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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 100, December 19, 2007

• Headlines from the Healthcare Audit Resource Center

  HealthSouth and physicians agree to repay $14.9M

• Tip: Watch out for overpayments

  Fielding requests for overpayment refunds is unfortunately an all-too-familiar scenario for most...

• Pay-Per-View: Complications arise with domestic abuse and PHI disclosure rules

  Healthcare providers are faced with new challenges regarding domestic abuse.

• Texas hospital to pay $1.9M for false claims

  Harris Methodist HEB Hospital (HEB), located in Bedford, Texas, agreed to pay the federal...

• NJ hospital agrees to $7.5M settlement

  Warren Hospital in Phillipsburg, N.J., agreed to pay the federal government $7.5 million to settle...

Issue 99, December 12, 2007

• CMS produces list of poor-performing nursing homes

  CMS released the ranking of the nation's poorest performing nursing homes. The facilities on the...

• DME operators charged for health care fraud in Southern Florida

  Four defendants were charged in a multi-million dollar health fraud scheme for allegedly defrauding...

• Pay-per-view: Sort out disclosures with new privacy tool

  A new resource will help public health professionals understand the intricacies of HIPAA and other...

• Tip: Malpractice insurance subsidies

  The OIG has long been concerned that hospitals subsidizing malpractice insurance for potential...

• Tired? Need new tools to refresh your compliance program and your career? Tell us about it.

  HCPro Inc., wants to know what we can do to help you wake up your facility's compliance efforts.

• Review of Medicare payments for home health services preceded by a hospital discharge

  The OIG wanted to determine whether or not Partners Home Care located in Waltham, MA complied with...

Issue 97, December 5, 2007

• Miami clinic owner sentenced to nine years in prison

  Raul Rodriguez was sentenced to nine years in prison for his role in a $6,400,000 healthcare fraud...

• OIG find overpayments in The Center for Living and Working Inc. in MA

  The OIG reviewed personal care services claimed by The Center for Living and Working Inc. in...

• Improper TANF payments found in Michigan

  The OIG wanted to determine whether or not the Michigan Department of Human Services made improper...

• Pay-per-view: Sort out disclosures with new privacy tool

  A new resource will help public health professionals understand the intricacies of HIPAA and other...

• Tip: Annual evaluations

  The performance evaluation process-how thoroughly managers evaluate employees-can provide a good...

• Tired? Need new tools to refresh your compliance program and your career? Tell us about it.

  HCPro Inc., wants to know what we can do to help you wake up your facility's compliance efforts.

Issue 95, November 29, 2007

• Southern Florida Medicare Strike force becomes permanent

  A Medicare fraud strike force in Southern Florida comprised of four prosecutors determined to fight...

• CMS reduces improper Medicare payments

  Recent error rate reductions have led to approximately $11 billion less in improper payments over...

• NHIC makes inappropriate payments for outpatient laboratory services

  The OIG found that the National Heritage Insurance Company (NHIC) made inappropriate Part B...

• Pay-per-view: Sort out disclosures with new privacy tool

  A new resource will help public health professionals understand the intricacies of HIPAA and other...

• Tip: Credit balances

  Create procedures that guarantee timely and accurate reporting of Medicare and other federal...

Issue 94, November 30, 2007

• Experts needed to answer questions

  Do you think you're a compliance expert? Would you like to answer questions for Compliance Monitor...

Issue 93, November 21, 2007

• Physiotherapy Associates will pay $16.6 Million in False Claims settlement

  Stryker Corporation and Physiotherapy Associates, its former outpatient therapy division, will pay...

• Illinois sues imaging centers, encourages other states to take a proactive approach to fraud detection

  A case in Illinois signals growing concern over physician arrangements with imaging facilities and...

• Follow up of OIG audit of AFDC overpayments in New York

  The OIG found the New York State agency refunded 1.8 million in its estimated share of AFDC...

• Be careful what you sign! Don't let yourself become the subject of DOJ investigations

  Compliance officers are the primary organizational watch dog. It is your responsibility to ensure...

• Tip: Compensation arrangements with physicians

  According to the OIG, hospitals should review their physician compensation arrangements and...

