower case that alleges Community Health Systems...

• DME provider sentenced to 63 months for creating and submitting false claims

  U.S. District Judge Steven D. Merryday sentenced Yosdan Castellanos to 63 months in prison for...

• Four Puerto Rico residents indicted for Medicaid fraud

  A federal grand jury in Puerto Rico indicted four individuals with charges of conspiracy to commit...

• Tip: Develop an identity theft prevention program

  Medical identity theft is an ugly reality for healthcare organizations, patients, and payers...

• Headlines from the Healthcare Audit Resource Center

  In this week's headlines Obama unveils his choices for the healthcare reform team and a Kansas M.D...

• Send us your compliance case studies

  HCPro is looking for compliance case studies for use in our elearning library and we want to hear...

Issue 9, March 4, 2009

• Man receives 20 years in prison for Medicaid fraud

  Lowndes (MS) County Circuit Court Judge Lee Howard sentenced Aaron Pulsifer, 39, of Columbus, MS...

• DME salesman sentenced for healthcare fraud

  United States District Judge Inge Johnson sentenced Joel Sloan, 44, of McCalla, AL, to 18 months in...

• Florida man sentenced in DME Medicare fraud case

  U.S. District Judge Cecilia Altonaga sentenced Jimmy A. Soto, of Miami Lakes, FL, to 140 months in...

• Q&A: Disclosing information for emergency flight discounts

   Q: When airlines call to confirm that a patient died in the hospital (due to family members...

• Survey: Revisiting HIPAA training

  Do you plan to revisit training methods in light of the stepped-up HIPAA enforcement? Yes...

• Headlines from the Healthcare Audit Resource Center

  In this week's headlines a doctor admits to "subdosing" AIDS patients and the OIG finds...

Issue 8, February 25, 2009

• Anesthesiologist convicted of violating federal False Claims Act

  On February 19, a federal jury found Eugene Chen, M.D., a Las Vegas anesthesiologist, guilty of...

• Medical equipment company owner sentenced in kickback case

  Walter Sanders, owner of Waltco Medical Equipment and Supplies, will serve 60 months in prison and...

• Monroe County recovers $3.3M in Medicaid overpayments

  The New York Office of Medicaid Inspector General ordered Saratoga Pharmacy to repay approximately...

• Tip: Retain patient emails

  HIPAA requires covered entities to manage electronic protected health information , including that...

• Headlines from the Healthcare Audit Resource Center

  In this week's headlines three healthcare professionals are diciplined in a wrong-surgery case and...

Issue 7, February 18, 2009

• Miami physicians, medical workers charged with Medicare fraud

  The Department of Justice (DOJ) has charged six Miami-area healthcare workers with defrauding...

• Couple charged as fugitives in Medicare fraud scheme

  Police arrested Sanjay Patel and his wife, Leena Bharat Kumar Patel, in Connecticut on Feburary 13...

• Couple charged as fugitives in Medicare fraud scheme

  Police arrested Sanjay Patel and his wife, Leena Bharat Kumar Patel, in Connecticut on Feburary 13...

• DME company owner charged with diaper fraud scheme

  Ernest Hogan, owner of a Houston-area durable medical equipment (DME) company, Shanet Medical...

• Q&A: What is HETS?

  Q: What is HETS? How do I connect to this system?

• Survey: How often does your facility provide compliance training?

  Survey: How often does your facility provide compliance training?

• Headlines from the Healthcare Audit Resource Center

  In this week’s headlines, Medicare pays for more than $33 million for invalid supply and...

Issue 6, February 11, 2009

• Consultant sentenced in healthcare fraud case

  On February 4, a federal judge sentenced William King, a consultant for skilled nursing facilities...

• Kansas recovers $17 million in Medicaid overpayments

  Kansas’ Medicaid program recovered more than $17 million in 2008 from multi-state litigation...

• Mental health counselor convicted of Medicaid fraud

  A mental health counselor allegedly continued to bill Medicaid for therapy services provided to...

