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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 49, December 29, 2010

Georgia hospital pays $13.9 million to resolve Medicaid False Claims Act charges
John D. Archbold Memorial Hospital Inc. paid the United States $13.9 million to settle allegations...
Stolen laptop contains information for more than 3,000 patients
A Dean Clinic physician’s personal laptop computer containing information for a specific...
DME company employees convicted of healthcare fraud
A jury found Ben Bane, 64, Greg Bane, 40, and Tracy Bane, 40, guilty of one count of conspiracy to...
Tip: Manage your password properly
Selecting a strong computer password—one that is easy for you to remember but difficult for...

Issue 48, December 22, 2010

Editor’s note: Happy holidays from HCPro, Inc.
On behalf of HCPro, Inc., and the members of the Case Management Monthly Advisory Board, I would...
Sebelius and Holder seek new tools to prevent and fight fraud
CMS is looking to acquire new state-of-the-art fraud fighting tools to prevent wasteful and...
Medical clinic owner and VP sentenced to prison for $23 million Medicare fraud scheme
Bernice Brown, 56, the owner of a Detroit-area physical therapy clinic, and Daniel Smorynski, 63...
Detroit-area doctor sentenced to 36 months in prison for Medicare fraud scheme
Alan Silber, MD, will serve 36 months in prison for participating in a scheme to defraud the...
Q&A: Taping intake and output sheets outside of patient rooms
Q: Our nursing staff continues to tape patient intake and output sheets outside of patient...
Survey: Vacation
Do you plan on using some vacation during the holiday season?

Issue 47, December 15, 2010

Pharmaceutical manufacturers to pay $421.2 million to settle False Claims Act cases
Abbott Laboratories Inc., B. Braun Medical Inc., Roxane Laboratories Inc., and affiliated entities...
Former hospital CEO convicted of six counts related to Medicaid fraud
Ken B. Beverly, former CEO of Thomasville, GA–based Archbold Memorial Hospital, was convicted...
Kos Pharmaceuticals to pay more than $41 million to resolve kickback and off-label promotion allegations
Kos Pharmaceuticals agreed to pay more than $41 million to resolve claims that it offered illegal...
Tip: Restrict PHI disclosures
The HIPAA Privacy Rule requires that access to and disclosure of protected health information (PHI...

Issue 46, December 8, 2010

DME company manager, driver sentenced for Medicare fraud scheme
Oliver Nkuku and Callistus Edozie were sentenced to 120 months in prison and 41 months in prison...
Speech therapists and three Idaho hospitals pay $2.425 million to settle healthcare fraud lawsuit
Two speech therapists, Matthew Stevens and Michelle Dahlberg, and three hospitals in Eastern Idaho...
St. John's hospitals pay $2.2 million to settle false claims allegations
St. John’s Mercy Health System and St. John’s Health System, Inc., agreed to pay $2.2...
Q&A: What is fraud?
Q: What is fraud?
Survey: Medicaid integrity contractors
Has your facility been audited by a Medicaid integrity contractor?

Issue 45, December 1, 2010

DOJ recovers $2.5 billion in healthcare fraud via False Claims Act
The Department of Justice (DOJ) recovered $2.5 billion in healthcare fraud recoveries for fiscal...
Florida-based Medicare Advantage plan owners and provider agree to $22.6 million settlement
Walter Janke, MD, his wife, Lalita Janke, and Medical Resources LLC agreed to pay $22.6 million to...
Seven CA facilities fined for privacy breaches
Six California hospitals and a nursing home must pay a total of nearly $800,000 for failing to...
Tip: Support your compliance program with a compliance committee
Creating and facilitating a compliance program is no easy task, so the responsibilities should not...