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

Issue 91, November 14, 2007

• Part of Stark III will be postponed by CMS

  CMS has announced that it will wait one year to implement a provision in the final rule that...

• DME company owners to spend time in prison and pay $1.4 million

  Four family members have been sentenced to 57 months each in prison for Medicare fraud, involving...

• Audit of Minnesota Medicaid Reimbursement for Targeted Case Management Services for Fiscal Years 2003 and 2004

  The OIG found the State agency claimed $7,311,860 for Medicaid reimbursement of TCM services that...

• 2008 OIG Work Plan: Hospital Compliance Concerns

  The Office of Inspector General’s (OIG) annual Work Plan gives you a sneak preview at what...

• Tip: Enforcing standards through well-publicized disciplinary guidelines

  The OIG recommends that an effective compliance program include guidance and guidelines regarding...

Issue 89, November 7, 2007

• CMS releases OPPS Final Rule

  The 2008 OPPS final rule was issued by CMS on Thursday, November 1, and the rule takes effect on...

• Grassley legislation helps recover $1.45 billion

  The justice department announced that $1.45 billion has been recovered by the federal treasury this...

• Medicare issues physician payment final rule

  CMS issued a final physician payment rule in order to improve the correctness of Medicare payments...

• 2008 OIG Work Plan: Hospital Compliance Concerns

  The Office of Inspector General’s (OIG) annual Work Plan gives you a sneak preview at what...

• Tip: Discounts to uninsured or underinsured patients

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

Issue 86, October 31, 2007

• Detroit doctor sentenced to 16 years in jail for Medicare fraud

  A Detroit doctor was found guilty on 80-counts of healthcare fraud. Dr. Zack Brown allegedly...

• Texas woman pleads guilty in wheelchair fraud scheme

  A Houston woman, Sharon Thomas, pleaded guilty to healthcare fraud and conspiracy to commit...

• Medical-billing errors becoming a regular occurrence

  Overcharges on bills for doctors, medical tests, or hospitals are becoming more common, according...

• Medical-billing errors becoming a regular occurrence

  Overcharges on bills for doctors, medical tests, or hospitals are becoming more common, according...

• Medical-billing errors becoming a regular occurrence

  Overcharges on bills for doctors, medical tests, or hospitals are becoming more common, according...

• Medical-billing errors becoming a regular occurrence

  Overcharges on bills for doctors, medical tests, or hospitals are becoming more common, according...

• Pay-per-view: There are no excuses when it comes to the present-on-admission indicator

  Every time you see a patient in the acute-care setting, coders assign ICD-9 codes based on the...

• Tip: Following up after exit interviews

  Don't hesitate to follow up with an employee after the exit interview. If possible, interview the...

• Headlines from the Healthcare Audit Resource Center

  Cardiologist pays $1.8 million for Medicare scheme OIG advisory opinion on contracts for emergency...

Issue 84, October 24, 2007

• Owner found guilty of DME fraud in Southern Texas

  The government has been zeroing in on durable medical equipment (DME) fraud, finding and...

• False Claim Act violations in urine drug screen billing

  Boston Clinical Laboratories, Inc., in Newton, MA, allegedly filed false Medicaid claims and...

• OIG advisory opinion on optometrists owning ASCs

  The OIG released an advisory opinion in regard to the addition of optometrists as owners of three...

• Pay-per-view: There are no excuses when it comes to the present-on-admission indicator

  Every time you see a patient in the acute-care setting, coders assign ICD-9 codes based on the...

• Tip: Relationships with federal healthcare beneficiaries

  Hospitals may not offer valuable items or services to Medicare or Medicaid beneficiaries to attract...

• Headlines from the Healthcare Audit Resource Center

  OIG audits Iowa Foundation for Medical Care Medicaid fraud settlement in Kentucky

Issue 82, October 17, 2007

• OIG releases 2006 report on CMS's prevention of fraud and abuse

  The OIG released CMS's Implementation of Safeguards During Fiscal Year 2006 To Prevent and Detect...

• Violations at University of Iowa hospitals

  Iowa state inspectors found 41 health and safety violations at University of Iowa Hospitals. The...

