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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 97, December 8, 2004

• Medco under the federal microscope for potential anti-kickback violations

  Federal prosecutors are examining payments that pharmacy benefit management company Medco Health...

Issue 99, December 16, 2004

• OIG saved government $30 billion, report says

  In addition to reporting savings of approximately $30 billion, the OIG excluded 3,293 individuals...

• CMS to increase oversight of contractors' payment error rates

  In a move to reduce improper payments, CMS said December 13 it will launch new steps to measure...

• Bush nominates EPA chief to head HHS

  President Bush nominated Michael O. Leavitt, a former three-term governor of Utah, to be secretary...

Issue 97, December 8, 2004

• HHS settles on regions to divide new Medicare drug benefit

  The Department of Health and Human Services (HHS) announced December 6 it established 26 regions...

• Gambro Healthcare to pay more than $350 million in Medicare fraud case

  In one of the largest settlements reached by the Department of Justice, renal dialysis clinic owner...

Issue 95, December 1, 2004

• CA psychologist sentenced in Medicare fraud case

  Joseph Yedid, a San Diego-based psychologist, was sentenced in federal court November 19 for...

• CMS says drug companies have to keep pricing records for 10 years

  Drug manufacturers who participate in the Medicaid rebate program will have to keep pricing records...

• Woman pleads guilty to impersonating an OIG 'compliance officer'

  A woman admitted she pretended to be an HHS employee in Ohio, trained healthcare providers and then...

Issue 93, November 24, 2004

• Study: Medicare drug benefit help certain beneficiaries

  A new study says that the new prescription drug benefit will help elderly people with low incomes...

• New ID tag could prevent surgical errors

  A radio frequency tag that patients can affix like a bandage to ensure doctors perform the right...

Issue 92, November 19, 2004 - VIEW THE FULL ISSUE

Issue 91, November 19, 2004 - VIEW THE FULL ISSUE

Issue 90, November 12, 2004

• Triage nurse billing

  According to EMTALA, every person who comes to the ED must receive a medical screening exam to...

• Waiving co-pays

  A: Many medical practices offer discounts to employees. Offering a discount to employees is not...

Issue 87, November 10, 2004

• Former cancer care worker sentenced in first federal HIPAA conviction

  A former cancer care center worker was sentenced November 5 to 16 months in prison, three years of...

• Justice Department, SEC, look more closely at Merck

  The Justice Department demanded information about sales and marketing practices related to Vioxx in...

Issue 86, October 29, 2004

• E/M codes for injection, infusion

  The key to this question is: What is the reason for the visit to the infusion center?

Issue 85, November 3, 2004

• Merck under public scrutiny after media report showed execs hid Vioxx data

  Shares of Merck fell more than 10% this week, according to the Associated Press. The cause appears...

• CMS vows to improve care for cancer patients

  CMS said November 1 it would implement a set of new steps to improve care for cancer patients by...

• Five charged in $34 million outpatient surgery fraud

  A federal grand jury indicted five defendants October 27, including the Millennium Outpatient...

Issue 84, October 22, 2004

• ED charges when patient doesn’t see doc

  A: Yes, it is possible to charge a level 3 visit when the patient never saw a physician.

Issue 83, October 27, 2004

• Judge dismisses suit by uninsured patients against hospitals

  Three uninsured patients could not sue Baptist Health System in federal court--because they already...

• Milliman survey reports lower HMO premium increases

  Milliman's 13th annual survey of health maintenance organization (HMO) and preferred provider...

• GAO finds per diem rate for hospice care higher than estimate

  The per diem payment rate for all hospice care was about 8% higher in 2000 than the estimated...

• Tip: 10 ways to help a victim of identity theft

  Under HIPAA, you have an obligation to mitigate the harm if one of your employees steals a...

Issue 81, October 20, 2004

• 2005 OIG Work Plan reveals gov’t target areas

  The OIG will continue to focus on long-running audits and evaluations in its Work Plan. Released...

• CMS allocates $2.5 million for LTC counseling

  State health insurance assistance programs (SHIPs) were the recipients of $2.5 million in...

