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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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Issue 52, June 22, 2003

• 1. HHS-sanctioned committee asks for flexible transactions deadline
  2. GAO

  1. HHS-sanctioned committee asks for flexible transactions deadline 2. GAO releases new yellow...

• 1. HHS posts semi-annual regulatory agenda
  2. Recent OIG enforcement actio

  1. HHS posts semi-annual regulatory agenda 2. Recent OIG enforcement actions 3. Pay-per-view...

• *HIPAA and the switchboard
  *Charging for intramuscular injections

  *HIPAA and the switchboard *Charging for intramuscular injections

• 1. CMS final rule could mean big changes for RHCs
  2. Grand Rapids hospital

  1. CMS final rule could mean big changes for RHCs 2. Grand Rapids hospital to pay $6.25 million...

Issue 51, June 22, 2003

• * Can we ask a physician for more documentation?
  * How can we settle compli

  * Can we ask a physician for more documentation? * How can we settle compliance turf battles...

• 1. OIG seeking recommendations on safe harbors, fraud alerts
  2. New HIPAA

  1. OIG seeking recommendations on safe harbors, fraud alerts 2. New HIPAA regulations come under...

• *Charging for treatment rooms
  *HIPAA-compliant electronic transactions

  *Charging for treatment rooms *HIPAA-compliant electronic transactions

Issue 50, June 22, 2003

• 1. AstraZeneca pays $355 million to settle fraud allegations
  2. EMG service

  1. AstraZeneca pays $355 million to settle fraud allegations 2. EMG services cause false claims...

Issue 49, June 22, 2003

• * Dueling privacy notices: Forming an OHCA
  * Can we charge a fee for retrie

  * Dueling privacy notices: Forming an OHCA * Can we charge a fee for retrieving records under...

• 
  1. Tom Scully to step down December 15
  2. OIG boasts record year for a

  1. Tom Scully to step down December 15 2. OIG boasts record year for audits, investigations 3...

• 
  *PHI and charitable giving
  *Defining legibility

  *PHI and charitable giving *Defining legibility

Issue 48, November 1, 2003

• 1. New prospective payment system for inpatient psych facilities
  2. Anothe

  1. New prospective payment system for inpatient psych facilities 2. Another clean audit for HHS...

• 1. $13 million dollar opinion upheld
  2. CMS announces participants in pilo

  1. $13 million dollar opinion upheld 2. CMS announces participants in pilot program 3...

Issue 47, June 22, 2003

• * How large should our audit sample be?
  * How can we convince our physician

  * How large should our audit sample be? * How can we convince our physician to complete the...

• *Is working at home a threat to HIPAA compliance?
  *Documenting medical nec

  *Is working at home a threat to HIPAA compliance? *Documenting medical necessity

Issue 46, June 22, 2003

• 1. CMS finalizes outlier rule
  2. Hospital CEO indicted on kickback allegati

  1. CMS finalizes outlier rule 2. Hospital CEO indicted on kickback allegations 3. Pay-per-view...

• 1. CMS issues EMTALA interim guidance for surveyors
  2. Spinal implant sale

  1. CMS issues EMTALA interim guidance for surveyors 2. Spinal implant salesmen indicted on $3.5...

• 1. CMS announces Medicare improper payment rate
  2. UIC Medical Center agre

  1. CMS announces Medicare improper payment rate 2. UIC Medical Center agrees to $2 million...

Issue 45, June 22, 2003

• * Protecting digital files under HIPAA
  * Getting physician buy-in for compl

  * Protecting digital files under HIPAA * Getting physician buy-in for compliance efforts * Tips...

• *What are the Medicare requirements for dates on physician's orders?
  *HIPA

  *What are the Medicare requirements for dates on physician's orders? *HIPAA and school records

Issue 44, June 4, 2003

• 1. Radiology venture is A-OK with feds
  2. Documentation problems prompt $2

  1. Radiology venture is A-OK with feds 2. Documentation problems prompt $2 million settlement for...

• 1. CMS final rule: Beneficiaries can seek appeal for NCDs
  2. Supreme Court

  1. CMS final rule: Beneficiaries can seek appeal for NCDs 2. Supreme Court reviewing whether...

• *EMTALA and dedicated emergency departments
  *Influenza and pneumonia vacci

  *EMTALA and dedicated emergency departments *Influenza and pneumonia vaccine standing orders

Issue 43, May 4, 2003

• * Changing patient status on rejected claims
  * Should we hold exit intervie

  * Changing patient status on rejected claims * Should we hold exit interviews for fired...