• Workers suspended for viewing star's medical records

  Twenty-seven employees from Palisades Medical Center were suspended without pay for allegedly...

• Pay-per-view: There are no excuses when it comes to the present-on-admission indicator

  Every time you see a patient in the acute-care setting, coders assign ICD-9 codes based on the...

• Tip: Relationships with other healthcare entities

  Hospitals may obtain referrals of federal healthcare program business from a variety of healthcare...

Issue 80, October 10, 2007

• OIG posts safe harbor for FQHCs

  The OIG recently posted a safe harbor for federally qualified health centers (FQHC) arrangements...

• CMS posts audit and enforcement information

  CMS recently posted information about its audit and enforcement initiatives regarding Medicare...

• Bristol-Myers Squibb settles with DOJ on range of illegal practices

  Bristol-Myers Squibb (BMS) will pay more than $515 million for a wide assortment of illegal drug...

• Pay-per-view: Manage subpoenas with a clear legal record definition

  As providers replace traditional paper records with electronic document management systems (EDMS...

• Tip: Develop these management skills to increase your leadership potential

  <p>Develop these management skills to increase your leadership potential

Issue 78, October 3, 2007

• OIG posts 2008 Work Plan

  The OIG posted their 2008 Work Plan on October 1, and they included areas and issues that will be...

• Orthopedic company settles with DOJ for $28 million

  The Orthopedic Reconstruction unit of Smith and Nephew, Inc. reached a settlement with the U.S...

• OIG finds wrong payments in Medicaid dental services

  The OIG found that 31% of Medicaid pediatric dental services in five states added up to $155...

• Pay-per-view: There are no excuses when it comes to the present-on-admission indicator

  Every time you see a patient in the acute-care setting, coders assign ICD-9 codes based on the...

• Tip: Requiring Training

  The OIG recommends that hospitals require attendance and participation in training programs. The...

• Headlines from the Healthcare Audit Resource Center

  Medical equipment company owner to spend 10 years in prison False claims for Medicaid...

Issue 76, September 26, 2007

• DOJ files suit against former Tenet general counsel

  The government filed a complaint against Christi Sulzback, the former Tenet general counsel...

• Flaw exposed in new Medicare ID system

  The American Medical Association (AMA) and the Medical Group Management Association are warning...

• Many U.S. hospitals not preventing infections

  Eighty-seven percent of US hospitals do not have policies to prevent hospital-acquired infections...

• Pay-per-view: There are no excuses when it comes to the present-on-admission indicator

  Every time you see a patient in the acute-care setting, coders assign ICD-9 codes based on the...

• Tip: Screening new employees

  The OIG suggests that hospitals screen new employees who have to make decisions involving...

• Headlines from the Healthcare Audit Resource Center

  OIG finds irregular number of claims for HIV/AIDS patients Adventis pays more than $190 million...

Issue 74, September 19, 2007

• Grassley, Durbin introduce bill to beef up False Claims Act

  On September 12, Senator Charles Grassley (R-Iowa) and Senator Richard Durbin (D-Ill) sponsored the...

• Illinois AG to refile suit against MRI Centers

  Illinois Attorney General (AG) Lisa Madigan will refile a suit against more than 20 magnetic...

• OIG posts new publication on corporate responsibility

  The OIG has posted a new publication designed to help healthcare organization boards ask...

• Pay-per-view: Precertification presents anti-kickback problems

  More and more insurers require that physicians obtain precertification, or preauthorization, for...

• Tip: When to use temporary privileges

  The Joint Commission clearly defines and limits the following two situations in which temporary...

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

Issue 72, September 12, 2007

• UnitedHealth settles 36 states' billing claims for $12 million

  Under a regulatory settlement agreement reached September 6, UnitedHealth will pay $12 million to...

• Durable medical equipment company owner convicted of Medicare fraud

  The owner and operator of a Florida durable medical equipment company and an assisted living...

• Maryland cardiologist to repay $476,000

  A Maryland cardiologist has agreed to repay $476,000 and enter into a corporate integrity agreement...