• Survey: Health savings accounts not well received by employers

  Ever wonder what employers are doing in terms of health savings accounts?

Issue 80, October 13, 2004 - VIEW THE FULL ISSUE

• Concurrent therapies in an IRF

  A: CMS has not provided clear written guidelines on how minutes of treatment would be counted in...

• Maine urologist guilty of fraud

  Joseph Olstein, MD, was sentenced October 6 to one year of probation and a $20,000 fine following a...

• Tip: The impact of CMS change request 3444

  A recent addition to CMS policy regarding changing inpatient admissions to observation (outpatient...

Issue 78, October 1, 2004

• Instruction for scheduled elective cardioversion

  If these cardioversions are prescheduled and elective and the ED is used as a treatment room for...

• Modifier -50

  That depends on your fiscal intermediary (FI). All the FIs are supposed to do things the same way...

• Two more lawsuits filed against nonprofits

  The numbers are in: 370 and counting. Hospitals in Oregon and Washington are the latest in a string...

• Florida Attorney General arrests four in $4.7 million Medicaid scheme

  Four parties were arrested in late September for participating in a $4.7 million scheme to defraud...

• CMS launches new clinical laboratory Web site

  CMS unveiled a new Web site section for providers to maintain easy access to clinical laboratory...

Issue 76, September 24, 2004

• Outpatient diagnostic services bundled into inpatient DRG

  You've posed a number of questions, so I'll address them individually:

• Three RI hospitals to reject funding for treating undocumented aliens

  In response to requests from its local American Civil Liberties Union (ACLU), at least three Rhode...

• Physician fined $30,000 for Medicaid fraud

  A Norwalk, CT physician charged in a vaccine fraud case was fined $30,000 and has been placed on...

• CMS launches DME advisory committee

  CMS has appointed a committee to advise the agency about the implementation of competitive bidding...

Issue 75, September 22, 2004

• CMS announces new transmittal on changing status from inpatient to outpatient

  A new condition code will be implemented on October 12 to help ease the administrative problems...

• Former TAP employee acquitted on kickback accusation

  A federal judge threw out the guilty plea of a former drug company employee September 14. The...

• CM survey: medical necessity tops training needs

  A recent Compliance Monitor survey found that medical necessity was the number one most important...

Issue 74, September 17, 2004 - VIEW THE FULL ISSUE

• Upcoding and medical necessity

  Upcoding is the practice of submitting codes at a level or frequency that is not supported by...

Issue 73, September 15, 2004

• CMS Boston official outlines agency's program integrity changes

  Medicare will shift certain duties normally held by its fiscal intermediaries and carriers over to...

• Survey says: Home oxygen equipment reimbursement rules should be changed

  Medicare expenditures for home oxygen equipment could be reduced by hundreds of millions yearly if...

• Aetna sets goals on increased plan expansion

  Aetna announced September 13 that it plans to continue offering Individual Medicare Advantage plan...

• Tip: Increase awareness of areas where ABN use is prohibited

  Providers cannot obtain routine Advance Beneficiary Notices (ABNs) from Medicare beneficiaries...

Issue 72, September 10, 2004

• Medicare coverage for devices

  Yes. Under the Category B device regulation, the delivery of the device is covered as is the device...

Issue 71, September 8, 2004

• GlaxoSmithKline starts releasing drug trial info

  GlaxoSmithKline posted some summaries of its drug trial results on the Internet, the Associated...

• Tenet sells off three CA hospitals

  Tenet Healthcare Corp. agreed to sell three Los Angeles hospitals to Centinela Freeman...

• Tip: Do some research when treating undocumented immigrants

  In line with the Medicare Prescription Drug, Improvement and Modernization Act of 2003, (MMA...

Issue 69, September 1, 2004

• GAO calls for CMS call center improvement

  CMS call center reps have a low incidence of accurate responses to policy-specific provider...

• Yale-New Haven accused of erroneous Medicare cost reports

  In an audit report released August 19, the OIG found that Yale-New Haven Hospital failed to comply...

• Calling all compliance superstars for HCPro contest

  What is it about your compliance program that makes you most proud? Is it an audit plan? A training...

