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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.

2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001

Issue 25, June 20, 2012

• Editor's Note: Compliance Monitor to cease publication June 27

  Next week’s issue will be the final Compliance Monitor. Thank you for being a loyal...

• Brooklyn physician convicted of defrauding Medicare

  A jury in U.S. District Court in Brooklyn convicted Boris Sachakov, MD, 43, of one count of...

• Health system settles False Claims Act allegations

  Christus Spohn Health System Corp. of Corpus Christi, Texas, paid $5 million to settle allegations...

• Philadelphia clinic owner convicted of Medicare fraud

  A federal jury in Philadelphia convicted Jo Benoit, 77, of King of Prussia, Pa., of 76 counts of...

• HIPAA Q&A: Home health patient information books

  Q: A home health agency was informed by an assisted living facility that the home health agency may...

Issue 24, June 13, 2012

• Miami woman receives 46-month sentence for Medicare fraud

  U.S. District Judge Patricia A. Seitz of the Southern District of Florida sentenced Leyanes...

• Detroit man sentenced for Medicare fraud

  Victor Jayasundera, 59, of Detroit, faces 30 months in prison for his role in a scheme that...

• Jury convicts LA physician assistant in $18.9 million Medicare fraud scheme

  A jury convicted David James Garrison, 50, of Los Angeles, of conspiracy, healthcare fraud and...

• HIPAA Q&A: Transporting records to satellite clinic

  Q: Our physician practice operates a satellite clinic. The practice does not use an electronic...

Issue 23, June 6, 2012

• Missouri psychologist faces Medicare, Medicaid fraud charges

  A Missouri psychologist faces charges of allegedly defrauding Medicare and Medicaid of $1.2...

• Task force uncovers $452 million in Medicare fraud

  Medicare Fraud Strike Force operations in seven U.S. cities resulted in fraud charges against 107...

• HIPAA Q&A: Answering service messages

  Q: Is a physician who uses an answering service and receives unencrypted messages from an answering...

Issue 22, May 30, 2012

• Boston area hospital to pay $750,000 for data breach

  Failing to keep confidential information secure will cost South Shore Hospital in Weymouth, Mass...

• Kansas women admit Medicaid fraud

  Two Kansas women pleaded guilty to defrauding the Kansas Medicaid agency and will pay $13,000 in...

• Portion of Southern California Renal Disease Council Medicare claims not allowed

  The Southern California Renal Disease Council is facing a hefty potential bill for costs not...

• HIPAA Q&A: Do 'turn and position sheets' violate HIPAA?

  Q. A nurse in a skilled nursing facility asked if she could post a paper form called “Turn...

Issue 21, May 23, 2012

• Temple University, former department chairman settle fraud claims

  Temple University and a former chairman will pay $1 million to resolve allegations the university...

• OIG audit finds Medicare overpaid St. Louis, Indianapolis hospitals

  Two hospitals received excess Medicare payments because they did not implement adequate controls to...

• N.Y. medical device sales manager pleads guilty to healthcare fraud

  Michael J. McKay, 32, of Saratoga Springs, N.Y., pleaded guilty to committing healthcare fraud...

• HIPAA Q&A: Level of encryption needed for email

  Q. Please explain in an understandable way for nontechnical individuals the necessary level of...

Issue 20, May 16, 2012

• Nurse posts photo of athlete/patient on Facebook

  My friend is a Facebook friend of a nurse at a hospital in another state. The nurse posted a...

• California hospital email to hundreds of workers violates HIPAA

  Shasta Regional Medical Center in Redding, Calif., violated patient confidentiality when it sent...

• Teach physicians, staff proper social media protocol

  Navigating the new world of social media is challenging for many professionals, but perhaps none...

• HIPAA Q&A: Managed care companies and PHI

  Q. I’m experiencing problems with managed care companies that request PHI for their...

• Survey: Inappropriate medical record access

  Survey: Inappropriate medical record access

Issue 19, May 9, 2012

• Share your HCCA conference experiences

  Did you know that the recent Health Care compliance Association (HCCA) conference in Las Vegas set...