• *Can codes for both CPR and the cardioversion be used for the same event?
  

  *Can codes for both CPR and the cardioversion be used for the same event? *Outpatient setting: Is...

• 1. Recent OIG enforcement actions Recent Medi-Cal fraud recovery pushes total re

  1. Recent OIG enforcement actions Recent Medi-Cal fraud recovery pushes total restitutions for...

Issue 42, May 4, 2003

• 1. Aetna settles lawsuit with physicians for $170 million
  2. Criminal charg

  1. Aetna settles lawsuit with physicians for $170 million 2. Criminal charges filed against...

• 1.OIG has authority to perform PATH audits
  2.Florida doctor accused of fra

  1.OIG has authority to perform PATH audits 2.Florida doctor accused of fraudulently collecting...

• 
  *Should a patient's name be on each page of the medical record?
  *Do ph

  *Should a patient's name be on each page of the medical record? *Do physicians' orders have an...

Issue 41, May 4, 2003

• * Can we integrate our compliance and patient grievance reporting systems?
  

  * Can we integrate our compliance and patient grievance reporting systems? * ABN-Gs and Ls...

• 1.Advisory group recommends "update" to sentencing guidelines
  2.Tenet affi

  1.Advisory group recommends "update" to sentencing guidelines 2.Tenet affiliate receives U.S...

• *Public emergencies and HIPAA
  *Call-in Scripts and privacy notices

  *Public emergencies and HIPAA *Call-in Scripts and privacy notices

Issue 40, May 4, 2003

• 1. GAO gauges specialty hospitals' impact
  2. "Facility fees" cause Florida

  1. GAO gauges specialty hospitals' impact 2. "Facility fees" cause Florida clinics to repay $16.9...

• *Sharing protected health information among providers
  *Inpatient comes bac

  *Sharing protected health information among providers *Inpatient comes back as outpatient: Report...

• 1.Fifth Circuit court throws out CMS decision on Louisiana RHCs
  2.Governme

  1.Fifth Circuit court throws out CMS decision on Louisiana RHCs 2.Government seeking intervention...

• 1.UMH signs "matching funds agreement"
  2.St. Louis University pays $1.8 mi

  1.UMH signs "matching funds agreement" 2.St. Louis University pays $1.8 million in settlement...

• *HIPAA compliance for company health plans
  *HIPAA and return to work notic

  *HIPAA compliance for company health plans *HIPAA and return to work notices

Issue 39, May 19, 2003

• * Hotline pros and cons
  * Are we required to bill for every patient encoun

  * Hotline pros and cons * Are we required to bill for every patient encounter? * Pay-per-view...

• 
  1.OIG trying to clear confusion surrounding excessive claims
  2.Children

  1.OIG trying to clear confusion surrounding excessive claims 2.Children's Hospital Boston...

Issue 38, May 19, 2003

• 1. Billing for E&M services leads to penalty for health system affiliates
  

  1. Billing for E&M services leads to penalty for health system affiliates 2. Bayer to pay $5...

• *Staying on top of credentialing due dates
  *Looking for answers to cataract

  *Staying on top of credentialing due dates *Looking for answers to cataract surgery...

Issue 37, May 19, 2003

• * Is our compliance checker wrong?
  * Can we leave answering machine messag

  * Is our compliance checker wrong? * Can we leave answering machine messages under HIPAA...

• 
  1.OIG developing compliance program guidance for sponsored research
  2.

  1.OIG developing compliance program guidance for sponsored research 2.Compliance officers take...

• 
  *Balancing privacy and accessibility
  *When are written orders necessar

  *Balancing privacy and accessibility *When are written orders necessary for radiologic...