• Tip: Evaluate physician coding profiles

  Evaluating your physician coding profiles often results in improved compliance and increased...

Issue 67, August 25, 2004

• First federal HIPAA privacy conviction settled

  The first HIPAA privacy conviction came down August 19 when Richard Gibson pleaded guilty in...

• Justice Department probes fraudulent charging of medical supplies

  The Justice Department opened a broad criminal investigation of the medical-supply industry, the...

• CMS posts HIPAA security FAQs

  CMS posted answers August 12 to 12 new frequently asked questions about the HIPAA Security Rule...

Issue 66, August 20, 2004

• SNF compliance plan

  The Office of Inspector General (OIG) has developed compliance program guidance for the healthcare...

Issue 65, August 18, 2004

• Travelers, UnitedHealth settle for $20.6 million without admitting wrongdoing

  Two insurers settled civil Medicare fraud charges with the U.S. Attorney’s office in New York...

• GAO reports barriers in future of healthcare IT

  Stark and anti-kickback laws present barriers to healthcare information technology (IT), according...

• CMS launches technology innovation group

  CMS announced August 13 it will launch a new council to make sure Medicare beneficiaries have the...

Issue 64, August 13, 2004 - VIEW THE FULL ISSUE

Issue 63, August 11, 2004

• MS hospital system reaches agreement with Scruggs for charity care practices

  In order to steer clear of a class-action lawsuit, North Mississippi Health Services, a...

• Boston Scientific expands stent recall

  Boston Scientific Corp. announced August 5 it expanded the recall on its Taxus Express2...

• U.S. attorney asks Tenet for physician relocation documents

  Tenet Healthcare Corp. said August 6 it is cooperating with a voluntary request for documents it...

• Tip: Questions to ask when auditing physician coding patterns

  When evaluating physician coding patterns, there are four things to resolve off the bat, said Terri...

Issue 62, August 6, 2004

• MRI services

  Medicare reimburses Independent Diagnostic Testing Facilities (IDTFs), a.k.a. "freestanding...

Issue 61, August 4, 2004

• CMS issues final inpatient payment (IPPS) rules for acute-care hospitals

  CMS issued its final fiscal year 2005 inpatient payment rules August 3, pledging to increase...

• Schering-Plough to pay $346 million to settle criminal, civil charges

  Schering-Plough Corp. agreed to pay $346 million in fines and damages to settle charges that it...

• Tenet vice chairman to resign

  Vice Chairman Barry P. Schochet will resign at the end of the year, after more than 25 years with...

• Tip: Medicare's pointers for billing preventive and problem visits

  Medicare considers a covered physician service provided at the same place and on the same date of...

Issue 60, July 30, 2004

• Expirations on standing orders

  There is no national policy that dictates the expiration date of standing orders such as these...

Issue 59, July 28, 2004

• Uninsured patients file more suits against nonprofit hospitals

  Uninsured patients have filed a string of class-action lawsuits against tax-exempt, nonprofit...

• CMS launches $1 billion program to help uninsured in the ED

  CMS announced July 21 a new program to provide $1 billion over four years to help hospitals and...

• JCAHO surveyors jeopardize patient safety, GAO reports

  Surveyors from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) failed to...

• Obtain necessary information to determine medical necessity for diagnostic tests

  To prove medical necessity when ordering a diagnostic test, referring physicians must:

Issue 58, July 23, 2004

• Outpatient therapy billing

  No it is not appropriate to bill for services as described.

Issue 57, July 21, 2004

• Indiana health system denies fraud accusations

  Porter Memorial Health System officials denied accusations by a former employee of Medicare fraud...

• Tip: Avoid compliance trap doors

  Are your physicians complying with on-call responsibilities under the Emergency Medical Treatment...

Issue 56, July 16, 2004

• Privacy in the physician office

  A: This is an interesting question as it includes the nuisance of adding the physician's name when...

Issue 55, July 14, 2004

• 13 LA hospitals join in HHS lawsuit

  Claiming the Medicare program owes them $226.3 million, 13 Louisiana hospitals joined dozens of...