• Pay-per-view: Health system’s new vendor policy stands its ground

  If you've attended a healthcare compliance conference within the past year, chances are you've...

• Headlines from the Healthcare Audit Resource Center

  Rhode Island Quality Improvement Organization accurately documents costs

Issue 70, September 5, 2007

• Michigan nursing home to pay $1.25 million fine

  A Michigan nursing home will pay $1.25 million and enter into a chain-wide corporate integrity...

• States to begin tamper-resistant prescription pad program

  Medicare and Medicaid prescribers will soon be required to use a new tamper-resistant prescription...

• Pay-Per-View: Build HIPAA into your overall compliance program

  One way to save time and money is to integrate your HIPAA compliance program with your...

• Tip: Facilitate compliance, or correct a mistake

  To ensure your facility takes the appropriate steps to comply with regulations regarding the...

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

Issue 67, August 24, 2007

• Medical staff bylaws

  Q: Are the medical staff bylaws a contract between the medical staff and the hospital?

• CMS issues Stark II Phase III final rules

  CMS issued the long-awaited Stark II Phase III final rules Monday and one of the biggest changes...

• Miami billing company charged with Medicare fraud

  The owner of a Miami-based Medicare billing company has been charged with submitting $170 million...

• 8th Circuit Court upholds penalties against owner of Iowa's largest home health agency

  The 8th Circuit Court of Appeals upheld penalties imposed by the Office of Inspector General (OIG...

• Pay-per-view: Tips to help tackle inpatient psych challenges

  Inpatient psychiatric facilities (IPF) have their own reimbursement and compliance challenges...

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

Issue 66, August 22, 2007

• Iasis is target of whistleblower lawsuit

  Iasis Healthcare could lose millions of dollars as a result of a whistleblower lawsuit just...

• New York hospital to pay more than $1 million to settle fraud allegations

  Parkway Hospital, Inc. has agreed to pay more than $1 million to settle charges it defrauded...

• Tip: Gather appropriate documentation

  Tip: Gather appropriate documentation

• OIG: New York, Nevada's false claims acts meet DRA incentive

  The OIG has posted two new state false claims act review letters for New York and Nevada. According...

• Pay-per-view: Spice up your privacy and security training sessions

  When Glennda Gore, executive director of corporate compliance for McAlester (OK) Regional Health...

• Access to phone conversations

  Q: Is it possible for unauthorized individuals to intercept cordless phone conversations?

Issue 65, August 15, 2007

• CMS: Serving millions while tracking billions

  CMS: Serving millions while tracking billions

• Hospital must pay $2 million fine for failing to keep drugs safe

  Hospital must pay $2 million fine for failing to keep drugs safe

• UCI settles transplant program lawsuits for $7.5 million

  UCI settles transplant program lawsuits for $7.5 million

• Tip: Working with the media

  Tip: Working with the media

• Pay-per-view: OIG targets hospitals’ vendor-rebate reporting

  Pay-per-view: OIG targets hospitals’ vendor-rebate reporting

Issue 64, August 10, 2007

• Giving information to relatives

  Can the hospital’s front desk receptionist give information to a caller asking whether a...

Issue 63, August 8, 2007

• Intruder attacks three patients at Cleveland hospital

  Intruder attacks three patients at Cleveland hospital

• Transmittal corrects PET coverage error

  Transmittal corrects PET coverage error

• CMS final rule calls for more quality reporting

  CMS’ final Inpatient Prospective Payment System (IPPS) rule released last week requires...