Issue 44, November 24, 2010

HIV clinic operator sentenced to 57 months in prison for Medicare fraud
U.S. District Judge Adalberto Jordan sentenced Jose Garcia, 55, to 57 months in prison for...
Five charged for stealing patient information
Florida authorities issued a criminal complainant against Albert Anthony Andrulonis, 26; Raushanah...
Ameritox, Ltd. pays $16.3 million to resolve kickback claims
Ameritox, Ltd., a laboratory based in Midland, TX, agreed to pay the U.S. government $16.3 million...
Q&A: Releasing patient records to insurance companies
Q: An insurance company is requesting copies of medical records to review our CPT ®...
Survey: Open Door Forum
Do you dial in and listen to CMS’ Open Door Forum conference calls?

Issue 43, November 17, 2010

St. Joseph Medical Center to pay $22M to settle federal charges
St. Joseph Medical Center agreed to pay $22 million to settle allegations that the hospital paid...
Twelve CA hospitals fined for failing to ensure health and safety of patients
The California Department of Public Health announced that 12 California hospitals have been...
Health Net pays $375K to settle data breach
Health Net of Connecticut agreed to pay $375,000 to Connecticut Insurance Department for failures...
Tip: Avoid Medicare exclusion
The Supplemental Compliance Program Guidance for Hospitals states that the OIG will exclude from...

Issue 42, November 10, 2010

CA hospital settles Medicare fraud case for $5.1M
Simi Valley (CA) Hospital paid the United States $5.1 million to resolve allegations that its...
OIG report says suspected fraud causes most CMS payment suspensions
The majority of providers that CMS suspended in 2007 and 2008 exhibited characteristics that...
Hospitals still do not have resources to prevent data breaches
Nearly three out of four (71%) of hospitals in the 100- to 600-bed range say they have inadequate...
Q&A: Can RACs review a claim more than once?
Q: Can a recovery audit contractor (RAC) review a claim more than once?
Survey: Compliance training update
When did you last update your organization’s compliance training program?

Issue 41, November 3, 2010

Christ Hospital enters five-year CIA to resolve anti-kickback case
The Christ Hospital (TCH) of Cincinnati, OH, and the Office of Inspector General (OIG) entered into...
Patient recruiter known as 'Red, White, & Blue Man' sentenced to 21 months in prison
James Roland Fuquay, 49, will serve 21 months in prison and pay $557,000 for his participation in a...
Patient recruiter pleads guilty to role in $5.2 million home healthcare scheme
A Houston-based patient recruiter pleaded guilty in connection with a $5.2 million Medicare fraud...
Tip: Consider the compliance department's role in your facility's RAC team
If your facility has a robust compliance department, the recovery audit contractor (RAC) team may...

Issue 40, October 27, 2010

NY patient pleads guilty to illegally soliciting Medicare beneficiary number
A Brooklyn, NY citizen pleaded guilty in U.S. District Court to receiving cash kickbacks to...
Pharmaceutical companies top list of FY 2010 fraud settlements
Pharmaceutical companies made up eight of the top ten settlements related to fraud in fiscal...
Houston patient recruiter pleads guilty to role in $5.2M Medicare fraud scheme
A Houston-based patient recruiter pleaded guilty to her role in a $5.2 million Medicare fraud...
Q&A: Using mobile phones to communicate PHI
Q: Can mobile phones and smartphones be used to communicate patient information?
Survey: Compliance training update
Survey: Compliance training update

Issue 39, October 20, 2010

Seventy-three members of crime syndicate indicted for $163M healthcare fraud scheme
Five judicial courts across the United States indicted 73 members of a major Armenian-American...
Seven more Houston citizens indicted in $5M Medicare fraud scheme
A U.S. District Court in Houston charged six patient recruiters and a nurse in an ongoing Medicare...
Detroit home health care owner pleads guilty to $6.97M Medicare fraud scheme
U.S. District Court Judge Denise Page Hood in Detroit sentenced the owner of a home health agency...
Tip: Discounting uninsured or underinsured patients
Tip: Discounting uninsured or underinsured patients