• 
  1.Tenet Healthcare faces exclusion from federal programs
  2.Griffin Hea

  1.Tenet Healthcare faces exclusion from federal programs 2.Griffin Health Services Corporation...

• *Privacy issues, incapacity, and minors
  *To round or not to round: How doe

  *Privacy issues, incapacity, and minors *To round or not to round: How does Medicare want...

Issue 36, May 19, 2003

• 1. EMTALA settlements raise the stakes for emergency departments
  2. Underp

  1. EMTALA settlements raise the stakes for emergency departments 2. Underpayments lead to...

• 1. OIG developing compliance program guidance for sponsored research
  2. Com

  1. OIG developing compliance program guidance for sponsored research 2. Compliance officers take...

Issue 35, September 3, 2003

• 1. CMS to release EMTALA final rule
  2. Hospital pays $1.2 million for kickb

  1. CMS to release EMTALA final rule 2. Hospital pays $1.2 million for kickbacks 3. Pay-per-view...

• * Can we require uninsured patients to pay up front?
  * Can we charge patien

  * Can we require uninsured patients to pay up front? * Can we charge patients for administrative...

Issue 34, April 28, 2003

• 1. Final OIG pharma guidance arrives
  2. OIG bulletin targets contractual jo

  1. Final OIG pharma guidance arrives 2. OIG bulletin targets contractual joint ventures 3...

• 1. CMS extends electronic cost report requirement
  2. Analyze gaps in your

  1. CMS extends electronic cost report requirement 2. Analyze gaps in your information systems...

Issue 33, April 28, 2003

• * Sorting out HIPAA enforcement
  * Documenting tests for "high risk" patien

  * Sorting out HIPAA enforcement * Documenting tests for "high risk" patients * Pay-per-view...

• * Sorting out HIPAA enforcement
  * Documenting tests for "high risk" patien

  * Sorting out HIPAA enforcement * Documenting tests for "high risk" patients * Pay-per-view...

• * Will Medicare pay for routine observations?
  * Can we bill patients for mu

  * Will Medicare pay for routine observations? * Can we bill patients for multiple copayments...

• 1. Mental health centers pay for improper billing
  2. CMS expands Medicare W

  1. Mental health centers pay for improper billing 2. CMS expands Medicare Web site 3...

• * Can we raffle donated tickets?
  * Are students considered business associ

  * Can we raffle donated tickets? * Are students considered business associates? * Rehab...

Issue 32, April 28, 2003

• 1. Cost report troubles lead health system to $2.9 million settlement
  2. S

  1. Cost report troubles lead health system to $2.9 million settlement 2. Surgeon settles over...

• 1. Tenet pays record-setting $54 million
  2. Senator Grassley questions back

  1. Tenet pays record-setting $54 million 2. Senator Grassley questions backlog in whistleblower...

Issue 31, April 18, 2003

• * True or false claim? Must a DME supplier meet all of the 21 supplier standards

  * True or false claim? Must a DME supplier meet all of the 21 supplier standards? * Coding for...

• 1. Physician pays $185,000 for overbilling
  2. Billing for consultations ver

  1. Physician pays $185,000 for overbilling 2. Billing for consultations versus visits 3...

• * Do we have to track all disclosures?
  * What is the time limit to adjust c

  * Do we have to track all disclosures? * What is the time limit to adjust claims? * Security...

Issue 30, April 18, 2003

• 1. HIPAA privacy rule deadline passes
  2. Advisory opinion: Rehab arrangeme

  1. HIPAA privacy rule deadline passes 2. Advisory opinion: Rehab arrangement needs more than safe...

• 1. Tenet indicted for physician recruitment scheme
  2. Documentation improve

  1. Tenet indicted for physician recruitment scheme 2. Documentation improvement tips for the...

• * How does HIPAA require facilities to shred confidential papers?
  * Change

  * How does HIPAA require facilities to shred confidential papers? * Change revenue code for 'N...

• 1. Hospitals settle for transplant fraud
  2. How to minimize FCA penalties

  1. Hospitals settle for transplant fraud 2. How to minimize FCA penalties 3. Pay-per-view...

• * Are insurance companies business associates under HIPAA?
  * Should we bill

  * Are insurance companies business associates under HIPAA? * Should we bill outpatients as...