• Consider third-party fair market value appraisals to ensure compliance

  Compliance officers should consider independent third-party appraisals when evaluating the fair...

• Repercussions potentially far-reaching in South Carolina identity theft scheme

  The South Carolina Law Enforcement Division is cracking down on state agency security systems...

• HIPAA Q&A: HIPAA concerns when discussing a colleague's health

  Q. One of my colleagues has been quite open about her health issues in the office. She is also a...

Issue 18, May 2, 2012

• McKesson to pay $190 million to settle False Claims violations

  Inflated price reporting on prescription drugs that led to higher payment rates for...

• OCR begins HIPAA compliance audits

  Mac McMillan, CISSM, has an insider’s look at what it’s like to undergo a HIPAA...

• Did you attend HCCA? Let us know!

  HCPro, Inc. attended the Health Care Compliance Association conference, and we want to know if you...

• HIPAA Q&A: Opt in or opt out?

  Q. How do “opt out” and “opt in” arrangements differ?

• Survey: Federal Register

  Check out our survey on the Federal Register.

Issue 17, April 25, 2012

• PA hospital's deficiencies detailed in corrective action plan

  Beleaguered Saint Catherine Medical Center, which filed for Chapter 11 bankruptcy earlier this...

• Employees steal patient information to file false tax returns

  Two employees from hospitals in Broward County, Fla., stole the identities of nearly 9,500...

• Michigan patient recruiter pleads guilty to Medicare fraud

  A Detroit-area patient recruiter pled guilty for his participation in a $2.5 million Medicare fraud.

• Michigan patient recruiter pleads guilty to Medicare fraud

  A Detroit-area patient recruiter pled guilty for his participation in a $2.5 million Medicare fraud.

• HIPAA Q&A: Facility directories

  Q. If a patient says he or she doesn’t want to be in the facility directory, what does this...

• Next month in Briefings on Coding Compliance Strategies

  Every month, Compliance Monitor provides a sneak peek at the upcoming issue of Briefings on Coding...

Issue 16, April 18, 2012

• PA medical center files for Chapter 11

  Saint Catherine Medical Center in Ashland, PA filed an emergency petition for Chapter 11 bankruptcy...

• Data breach in Utah compromises thousands of Medicaid claims

  The Utah Department of Health (UDOH) released an update April 9 regarding a data breach caused by a...

• Tenet settles false claims allegations for nearly $43 million

  Tenet Healthcare Corporation agreed to pay $42.75 to settle false claims allegations stemming from...

• HIPAA Q&A: PHI and covered entity disciplinary actions

  Q. A covered entity is required to impose sanctions against workforce members who violate the...

• Survey: ICD-10-CM/PCS Delay Proposed Rule

  Survey: Do you think the proposed rule to delay ICD-10-CM/PCS implementation until October 2014...

Issue 15, April 11, 2012

• Immediate Jeopardy for PA Medical Center

  Saint Catherine Medical Center in Ashland, PA faces the wrath of federal and state officials in the...

• FTC issues best practices for privacy protections

  HIPAA privacy officers may want to take a peek at the Federal Trade Commission’s March 26...

• DOJ, HHS announce efforts to enhance prevention of healthcare fraud

  HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced the implementation of...

• HIPAA Q&A: Business associates and disclosure accounting log

  Q. During a recent webinar, a presenter indicated disclosure of PHI to business associates needed...

Issue 14, April 4, 2012

• State-by-state differences for Medicaid Recovery Audit Programs

  While many of the administrative and organizational efficiencies that providers currently use to...

• HIPAA/HITECH final rules sent to Office of Management & Budget

  OCR made the final step before publishing final rules on HIPAA/HITECH, sending its rules to the...

• Washington doctor, mother sentenced to prison for healthcare fraud

  A federal judge sentenced a Washington-based doctor and his mother to prison for fraudulently...

• HIPAA Q&A: Potential PHI disclosures through posted forms

  Q. A nurse in a skilled nursing facility asked if she could post a paper form called “Turn...

• Survey: Which of the following security vulnerabilities is your facility currently focusing on correcting?