• Tip: Understanding attorney-client privilege

  Tip: Understanding attorney-client privilege

• Pay-per-view: Beware: Baby Boomers are headed your way

  Pay-per-view: Beware: Baby Boomers are headed your way

Issue 62, August 3, 2007

• New E/M guidances

  New E/M guidances

Issue 61, August 1, 2007

• Healthcare consulting firm faces conflicts of interest claims

  Healthcare consulting firm faces conflicts of interest claims

• Kaiser given record-breaking $3 million fine

  Kaiser given record-breaking $3 million fine

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

• Tip: Check your 2007 reimbursement for specific drugs

  Tip: Check your 2007 reimbursement for specific drugs

• Pay-per-view: Ensure compliance with a more organized medical record

  Pay-per-view: Ensure compliance with a more organized medical record

Issue 60, July 27, 2007

• Reimbursement changes for vaccines

  Reimbursement changes for vaccines

Issue 59, July 25, 2007

• Illinois hospital wins battle in charity care case

  Illinois hospital wins battle in charity care case

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

• Tip: Make the proposed revised CC list more manageable for coders

  Tip: Make the proposed revised CC list more manageable for coders

• Pay-per-view: Ensure HIPAA compliance in the long-term care setting

  Pay-per-view: Ensure HIPAA compliance in the long-term care setting

• Senators introduce bill to revise and update HIPAA

  Senators introduce bill to revise and update HIPAA

Issue 58, July 20, 2007

• Patient privacy rights

  Patient privacy rights

Issue 57, July 18, 2007

• CMS announces changes to the Outpatient Prospective Payment System

  CMS announces changes to the Outpatient Prospective Payment System

• Pay-per-view: Provisions address signatures on requisitions and orders

  Pay-per-view: Provisions address signatures on requisitions and orders

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

• Doc pleads guilty to performing unnecessary surgeries in

  Doc pleads guilty to performing unnecessary surgeries in "rent-a-patient" scheme

• Tip: Prepare for POA implementation by following other states’ examples

  Tip: Prepare for POA implementation by following other states’ examples

Issue 56, July 13, 2007

• Revenue codes

  Revenue codes

Issue 55, July 11, 2007

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

• Pay-per-view: Follow these tips to comply with the Deficit Reduction Act

  Pay-per-view: Follow these tips to comply with the Deficit Reduction Act

• Tip: Beware of common postacute transfer pitfalls

  Tip: Beware of common postacute transfer pitfalls

• Another academic medical facility gets tough on vendor relationships

  Another academic medical facility gets tough on vendor relationships

• Richmond man receives jail term for Medicaid fraud scheme

  Richmond man receives jail term for Medicaid fraud scheme

Issue 54, July 6, 2007

• Reporting modifiers for reduced-service echocardiograms

  Reporting modifiers for reduced-service echocardiograms

Issue 53, July 4, 2007

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

• OIG finds vulnerabilities in CMS’ outpatient outlier program

  OIG finds vulnerabilities in CMS’ outpatient outlier program

• CT hospital settles suit that claimed it over-billed Medicare

  CT hospital settles suit that claimed it over-billed Medicare

• Tip: Ensure that your staff is properly reporting modifier -59

  Tip: Ensure that your staff is properly reporting modifier -59

• Pay-per-view: CMS proposes switch to MS-DRGs in 2008

  Pay-per-view: CMS proposes switch to MS-DRGs in 2008

Issue 52, June 29, 2007

• Present on admission reporting

  Present on admission reporting

Issue 51, June 27, 2007

• Court rules e-mail is private under fourth amendment

  Court rules e-mail is private under fourth amendment

• Tip: Prepare now for the present-on-admission indicator

  Tip: Prepare now for the present-on-admission indicator

• Regulators contemplate closing California hospital

  Regulators contemplate closing California hospital

• Pay-per-view: Help your hospital’s compliance by using specialized IR staff

  Pay-per-view: Help your hospital’s compliance by using specialized IR staff

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

Issue 50, June 22, 2007

• Preterm DRGs

  Preterm DRGs

Issue 49, June 20, 2007

• Pay-per-view: CMS issues HIPAA security guidance for covered entities

  Pay-per-view: CMS issues HIPAA security guidance for covered entities

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

• Tip: Tools for training your staff

  Tip: Tools for training your staff

• Ohio looks to keep EDs open around the clock

  Ohio looks to keep EDs open around the clock

• OIG releases advisory opinion on ASCs and its physician investors

  OIG releases advisory opinion on ASCs and its physician investors

Issue 48, June 15, 2007

• Is this a conflict of interest?

  Is this a conflict of interest?