• Study: Two in 10 expect to enroll in Medicare drug benefit program in 2006

  Two in 10 Medicare beneficiaries expect to enroll in the drug benefit program in 2006, in spite of...

• OIG targets health plan for prompt pay violation

  Providence Health Plans was the target of an OIG audit that found the plan to be noncompliant with...

• Tip: Use COSO to deal with risks

  The Council of Sponsoring Organizations (COSO) of the Treadway Commission’s enterprise...

Issue 54, July 9, 2004

• Privacy and DSS

  There are two important provisions of the privacy rule that can help resolve the situation.

Issue 53, July 7, 2004

• Boston Scientific recalls Taxus Express2 stents

  Boston Scientific Corp. announced July 2 it will recall 200 of its recently approved drug-coated...

• OIG, AHLA publish board member compliance resource

  The OIG and the American Health Lawyers Association (AHLA) released July 1 a jointly developed...

• CMS encourages use of HIPAA-compliant electronic claims

  As of July 1, electronic Medicare claims that do not meet Health Insurance Portability and...

• Tip: Use a layered approach for HIPAA security

  HIPAA defines "workstation" as an electronic computing device, such as a laptop or desktop...

Issue 52, July 2, 2004

• Billing for conscious sedation

  When conscious sedation is administered in a hospital-based outpatient setting it should generally...

Issue 51, June 30, 2004

• OIG seeks largest-ever civil monetary penalty against PharMerica

  On June 17, the OIG announced it is seeking the largest amount of money to date in a civil monetary...

• Prominent hospitals targeted in charity care class-action suits

  More hospitals and healthcare systems have been named in federal class-action lawsuits alleging...

• CA physician admits to false billing for motorized wheelchairs

  CMS reported months ago that fraudulent billing for motorized wheelchairs was prevalent and would...

• Tip: Avoid noncompliance with written orders

  Written orders-taken either by nurse practitioners or physician extenders-and verbal orders from...

Issue 49, June 23, 2004

• CMS to expand Alzheimer's test-related coverage

  CMS announced June 15 that it will expand Medicare coverage of positron emission tomography (PET...

• Harvard, Beth Israel Deaconess pay $2.4 million to settle NIH false claims

  In connection with four federal grants, Harvard and Beth Israel Deaconess Medical Center agreed...

• HealthSouth CFO to pay $2.4 million for accounting scandal

  A federal judge on June 19 sentenced a former HealthSouth Corp. chief financial officer to six...

Issue 48, June 18, 2004

• Physician order requirements

  I would recommend viewing the CMS Web site but state regulations would be a better source for...

Issue 47, June 16, 2004

• Tenet settlement tag could reach $1 billion

  The nation's second-largest for-profit hospital chain could pay more than $1 billion to settle...

• AMA rejects soft take on physician-pharma relationship

  The American Medical Association (AMA) rejected a proposal that would have softened the group's...

• Warner-Lambert pleads guilty to off-label promotion

  Pharmaceutical manufacturer Warner-Lambert June 7 pleaded guilty to criminal healthcare fraud...

Issue 45, June 9, 2004

• OIG issues supplemental compliance guidance

  Using 11 compliance recommendations from the healthcare provider community, the OIG released a...

• CMS, NCI to bring new drugs, better treatment to cancer patients

  CMS and the National Cancer Institute (NCI) announced June 7 they will join forces to bring new...

• OIG saves taxpayers $16.8 billion in first half of 2004

  Last week, the OIG sent HHS and Congress its semiannual report for the first half of FY 2004 with...

• Tip: Understand business risk and internal controls

  Before beginning a risk assessment, you must understand the nature of business risk and internal...

Issue 44, June 4, 2004

• Observation codes

  A: Use code G0264. When patients are directly admitted to the facility from a physician’s...

Issue 43, June 2, 2004

• CMS forms EMTALA advisory group

  CMS announced May 27 it formed technical advisory group to review regulations affecting hospital...

• 15 Missouri hospitals bungle Medicare cost reports

  A May 6 OIG audit found that 15 Missouri hospitals failed to record the refund of provider tax...

• Electronic health records get CMS endorsement

  CMS awarded a $100,000 grant to the American Academy of Family Physicians (AAFP) so they can...