  Which of the following security vulnerabilities is your facility currently focusing on...

Issue 13, March 28, 2012

• Healthcare reform poses funding challenges for academic medical centers

  The future of academic medical centers: Strategies to avoid a margin meltdown, a study recently...

• Overview of CMS privacy updates

  CMS recently issued further guidance regarding patient rights to privacy and medical record...

• DOJ, EUSA Pharma settle false claims action

  EUSA Pharma, a radiopharmceutical company based in Langhorne, Pa., has agreed to pay $180,000 to...

• HIPAA Q&A: Email encryption advice for technology novices

  Q. Please explain the level of encryption necessary to email to be considered secured as required...

• Next month in Briefings on Coding Compliance Strategies

  Every month, Compliance Monitor provides a sneak peek at a future issue of Briefings on Coding...

Issue 12, March 21, 2012

• BCBS settlement details $17 million in corrective actions

  HIPAA compliance 101—policies, training, monitoring, and risk assessments—might have...

• Q&A with OCR: We investigate all 500-plus HIPAA breaches

  The following is a Q&A between HCPro, Inc. and an Office for Civil Rights (OCR) spokesperson...

• Florida man admits role in $200 million Medicare fraud scheme

  A Florida man pleaded guilty for his role in a Medicare fraud scheme that resulted in more than...

• HIPAA Q&A: Psychotherapy notes and privacy

  Q. I am confused about the privacy of psychotherapy notes. Will you explain?

• Survey: Impact of additional HIPAA 5010 enforcement delay

  What impact does the additional delay of enforcement of HIPAA 5010 have on your...

Issue 11, March 14, 2012

• ONC: send us comments on securing mobile devices

  The Office of the National Coordinator for Health Information Technology (ONC) wants input on...

• New tool could convince senior leaders to invest in privacy, security

  Covered entities (CEs) and business associates (BAs) now have a new method to convince senior...

• New Jersey medical assistant charged for treating patients without medical license

  A grand jury in New Jersey indicted a medical assistant who worked for two large medical services...

• HIPAA Q&A: Maintain HIV information in medical record

  The HIPAA privacy standards treat HIV information like any other health information. Therefore...

Issue 10, March 7, 2012

• Mobile devices another PHI challenge

  They are becoming as common in healthcare as a stethoscope draped around a physician's neck. Check...

• As CMS approves Parkland's corrective action plan, board chair resigns

  CMS’ Dallas office February 29 approved the most recent corrective action plan submitted by...

• Doctor arrested for alleged role in $375 million healthcare fraud scheme

  Federal agents arrested a Dallas area physician and his practice office manager in connection to a...

• HIPAA Q&A: STD information and parents

  Q. What is the responsibility of the pharmacist if he or she dispenses a prescription for a minor...

• Survey: Mobile device compliance policies

  Does your facility have a mobile device policy? Yes No We are in the process of...

Issue 9, February 29, 2012

• HHS announces stage 2 of meaningful use requirements

  HHS Secretary Kathleen Sebelius announced the proposed Stage 2 meaningful use requirements for...

• Parkland Hospital analysis shows problems continue

  Consultants for the troubled Parkland Health and Hospital System submitted on February 17 a...

• California pastor sentenced to prison for Medicare fraud

  A former Los Angeles church pastor who orchestrated a $14.2 million Medicare fraud scheme, was...

• HIPAA Q&A: Skilled nursing facility

  Q: Can a skilled nursing facility (SNF) display residents’ names and pictures on a plaque...

Issue 8, February 22, 2012

• HHS confirms ICD-10 delay: What does it mean for you?

  It’s no longer a mere possibility; HHS has confirmed its intent to delay the ICD-10...

• Thousands of medical records leaked in California

  A glitch in the network security settings of five California hospitals allowed outside search...

• How to respond to audit findings

  Truth be told, the real work for healthcare organizations may come after a HIPAA compliance audit...

• HIPAA Q&A: Power of attorney

  Q: Is a power of attorney still effective after a patient’s death? I was told that a woman...