Issue 47, June 13, 2007

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

• Providers face July 1 deadline to begin delivering discharge message

  Providers face July 1 deadline to begin delivering discharge message

• Ambulance company settles in "swapping" suit

  Ambulance company settles in "swapping" suit

• Pay-per-view: CMS still fine-tuning changes to severity-adjusted DRGs

  Pay-per-view: CMS still fine-tuning changes to severity-adjusted DRGs

• Tip: Transmittal 66

  Tip: Transmittal 66

Issue 46, June 8, 2007

• Payments for overseas contractors who read radiology films

  Payments for overseas contractors who read radiology films

Issue 45, June 6, 2007

• Medical group sues health plan over payments

  Medical group sues health plan over payments

• CMS clarifies discarded drugs and biologicals policy

  CMS clarifies discarded drugs and biologicals policy

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

• Pay-per-view: Audit ambulance rates to prevent inappropriate discounts

  Pay-per-view: Audit ambulance rates to prevent inappropriate discounts

• Tip: Redesign your organization during EHR implementation

  Tip: Redesign your organization during EHR implementation

Issue 44, June 1, 2007

• ED visit level APCs

  Can you explain, and also provide examples of, the types of services that contribute to the cost of...

Issue 42, May 30, 2007

• Report: Fewer children enrolled in Medicaid

  Report: Fewer children enrolled in Medicaid

• Medicare may no longer pay for some medical mistakes

  Medicare may no longer pay for some medical mistakes

• Revised ’Important Message from Medicare’ released

  Revised ’Important Message from Medicare’ released

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

• Tip: CMS releases NPI data dissemination notice

  Tip: CMS releases NPI data dissemination notice

• Having trouble appealing your denied claims?

  Having trouble appealing your denied claims?

• RAC programs

  RAC programs

Issue 41, May 23, 2007

• Man sentenced to 10 years in prison for defrauding Medicare

  Man sentenced to 10 years in prison for defrauding Medicare

• Challenges, high standards await new CMS administrator

  Challenges, high standards await new CMS administrator

• Report: Public facilities should announce changes in auditors

  Report: Public facilities should announce changes in auditors

• Tip: Compliance training for board members

  Tip: Compliance training for board members

• Pay-per-view: Groups call for NPI compliance contingency period

  Pay-per-view: Groups call for NPI compliance contingency period

• Headlines from the Healthcare Audit Resource Center

  Headlines from the Healthcare Audit Resource Center

Issue 40, May 18, 2007

• PHI and the medical staff

  PHI and the medical staff

Issue 39, May 16, 2007

• OIG continues rebate audits

  OIG continues rebate audits

• Clerical error results in confidentiality breach

  Clerical error results in confidentiality breach

• Purdue, execs plead guilty to misbranding OxyContin, agree to $634.5M fine

  Purdue, execs plead guilty to misbranding OxyContin, agree to $634.5M fine

• Pay-per-view: HIPAA privacy violations continue despite efforts to train staff

  Pay-per-view: HIPAA privacy violations continue despite efforts to train staff

• Tip: Compare physician vs. facility documentation when auditing your ED

  Tip: Compare physician vs. facility documentation when auditing your ED

Issue 38, April 12, 2007

• Should a local psychology class be permitted to observe our dementia unit?

  A local college psychology class would like to observe residents in our dementia unit. Is this...

Issue 37, May 9, 2007

• Tip: Establish a process for employees to access their own medical records

  Tip: Establish a process for employees to access their own medical records

• States push new false claims legislation

  States push new false claims legislation

• Did you know? CMS bundling rules

  Did you know? CMS bundling rules

• Web site provides secure emergency access to patient Rx history

  Web site provides secure emergency access to patient Rx history

• Pay-per-view: Review coder compliance with diabetes guidelines

  Pay-per-view: Review coder compliance with diabetes guidelines

Issue 36, May 4, 2007

• ED visit-level APCs

  Q: Can you explain the types of services that contribute to the cost of ED visit level APCs but are...