• Tip: How to attack risks

  Develop you risk-assessment process based on your organization’s size and needs. Consider...

• Headlines from the Healthcare Audit Resource Center

  This week’s headlines include Medicare and Medicaid paying for the same services and making...

Issue 5, February 4, 2009

• Two more hospital executives arrested in LA Skid Row scheme

  A federal indictment named two more individuals in an alleged Medicare fraud scheme that recruited...

• Two Chicago physicians accused of Medicare fraud

  Federal authorities recently charged four Chicago-area individuals, including two physicians, in...

• Economic stimulus bill includes whistleblower protection

  The latest draft of the government’s economic stimulus package protects federal employees who...

• Q&A: Gifts between physicians and providers

   Q: Can a gift exchange between physicians and providers lead to a Stark violation?

• Survey: Biggest compliance concerns

  We want to know what your biggest compliance concern is for 2009. Take our survey and let us...

• Headlines from the Healthcare Audit Resource Center

  This week’s briefs include a report about the improved Medicare appeals process and New York...

Issue 4, January 28, 2009

• Pharma executives banned from federal healthcare programs

  An administrative law judge stripped three former Purdue Frederick executives of their...

• Infusion clinic owners and employee plead guilty to healthcare fraud

  The owners and operators of two Miami-area HIV infusion clinics along with a phlebotomist employed...

• Medicare and Medicaid identified as high-risk for fraud and abuse

  On January 22, the U.S. Government Accountability Office (GAO) released its biennial list of...

• Tip: Examine financial arrangement to ensure Stark Law compliance

  Upcoming changes to Stark Law should put financial arrangement audits at the top of compliance...

• Headlines from the Healthcare Audit Resource Center

  This week’s headlines include National Coverage Determinations for never events and a look at...

Issue 3, January 21, 2009

• Hospice organization settles healthcare fraud claims

  The Alabama-based hospice organization, SouthernCare Inc., agreed to pay $24.7 million to settle...

• Woman pleads guilty to $1 million healthcare fraud scheme

  On January 15, Kim Joann Austen, a former Department of Human Service (DHS) employee, pleaded...

• Another Miami DME owner sentenced for Medicare fraud

  Alfredo F. Lopez was sentenced to 10 years in prison for healthcare fraud, according to a...

• Q&A: Releasing a former inmate's medical record

  Q: We treat many patients who come from a state prison. When these patients come to our facility...

• Survey: Electronic health records

  Does your facility use electronic health records?

• Headlines from the Healthcare Audit Resource Center

  In this week’s headlines, the OIG releases its annual report and the Massachusetts Medicaid...

Issue 2, January 14, 2009

• Boston facilities settle false claims charges

  Boston Medical Center (BMC) and East Boston Neighborhood Health Center (EBNHC) agreed to pay...

• Pharmed co-owners get nine years for fraud scheme

  A U.S. District Court judge sentenced Carlos De Cespedesand Jorge De Cespedes, brothers and...

• Seven NY hospitals charged with Medicaid fraud

  Seven hospitals in New York have been accused of fraudulently billing the Medicaid program for...

• Tip: How to obtain on-call physicians

  The most common solution to obtain physicians for on-call coverage is to provide a stipend or...

• Headlines from the Healthcare Audit Resource Center

  This week’s headlines include an HCCA survey that shows the concerns compliance officers are...

Issue 1, January 7, 2009

• Cardiologist convicted on 51 counts of fraud

  On December 30, 2008, a federal jury convicted Dr. Mehmood Patel, of Lafayette, LA, on 51 counts of...

• Midwife accused of Medicaid fraud

  Wylene Simmons, a midwife from Lauderhill, FL, allegedly defrauded the state Medicaid program for...

• Q&A: Police tips

  Q: Say a police officer provided the name of a woman with a drug problem to a facility as a heads...

• Survey: Economic impact

  Survey: Economic impact

• Headlines from the Healthcare Audit Resource Center

  This week's headlines include a look at a chlorine gas disaster in Michigan and charges of...