Issue 38, October 13, 2010

Los Angeles DME owner sentenced to prison for submitting false claims to Medicare
A Los Angeles U.S. District Court sentenced the owner and operator of a durable medical equipment...
Texas home health nurse falsified Medicare beneficiary records
A Texas nurse pleaded guilty to falsifying records in a Medicare home healthcare fraud scheme...
Idaho counselor illegally bills Medicaid for concert tickets
An Idaho psychosocial rehabilitation counselor will spend 30 days in jail after fraudulently...
Q&A: Cameras in patient rooms
Q: The nursing department in my facility wants to install cameras in a few of the patient rooms. It...
Survey: Join venture arrangements
Survey: Join venture arrangements

Issue 37, October 6, 2010

OIG releases 2011 Work Plan: EMTALA out, radiation therapy and medical devices in
OIG releases 2011 Work Plan: EMTALA out, radiation therapy and medical devices in
Novartis Pharmaceuticals pays $422.5M to resolve False Claims and kickback allegations
New Jersey-based Novartis Pharmaceuticals Corporation will pay $422.5 million to resolve criminal...
New Orleans DME company physician and owner plead guilty to Medicare fraud
A New Orleans-area physician and the owner and operator of a durable medical equipment company...
Tip: Submission of claims for laboratory services
Tip: Submission of claims for laboratory services

Issue 36, September 15, 2010

Allergan will pay $600M for promoting off-label uses of Botox®
Pharmaceutical company Allergan Inc. will pay $600 million in fines after pleading guilty to...
House passes Medicare anti-fraud bill
The U.S. House of Representatives passed a bill that expands the authority of the HHS Office of...
New Jersey physician and co-conspirators charged for $1.8M Medicaid fraud
An FBI-led investigation led to a criminal complaint that alleges a New Jersey doctor and four...
Four sentenced in Miami Medicare fraud scheme
U.S. District Court Judge Alan S. Gold sentenced three Miami-area residents to prison for their...
Miami HIV clinic owner pleads guilty in $23M Medicare fraud scheme
A Miami-area HIV infusion clinic owner pleaded guilty in U.S. District Court to her role in a $23...
Three defendants plead guilty to fraud scheme involving hurricane damaged wheelchairs
On September 23, three individuals pleaded guilty in connection with a Medicare fraud scheme...
Q&A: Notice of Privacy Practices
Q: Patients receive a Notice of Privacy Practices (NPP) at their initial visit that includes...
Q&A: Protect patient information at nursing kiosks
Q: We are planning to install wall-mounted kiosks in our skilled nursing facility to...
Survey: Physician champions
Survey: Physician champions
Survey: RAC coordinator
Does your facility have a dedicated RAC coordinator?

Issue 35, September 8, 2010

Three plead guilty to $6.5M Medicare fraud scheme
Three people pleaded guilty in U.S. District Court in Georgia to their roles in a $6.5 million...
HCCA New England Regional Conference Roundup: Part 1
On Monday, September 13, healthcare compliance experts met at the Health Care Compliance...
Volunteers needed!
Volunteers needed!
Miami clinic owner, physician, and nurses plead guilty to home health fraud scheme
A South Florida clinic owner, physician, and four nurses pleaded guilty in a Miami U.S. District...
CA hospital to pay $2.2M for inflating charges to Medicare
A California hospital will pay the United States $2.2 million, plus interest, for allegedly...
DC DME owner sentenced for Medicaid fraud
A Washington, DC, U.S. District court judge sentenced a former durable medical equipment (DME...
Home healthcare patient recruiter convicted for distributing and receiving kickbacks
A federal jury in Miami convicted a patient recruiter of one count of conspiracy to commit...
Tip: Emergency access procedures
Tip: Emergency access procedures
Tip: Quality of care
Tip: Quality of care