• Next month in Briefings on Coding Compliance Strategies

  Every month, Compliance Monitor provides a sneak peek at a future issue of Briefings on Coding...

Issue 7, February 15, 2012

• HIPAA 5010 logjam means no pay for physicians

  A strange thing is happening as physician practices transition toward HIPAA version 5010 electronic...

• Minnesota debt collector sued over stolen medical data

  Minnesota Attorney General Lori Swanson filed a lawsuit January 19 against a debt collection agency...

• Houston assistant administrator indicted for Medicare fraud scheme

  Mohammed Khan, an assistant administrator at a Houston-area hospital, was charged with one count of...

• HIPAA Q&A: Guarding against incidental disclosures

  Q: Our phlebotomy area has two drawing chairs and is divided by a curtain. Is it a HIPAA violation...

• Survey: Has the transition to HIPAA 5010 posed unforeseen problems at your facility?

  Survey: Has the transition to HIPAA 5010 posed unforeseen problems at your facility? Yes, we...

Issue 6, February 8, 2012

• HIPAA 5010 deadline extended, but threat remains, says AMA

  CMS' Office of E-Health Standards and Services (OESS) has announced a 90-day period of...

• HHS task force: Consider privacy, security with text messages

  An HHS task force recommends that if the government encourages and helps develop health text...

• Tip: Perform your own internal investigation prior to government audit

  If the government is paying your facility a visit, you'd better understand what they're looking for...

• HIPAA Q&A: Flu shot requirement for hospital employees

  Q: Our healthcare facility is requiring employees to get the flu shot or they will have to wear a...

• This month in Briefings on Coding Compliance Strategies

  Every month, Compliance Monitor provides a sneak peek at Briefings on Coding Compliance Strategies...

Issue 5, February 1, 2012

• Physician referral patterns ripe for scrutiny

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

• Nurse pleads guilty to Medicare fraud

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

• Dealing with data breaches

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

• HIPAA Q&A: HIPAA-compliant phone messages

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

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

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

Issue 4, January 25, 2012

• Cape Fear Valley Medical Center averts Medicare defunding

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

• Ten arrested for Medicare fraud in Puerto Rico

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

• Atlanta man gets jail time for stealing PHI

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

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

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

Issue 3, January 18, 2012

• Third immediate jeopardy for Cape Fear Valley Medical Center

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

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

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

• Study: HIPAA breaches on the rise

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

• Compliance Q&A: Annual log of data breaches

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

• Survey: RAC audit trending

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

Issue 2, January 11, 2012

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

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

• Sneak peek: Put the focus on clinical documentation

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

• Compliance Q&A: Potential breach from medical records

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

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

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Issue 1, January 4, 2012

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

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

• DME company owner sentenced for Medicaid fraud scheme

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

• HIPAA Q&A: Leaving PHI on voicemail

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

• Tip: Improve quality at your facility

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

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

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

Issue 26, June 27, 2012

• Editor's Note: Final issue of Compliance Monitor

  This is the final Compliance Monitor. Thank you for being a loyal subscriber.

• NJ hospital pays $9 million to settle fraud allegations

  AHS Hospital Corp., Atlantic Health System Inc., and Overlook Hospital, located in New Jersey, will...

• Oklahoma hospital, physician settle Medicare fraud claims for $1.5 million

  Harmon County Healthcare Authority (HCHA) and Akram R. Abraham, MD, of Hollis, Okla., will pay...

• Detroit clinic owner admits defrauding Medicare

  Louisa Thompson, 63, of Detroit, pleaded guilty to participating in a $16 million Medicare fraud...

• HIPAA Q&A: Sharing patient information with specialists

  Q: A patient who presented with an order from the primary care physician for laboratory work had...

Issue 23, June 6, 2012

• Texas chiropractor to serve two years, pay restitution for fraud conviction

  U.S. District Judge Nancy F. Atlas sentenced Justina Okehie, aka Dr. Tina Collins, of Richmond...

Issue 19, May 9, 2012

• Tip: Ensure discharge dispositions don't affect reimbursement

  Incorrect discharge disposition can result in CMS recoupments from referring acute facilities...