Issue 35, May 2, 2007

• CMS prepares to release compliance effectiveness pilot results

  CMS prepares to release compliance effectiveness pilot results

• New guidance for emergency department services released

  New guidance for emergency department services released

• Healthcare Audit Resource Center headlines

  Healthcare Audit Resource Center headlines

• Pay-per-view: Review coder compliance with diabetes guidelines

  Pay-per-view: Review coder compliance with diabetes guidelines

• Tip: Include risks in work plan to reduce possibility for error

  Tip: Include risks in work plan to reduce possibility for error

• Survey of the Week

  Survey of the Week

Issue 34, April 27, 2007

• Complying with EMTALA

  Q: Within a dual staffing arrangement in the emergency department (ED), what do we need to be...

Issue 33, April 25, 2007

• CMS, OIG: Medicare fraud still costs country billions each year

  CMS, OIG: Medicare fraud still costs country billions each year

• Study suggests physicians avoid Stark regulations

  Study suggests physicians avoid Stark regulations

• Auditing news

  Auditing news

• Tip: Avoid these ongoing compliance problems in your facility

  Tip: Avoid these ongoing compliance problems in your facility

• Pay-per-view: Hospitals must overcome physician resistance to P4P

  Pay-per-view: Hospitals must overcome physician resistance to P4P

Issue 32, April 20, 2007

• How do we conduct an audit of our urgent/wound care centers?

  Q: We would like to conduct an audit of our urgent care and wound care centers. Where should we...

Issue 31, April 18, 2007

• Tip: Five ways to prevent would-be whislteblowers

  Tip: Five ways to prevent would-be whislteblowers

• Pay-per-view: Health system nixes freebies, implements strict rules

  Pay-per-view: Health system nixes freebies, implements strict rules

• CMS posts new NPI FAQs

  CMS posts new NPI FAQs

• CMS proposes Inpatient Prospective Payment System changes for 2008

  CMS proposes Inpatient Prospective Payment System changes for 2008

• Jeb Bush to join Tenet Healthcare board

  Jeb Bush to join Tenet Healthcare board

Issue 28, April 11, 2007

• Tenet reaches $10 million settlement in fraud case

  Tenet reaches $10 million settlement in fraud case

• CMS to hold NPI contingency roundtable

  CMS to hold NPI contingency roundtable

• Hospital safety mistakes rise 3%

  Hospital safety mistakes rise 3%

• Tip: Ensure joint venture meet OIG guidance

  Tip: Ensure joint venture meet OIG guidance

• Hosting internal social events

  Q: With summer just around the corner, we would like to host some nice breakfasts and dinners for...

Issue 27, April 4, 2007

• Drug, device ties capped at $50K for docs on FDA ad boards

  Drug, device ties capped at $50K for docs on FDA ad boards

• Texas Web site provides price transparency

  Texas Web site provides price transparency

• Parents hide webcam in hospital room

  Parents of a child receiving treatment at Children’s Hospital in Boston surreptitiously...

• Tip: Take a look at your amendment policy when defining your legal health record

  Tip: Take a look at your amendment policy when defining your legal health record

• Pay-per-view: Check for compliance with new record-retention rules

  Pay-per-view: Check for compliance with new record-retention rules

Issue 26, March 30, 2007

• Judging efficiency

  Q: Are there any independent methods to judge a physician’s efficiency?

Issue 25, March 28, 2007

• OIG approves two states' whistleblower laws

  The OIG announced it approved both Hawaii and Virginia's new whistleblower laws last week.

• CMS releases additional guidance on new DRA requirements

  CMS issued a letter to state Medicaid directors Thursday that includes additional guidance on...

• CMS extends Stark regulations deadline

  CMS announced March 23 that will extend the deadline for issuing the next round of Stark...

• Pay-per-view: The RAC project--Its effect on one hospital system

  Last month, SHCC looked at an overview of the recovery audit contract (RAC) project and the...

• Tip: Keep in compliance with modifier -25

  Keep the following tips in mind to properly assign modifier -25 and remain in compliance:

Issue 24, March 23, 2007

• Disclosing breaches

  Q: When should we voluntarily tell patients about privacy breaches?

Issue 23, March 21, 2007

• OIG releases new advisory opinion

  The OIG focused its most recent advisory opinion on whether hospitals could subsidize the cost of...

• NJ hospital will pay $7.5 million in fraud suit

  New Jersey-based Raritan Bay Medical Center will pay the federal government $7.5 million to settle...