Issue 29, April 18, 2003

• * Working with schools in the HIPAA era
  * Sorting out the duties of mid-le

  * Working with schools in the HIPAA era * Sorting out the duties of mid-level providers...

• * When may we use the nurse practitioner's UPIN?
  * May I withhold access t

  * When may we use the nurse practitioner's UPIN? * May I withhold access to a patient's medical...

• 1. Medicare Part B providers ready, but concerned about vendor compliance
  2

  1. Medicare Part B providers ready, but concerned about vendor compliance 2. Abbott Labs settles...

• * Can our board view protected health information?
  * Should internal audito

  * Can our board view protected health information? * Should internal auditors report to our HIM...

• 1. FTC cites physician network for price-fixing
  2. Twelfth HealthSouth exec

  1. FTC cites physician network for price-fixing 2. Twelfth HealthSouth executive pleads guilty 3...

• * Can we bill for services if a patient complains about them?
  * Do we need

  * Can we bill for services if a patient complains about them? * Do we need to send our NPP to...

Issue 28, April 18, 2003

• 1. Governing boards get compliance help from the OIG
  2. Former clinic VP f

  1. Governing boards get compliance help from the OIG 2. Former clinic VP faces fines, prison for...

Issue 27, April 18, 2003

• * Billing for nutritional counseling after surgery
  * Insurers, physicians,

  * Billing for nutritional counseling after surgery * Insurers, physicians, and business associate...

Issue 26, April 18, 2003

• 1. Chief operating officer gets prison sentence over kickbacks
  2. PA compa

  1. Chief operating officer gets prison sentence over kickbacks 2. PA company sues Internet...

Issue 25, March 3, 2003

• * Can we use e-mail under HIPAA?
  * Disclosing financial relationships with

  * Can we use e-mail under HIPAA? * Disclosing financial relationships with vendors...

Issue 24, March 3, 2003

• 1. DOJ enforces Sarbanes-Oxley against HealthSouth
  2. Ambulance companies

  1. DOJ enforces Sarbanes-Oxley against HealthSouth 2. Ambulance companies get OIG advice 3...

Issue 23, April 3, 2003

• * Should we wait for a subpoena?
  * Coding for three procedures with unexpe

  * Should we wait for a subpoena? * Coding for three procedures with unexpected results...

Issue 22, March 21, 2003

• 1. Pneumonia codes problematic for FL hospital
  2. OIG audit finds NJ filed

  1. Pneumonia codes problematic for FL hospital 2. OIG audit finds NJ filed duplicate claims, owes...

Issue 21, March 21, 2003

• * How do we perform a criminal background check?
  * ABNs, routine and not

  * How do we perform a criminal background check? * ABNs, routine and not * Pay-per-view...

Issue 20, March 13, 2003

• 1. Hospital pays $6.2 million over cost reports
  2. IG Rehnquist resigns am

  1. Hospital pays $6.2 million over cost reports 2. IG Rehnquist resigns amidst controversy 3...

Issue 19, March 13, 2003

• * Can a human resources employee serve as our privacy officer?
  * How can ou

  * Can a human resources employee serve as our privacy officer? * How can our lab get proper...

Issue 18, March 13, 2003

• 1. CMS rule to reign-in outliers
  2. DME telemarketing prompts Fraud Alert<

  1. CMS rule to reign-in outliers 2. DME telemarketing prompts Fraud Alert 3. Pay-per-view...

Issue 17, February 28, 2003

• * What can we do about illegible physician handwriting?
  * Do we have to gi

  * What can we do about illegible physician handwriting? * Do we have to give our privacy notice...

Issue 16, February 27, 2003

• 1. Hospital accused of hoarding "free bed" funds
  2. Jail time, fines for M

  1. Hospital accused of hoarding "free bed" funds 2. Jail time, fines for Missouri home health...

Issue 15, February 27, 2003

• * What is the best way to handle a patient's credit balances?
  * Is it a co

  * What is the best way to handle a patient's credit balances? * Is it a compliance issue when...