• Tip: ABN primer: the right way to complete the form

  Do you have a policy in place that outlines the correct way to fill out an Advance Beneficiary...

Issue 42, May 28, 2004 - VIEW THE FULL ISSUE

Issue 41, May 26, 2004

• More hospitals report quality data

  Hospital participation in the National Voluntary Hospital Reporting Initiative (NVHRI) is booming...

• OIG issues interim rule on CMPs for drug card violations

  The OIG announced it can fine those who defraud Medicare's Discount Drug Card program $10,000 per...

• Physician impersonator caught again

  A man currently serving a 12.5-year sentence for impersonating a physician was sentenced May 17 to...

• Tip: Help improve physician documentation with positive attitude

  The adage that you catch more flies with honey is right on the money when you’re talking...

Issue 40, May 21, 2004

• Post-op pain management

  A: There are CPT Assistants (10/01 and 7/98) that indicate that if the block were intended...

Issue 39, May 19, 2004

• CMS issues final proposed rule for 2005 inpatient payment increases

  Acute-care hospitals with a focus on rural facilities are the target of CMS' latest announcement on...

• Pfizer pleads guilty to promoting drug for off-label use

  Pfizer Inc. became an industry example last week when it plead guilty to promoting its anti-seizure...

• SNF operator to pay $232,000 for false claims

  Robert C. Bristol and his company Regency Health Services agreed May 6 to pay $232,000 to the...

• Tip: Advice for claims denial audits

  Monitoring and correcting claims denials has many benefits. Review your facility's claims denials...

Issue 38, May 14, 2004

• Defining Secondary Geographic Jurisdiction

  A: Primary jurisdiction refers to when a contractor handles the majority of providers in a...

Issue 37, May 12, 2004

• CMS announces compliance effectiveness pilot project

  CMS is set to launch a pilot program that will result in metrics to measure compliance...

• Medi-Cal fraud case results in longest-ever prison sentence

  Orange County Superior Court sentenced Tahir Saeed Sherani to 18 years and eight months in prison...

• HCCA survey results show compliance concerns, objectives

  Compliance officers' training efforts, greatest challenges, and top compliance goals are all...

• Tip: Advice for utilization-management audits

  When you audit your utilization management (UM) process and only focus on business aspects of your...

Issue 35, May 5, 2004

• Gov't to reduce fraud and abuse for power wheelchair payments

  With spending 400% higher since 2000 for power wheelchairs covered by Medicare, CMS announced April...

• U.S. Sentencing Commission proposes amended guidelines

  The U.S. Sentencing Commission sent a proposal to Congress April 30 to amend the federal...

• Former nurse pleads guilty to murdering 13 patients

  Sanction screening is a well-known responsibility for compliance officers, but in some cases...

• Tip: Protect yourself from inducements

  It's common knowledge that the government believes all medical decisions should be made in the...

Issue 34, April 30, 2004

• E/M coding

  A: Simple suture removal only in a minor procedure with a global of 10 days is bundled into the...

Issue 33, April 28, 2004 - VIEW THE FULL ISSUE

• AHIMA releases HIPAA compliance study results

  To celebrate the HIPAA privacy rule's first birthday in April, the American Health Information...

• Insurer to pay $1.5 million to settle false claims with Medicare

  Highmark Inc., the country's ninth largest health insurer, will pay $1.5 million to the federal...

• Tip: Avoid denied claims for ED diagnostic testing

  Medical necessity determinations in the ED can be a controversial subject. Section 944 of the MMA...

Issue 32, April 23, 2004

• Billing for drugs administered in an ambulance

  A: If an ambulance company restocks its supplies at the hospital, there should be a written...

Issue 31, April 21, 2004

• TAP's federal fraud case begins

  Opening remarks began Tuesday in the federal fraud case against 11 current and former sales...

• Tenet to sell Redding Medical Center to HPA

  Tenet Healthcare Corp., based in Santa Barbara, CA, has agreed to sell Redding Medical Center to...

• CMS launches initiative to improve care for hemodialysis patients

  CMS announced April 14 it is leading a national initiative to increase the use of fistulas in...