• OIG starts HIPAA security audits

  The OIG confirmed that it has begun auditing covered entities for HIPAA compliance.

• Tip: Charitable donations and Stark

  The Stark regulations provide that "[b]ona fide charitable donations" made by a physician or...

• Pay-per-view: Raise the bar on HIPAA compliance with security metrics

  The good news-you have a robust security program in place that is well-supported by management...

Issue 22, March 16, 2007

• Fee Splitting

  Q: We are a primary care physician group practice that refers a lot of surgical procedures to...

Issue 21, March 14, 2007

• Hospital worker sues doctor for reading her personal medical information

  A Massachusetts hospital employee is suing a colleague for accessing her medical chart in order to...

• Attorney pleads guilty to Medicare fraud conspiracy

  South Florida attorney Benjamin Metsch pleaded guilty to charges that he defrauded Medicare between...

• Medicare reviewing pay for off-label use of coated stents

  Medicare is currently reviewing whether to pay for "off-label" use of drug-coated stents, according...

• Pay-per-view: Be wary of radiology, cardiovascular 2007 CPT Manual changes

  If you haven’t already notified your radiology or cardiovascular departments of this...

• Tip: Auditing the registration process

  It’s helpful to conduct an audit to ensure that the registration staff in your organization...

Issue 20, March 9, 2007

• Identifier fields in the UB-04

  Q: The UB-04 requirements are only for nine characters in fl76-fl79 line 1, Secondary Identifier...

Issue 19, March 7, 2007

• Hospital to spend millions as part of federal probe

  The White Plains, NY-based Westchester Medical Center will likely spend millions in order to comply...

• CMS proposes to substantially revise advanced beneficiary notification forms

  CMS published in the February 23 Federal Register a request for comments on its proposal to revise...

• Attorney General proposes pharmaceutical gift disclosure legislation

  Marketing drugs in Connecticut may hinge on a requirement for pharmaceutical companies to disclose...

• Pay-per-view: Profiling data depend on accurate documentation

  You're probably aware that earning the appropriate reimbursement depends heavily on physician...

• Tip: Tackle your facility's security risk

  Protect patients and staff by assessing your organization's security risks and determining the...

Issue 18, March 2, 2007

• Ensuring confidentiality

  Q: How can we preserve confidentiality when it comes to our credentialing information?

Issue 16, February 23, 2007

• Billing CTs

  Q: Our staff performed an abdominal/pelvis computed tomography (CT). The physician reviewed the...

Issue 14, February 16, 2007

• "Wanted" patients

  Q: Can we notify police when our hospital discharges a patient who is a suspect or has a warrant...

Issue 12, February 9, 2007

• Non-employee access to technology

  Q: Our hospital is considering implementing an e-prescribing system. Is it okay to provide this...

Issue 10, February 2, 2007

• Screen saver regulations

  Q: What is the amount of time that employees who work on computers, such as admissions, coding...

Issue 8, January 26, 2007

• Joint ventures

  Q: We are internal medicine and family practice physicians who have individual practices, and who...

Issue 7, January 25, 2007

• Contractor overpays Massachusetts hospitals

  Associated Hospital Service (AHS), a Medicare contractor based in Maine, made inaccurate payments...

• Report: Abbott raised price of one AIDS drug to increase sales of other

  According to a Wall Street Journal report earlier this month, Abbott Laboratories increased the...

Issue 6, January 19, 2007

• Taking PHI out of the office

  Is it a HIPAA violation to take files containing personal health information out of the office to...

Issue 4, January 12, 2007

• Revising bylaws

  Q: Before we begin to revise our medical staff bylaws, are there any legal issues we should...

Issue 3, January 10, 2007

• OIG: States aren’t meeting incentive requirements under the Deficit Reduction Ac

  Despite the promise of financial incentives offered to states with laws that meet the OIG state...

• Seven steps for surviving your next external audit

  Checking and rechecking other people’s work is part of being an auditor. But checking your...

Issue 2, January 5, 2007

• Taking charts out of the office

  Is it a HIPAA violation to take patient charts home or on vacation to complete dictation?