Issue 14, February 20, 2003

• 1. HIPAA final security rule finally arrives
  2. University settles for $80

  1. HIPAA final security rule finally arrives 2. University settles for $800,000 3. Pay-per-view...

Issue 13, February 20, 2003

• * Cell phones and HIPAA: A bad mix?
  * How do I bill for labs that don't fa

  * Cell phones and HIPAA: A bad mix? * How do I bill for labs that don't fall under preventive...

Issue 12, February 14, 2003

• 1. OIG: Uniform outpatient rates could save a billion
  2. Grassley wants co

  1. OIG: Uniform outpatient rates could save a billion 2. Grassley wants congress to "check" False...

Issue 11, February 10, 2003

• * Should compliance officers do their own staff training?
  * Do I have to t

  * Should compliance officers do their own staff training? * Do I have to tell our compliance...

Issue 10, February 5, 2003

• 1. OIG gives the green light to excluded parties in limited situations
  2.

  1. OIG gives the green light to excluded parties in limited situations 2. FL oncologist accused...

Issue 9, January 28, 2003

• * Can we use the overhead pager?
  * Can we charge for set-up when the patie

  * Can we use the overhead pager? * Can we charge for set-up when the patient cancels...

Issue 8, January 28, 2003

• 1. MI hospital pleads guilty to criminal fraud
  2. CMS adopts quality impro

  1. MI hospital pleads guilty to criminal fraud 2. CMS adopts quality improvement requirement 3...

Issue 6, January 22, 2003

• 1. OIG gives guidance on malpractice assistance...sort of
  2. Former Genera

  1. OIG gives guidance on malpractice assistance...sort of 2. Former General American employees...

Issue 5, January 17, 2003

• * To restrict or not to restrict?
  * How do I properly code for outpatient

  * To restrict or not to restrict? * How do I properly code for outpatient group therapy...

Issue 4, January 15, 2003

• 1. South Dakota hospital pays $6 million for Stark violations
  2. California

  1. South Dakota hospital pays $6 million for Stark violations 2. California sues drug companies...

Issue 3, January 13, 2003

• * Can you provide some guidelines for giving gifts to physician referral sources

  * Can you provide some guidelines for giving gifts to physician referral sources? * Are...

Issue 2, January 8, 2003

• 1. OIG audits Rhode Island hospital over outliers
  2. Tenet adopts new outl

  1. OIG audits Rhode Island hospital over outliers 2. Tenet adopts new outlier policy 3...

Issue 1, January 3, 2003

• * Can we create an increased pricing structure for on-call services?
  * How

  * Can we create an increased pricing structure for on-call services? * How can we secure radiology...

Issue 21, May 28, 2003

• Physician faces exclusion, fines for upcoding and false claims

  Physician faces exclusion, fines for upcoding and false claims

Issue 34, August 27, 2003

• Hospital must improve cardiac rehabilitation billing

  Hospital must improve cardiac rehabilitation billing

Issue 20, May 20, 2003

• Adopt Sarbanes-Oxley Act provisions now

  Adopt Sarbanes-Oxley Act provisions now

Issue 5, February 4, 2003

• FL oncologist accused of diluting Lupron

  FL oncologist accused of diluting Lupron

Issue 48, December 5, 2003

• *Nurse documentation and diagnosis coding
  *Injured staff and EMTALA

  *Nurse documentation and diagnosis coding *Injured staff and EMTALA

Issue 35, September 5, 2003

• * What rules apply for non-physician staff and evaluation and management codes?<

  * What rules apply for non-physician staff and evaluation and management codes? * Does Medicare...

Issue 33, July 19, 2003

• Mental health centers pay for improper billing

  Mental health centers pay for improper billing

Issue 22, June 4, 2003

• Documentation problems prompt $2 million settlement for PA hospital

  A Philadelphia hospital network agreed to pay nearly $2 million on May 28 to settle allegations...

Issue 18, May 7, 2003

• EMTALA settlements raise the stakes for emergency departments

  Two separate settlements in the last week have turned the spotlight on the Emergency Medical...