• Tip: Determine whether your new-employee policy measures up

  Make sure your hospital’s policy for new employees includes the following provisions:

Issue 29, April 14, 2004

• CMS adds new drugs, technologies to OPPS list

  In a move to help ease the financial strain of hospitals using new drugs and technologies, CMS...

• Suit against University of Chicago can proceed, says judge

  An appeals court has reinstated six counts in a lawsuit against the University of Chicago and its...

• Tip: Learn how EMTALA violations can affect your accreditation

  Hospitals that are not in compliance with EMTALA may not receive accreditation from the Joint...

Issue 27, April 7, 2004

• Texas psychiatrist convicted of fraud, receiving kickbacks for wheelchairs

  Psychiatrist Lewis Gottlieb was convicted April 1 for participating in a scheme to defraud Medicare...

• CMS issues Stark II, Phase II correction

  CMS announced it inadvertently omitted two sections from the preamble of the March 26 posting in...

• OIG posts alert on added charges for covered services

  The OIG posted March 31 an alert for physicians about added charges for covered services. In the...

• Tip: "Incident to" services: Don't fall prey to the OIG

  OIG auditors have been busily investigating outpatient cardiac-rehabilitation services, and as a...

Issue 25, March 31, 2004

• Tenet will pay nearly $31 million to settle two cases

  Tenet Healthcare Corp. agreed to pay nearly $31 million to settle one investigation involving a...

• CMS says managed care payment rates for 2005 could increase 6.6%

  CMS announced March 26 that Medicare Advantage (formerly Medicare+Choice) capitation rates in 2005...

• Hospital abortion records privacy wins support of federal appeals court

  A federal appeals court March 26 rejected the Justice Department's demand for abortion records from...

• Tip: Using software helps determine medical necessity

  Advance Beneficiary Notices (ABNs) are an extremely intricate part of laboratory compliance, and...

Issue 24, March 25, 2004

• CMS issues Stark II, Phase II rule

  CMS issued today the second phase of its final regulations addressing physician referrals to...

• Hospital-vendor conflict of interest

  Determining if a potential conflict of interest exists really depends on the facts and...

Issue 23, March 24, 2004

• CMS announces guidelines for specialty hospital moratorium

  CMS announced March 19 guidelines for physician referrals to specialty hospitals under the new...

• Consumer group sues Kaiser Foundation over patient privacy violations

  The California Consumer Health Care Council (CCHCC) filed a representative-action lawsuit March 15...

• Stark II, Phase II rules out soon?

  The Office of Management and Budget (OMB) on March 15 completed its review of the Phase II...

• Tip: Help your facility manage the on-call crisis

  Many hospitals have problems getting their physicians to serve on call. Here are some ideas to help...

Issue 22, March 19, 2004

• Write-offs when a patient won’t pay

  I don’t know why any provider would want to write off a patient’s deductible or...

Issue 21, March 17, 2004

• Psychologist found guilty of defrauding Medicare

  Joseph Yedid, MD, a San Diego-based psychologist, pleaded guilty March 10 in San Diego federal...

• HCCA issues comments on proposed changes to U.S. sentencing guidelines

  The executive committee of the Health Care Compliance Association (HCCA) submitted comments March 8...

• Senate approves McClellan to head CMS

  The U.S. Senate approved the nomination of Mark McClellan early on Friday to run CMS despite a...

• TIP: Five steps to audit cardiac cath billing

  1. Select a sample. For a focused review, use a statistically valid or stratified random sample.

Issue 20, March 12, 2004

• Signing lab results

  You won't find documentation of regulations specifically mandating the ordering physician's...

Issue 19, March 10, 2004

• Burn center hit with largest-ever patient dumping fine

  A south Florida hospital system last month became a ready-made agenda item for a new, Washington...

• Fugitive doctor accused of fraud

  A federal judge sentenced a Texas-based physician to 10 years in prison and ordered him to pay...

• Kuhn to lead Center for Medicare Management

  The Centers for Medicare and Medicaid Services (CMS) announced March 5 that veteran healthcare...

• Tip: Start thinking about the security provisions of your business associate con

  The HIPAA security rule goes into effect in April 2005, and it's time to start looking at your...

Issue 18, March 5, 2004

• Sanctions and exclusions

  Both the United States Sentencing Guidelines and the Office of Inspector General (OIG) Guidelines...

• PHI and a clinical research company

  Under HIPAA, for any health care provider to use or disclose PHI (protected health information) for...

Issue 17, March 3, 2004

• CMS will match states' costs of disease management programs

  The Centers for Medicare and Medicaid Services (CMS) urged states to adopt programs to help those...

• Johns Hopkins University Medical Center to pay $2.6 million in whistleblower set

  Baltimore's Johns Hopkins University and Johns Hopkins Bayview Medical Center have been ordered to...

• MA health insurer alters procedures for imaging

  Harvard Pilgrim Health Care, one of Massachusetts' largest health insurers, said physicians are...

• Tip: Train staff on electronic safeguards

  Electronic safeguards such as passwords and codes certainly help protect systems from unauthorized...

Issue 16, February 27, 2004

• Consent and patient transportation

  I would recommend that you have the transportation company contact the patient for that information...

Issue 15, February 25, 2004

• Bush nominates McClellan to head CMS

  President Bush will nominate Food and Drug Administration (FDA) Commissioner Mark B. McClellan to...

• Hospitals can provide discounts to uninsured

  The Bush administration is encouraging hospitals to give discounts to uninsured patients and...

• CMS announces increase in hospitals voluntarily reporting quality data

  About one out of three U.S. hospitals paid by Medicare and Medicaid are now voluntarily reporting...

• Tip: Maintaining on-call obligations under EMTALA

  Hospitals must maintain their on-call lists to best meet the needs of patients who receive services...

Issue 14, February 20, 2004

• HIPAA and the parent/child relationship

  Our question concerns adult children who are insured through their parents. If the PHI or medical...

• C code update

  Is there a final list of the C codes that we will be able to use now that the codes are coming...

Issue 13, February 18, 2004

• SC hospital to pay $9.5 million in OIG settlement

  St. Francis Hospital, Inc., based in Greenville, S.C., agreed to pay nearly $9.5 million to resolve...

• OCR update: more than 4,000 HIPAA violation complaints filed

  The Office for Civil Rights (OCR), a division of the U.S. Department for Health and Human Services...

• CMS expects 2003 to mark first slowdown in health care cost growth

  U.S. health care spending is projected to grow 7.8 percent in 2003, down from the 9.3 percent...

• Tip: Use publicly available benchmarking tools to enhance the audit process

  You can use the many benchmarking tools that are publicly available to make the audit process as...

Issue 12, February 13, 2004

• EMTALA and psychiatric patients

  EMTALA does apply to psychiatric patients who do not present with physical emergency medical...

Issue 11, February 11, 2004

• CA hospital to pay $4.1 Million to settle Medicare fraud claims

  To resolve allegations that Coast Plaza and the former CEO defrauded the federal Medicare program...

• OIG zeroes in on outpatient cardiac rehab -- again

  The Office of the Inspector General (OIG) recently found holes in outpatient cardiac rehabilitation...

• CMS posts provider identifier FAQs

  The Centers for Medicare & Medicaid Services (CMS) recently posted 16 frequently asked questions to...

Issue 10, December 22, 2004 - VIEW THE FULL ISSUE

• Q&A: HIPAA Notice of Privacy

  How often do you have to get patient signatures on the HIPAA Notice of Privacy? How often does a...

• U.S. Attorney charges pharma rep in kickbacks

  The U.S. Attorney in Massachusetts December 15 charged a pharmaceutical sales representative with...

• Medical supply firm owners indicted in power wheelchair fraud ring

  Three medical supply company owners were named in a federal grand jury's 43-count indictment last...

• UnitedHealthcare to pay $3.5 million in fraud settlement

  UnitedHealthcare Insurance Company has agreed to pay the federal government $3.5 million to settle...

• Tenet enters $395 million settlement for unnecessary cardiac procedures

  Tenet Healthcare Corp. agreed December 21 to pay $395 million to settle lawsuits alleging...

• Pfizer to pull Celebrex ads

  Pfizer Inc. said December 20 it will pull advertising for its arthritis pain reliever Celebrex...

• Massachusetts firm settles fraud charges with state, feds for $960,000

  Columbia Hospital Corporation of Massachusetts has agreed to pay $960,000 to settle civil claims...

• Tip: Watch for signs that risk analysis could go off course

  Certain roadblocks can halt your risk analysis and cause a domino effect in your facility...

Issue 9, February 4, 2004

• CMS now accepts comments online

  The Centers for Medicare & Medicaid Services (CMS) said January 30 that it has established an...

• Medicare reform update: EMTALA provision alters billing outcome

  A new change to the Medicare reform bill (H.R.1-2003), which went into effect January 1, has a...

Issue 7, January 28, 2004

• CMS releases final provider identifier rule

  All but small health plans will be required to use a unique identifier for filing and processing...

• OIG subpoenas Tenet for financial records

  Tenet Healthcare, of Santa Barbara, CA, said it received copies of subpoenas for documents relating...

• Memphis physician indicted for insurance fraud

  The U.S. Department of Justice (DOJ) announced January 20 that a federal grand jury returned a...

Issue 6, January 23, 2004

• Q&A: HIPAA and patient directories

  Do the privacy rule requirements for patient directories apply equally to inpatient areas and ERs?

• Q&A: Patient observation coding

  A physician writes an order to admit a patient to observation on October 25, 2003, at 2 p.m., and...

Issue 5, January 22, 2004

• Outpatient cardiac rehab services under the OIG microscope

  Outpatient cardiac rehab services under the OIG microscope

• Outpatient cardiac rehab services under the OIG microscope

  Medical records from a Massachusetts hospital's outpatient cardiac rehab program failed to show...

• South Carolina hospital pays settlement for violating exclusion list

  Lexington Medical Center, a 292-bed hospital in West Columbia, SC, agreed last month to pay $99,400...

• Optometrist overbilled MA Medicaid $50,000

  An optometrist agreed to repay the Massachusetts Medicaid program $50,000 for overpayments he...

• Tip: Collecting copayment and deductibles from those eligible for Medicare

  Current law bars the recovery of the deductible or coinsurance from poor beneficiaries who are...

Issue 4, January 16, 2004

• Q&A: C codes and CMS

  Since the device C codes are not required and since they do not generate any additional or separate...

• Q&A: HIPAA and electronic medical records development

  From a privacy standpoint electronic medical records should be viewed much like traditional paper...

Issue 3, January 14, 2004

• Whistleblowers receive $8.1 million settlement in Redding Medical Center case

  Two Catholic priests were awarded $8.1 million last week based on their whistleblower complaint...

• U.S. attorney's office files complaint against Ernst & Young

  U.S. Attorney Patrick L. Meehan announced January 5 the filing of a federal complaint against Ernst...

• U.S. health care spending on the rise

  U.S. health care spending hit $1.6 trillion in 2002, up from $1.4 trillion in 2001 and $1.3...

• Use caution when relying on independent auditors' work

  If your independent auditor conducts an annual audit, review the working papers to establish their...

Issue 2, January 9, 2004

• Q&A: HIPAA and peer reviews

  These are normally legitimate uses of PHI. But as the question acknowledges, they could lead to a...

• Q&A: UTI codes

  Guidelines for coding diagnostic tests differ depending on whether you are coding in an ambulatory...

Issue 1, January 7, 2004

• CMS makes changes to payments for outpatient services

  A new interim rule from the Centers for Medicare and Medicaid Services (CMS) will change payments...

• California DME fraud case costs Medicare $2.6 million

  Four Los Angeles-area men, including a physician, allegedly received $2.6 million from Medicare for...

• CMS outlines geographic classification appeals process

  CMS outlined steps that certain qualifying hospitals can follow to change their geographical...

• Watch for fraud red flags

  In spite of checks and balances, heavy consequences, and other deterrents, people still commit...

Issue 53, January 5, 2004

• *Q Codes
  *Nurses and nebulizer treatments

  *Q Codes *Nurses and nebulizer treatments