Issue 34, September 1, 2010

CA hospital to pay US $5.25 million for "turbocharging"
A Santa Monica, CA hospital will pay the United States $5.25 million to resolve allegations that...
Detroit husband and wife convicted in $2.3 million Medicare fraud scheme
A Detroit federal jury convicted the owner of a purported injection and infusion clinic and his...
Attorney General Holder and HHS Secretary Sebelius host healthcare summit in Los Angeles
On Thursday, August 26 Attorney General Eric Holder and U.S. Department of Health and Human...
Q&A: Criminal and civil penalties
Q: How did HITECH change HIPAA’s existing criminal and civil penalties?
Survey: Tax-exempt status
Survey: Tax-exempt status

Issue 33, August 25, 2010

Coming soon in Briefings on Coding Compliance Strategies
Coming soon in Briefings on Coding Compliance Strategies
Detroit-area physician sentenced to 14 years in prison for Medicare fraud scheme
A U.S. District Judge sentenced Jose Castro-Ramirez, MD, to 14 years in prison and to pay $9.4...
Two Miami DME company presidents separately indicted for Medicare fraud
Two Miami-Dade County durable medical equipment (DME) company presidents were separately indicted...
Florida tops $400 million in Medicaid fraud recoveries
Florida’s Attorney General, Bill McCollum announced that the state’s Medicaid Fraud...
Tip: Cost reports
The Office of Inspector General’s (OIG) Compliance Program Guidance for Hospitals advises...

Issue 32, August 18, 2010

Detroit clinic owner sentenced for Medicare fraud scheme
The owner of a Detroit-area medical clinic will serve 56 months in prison and pay $2 million in...
Louisiana's Medicaid Fraud Control Unit returns $45M to state and federal programs
Louisiana Attorney General Buddy Caldwell announced that the state’s Medicaid Fraud Control...
New York physician and eight others charged for illegal distribution of oxycodone pills
Authorities charged nine New Yorkers with participation in a Manhattan-based drug ring that...
Q&A: Notice of Privacy Practice for patients
Q: Must patients receive a paper copy of our Notice of Privacy Practices (NPP) during every...
Survey: Employee handbooks
Survey: Employee handbooks

Issue 31, August 11, 2010

Florida citizens plead guilty to separate Medicare schemes
Two Florida citizens pleaded guilty in U.S. District Court for their participation in separate...
Physician assistant's wife pleads guilty to defrauding Medicare and Texas Medicaid
The wife of a Texas physician assistant pleaded guilty in U.S. District Court for conspiracy to...
Medicare fraud fugitive pleads guilty to $10.9M scheme
A two-year fugitive pleaded guilty in U.S. District Court in Miami for his participation in...
Tip: Notice of privacy practice
Tip: Notice of privacy practice

Issue 30, August 4, 2010

CMS releases cost-saving projections through the Affordable Care Act
The Centers for Medicare and Medicaid Services (CMS) projects that the Affordable Care Act will...
Ex-husband and wife sentenced for $5.8 million infusion fraud scheme
Former husband and wife, David and Maria Marrero, will serve time in prison for submitting...
Ex-husband and wife sentenced for $5.8 million infusion fraud scheme
Former husband and wife, David and Maria Marrero, will serve time in prison for submitting...
Miami brothers plead guilty to $13.7 million HIV fraud scheme
Two brothers pleaded guilty in Miami U.S. District Court for their roles in a $13.7 million HIV...
Q&A: Releasing records to attorneys
Q: When an attorney requests we release all records, must we comply and send all of the...
Survey: Employee compliance training
At your facility, which professionals require the most compliance training?

Issue 29, July 28, 2010

Coming soon in Briefings on Coding Compliance Strategies
Coming soon in Briefings on Coding Compliance Strategies
Husband and wife plead guilty to HIV infusion fraud scheme
A Miami couple pleaded guilty in U.S District Court for a $13.7 million HIV infusion Medicare fraud...
Houston patient recruiter sentenced for DME fraud scheme
U.S. District Judge Ewing Werlein Jr. sentenced a Houston-area patient recruiter to 21 months in...
Four CA citizens indicted on 17 counts of Medicare fraud
U.S. District Judge Roger T. Benitez indicted four Californians on 17 counts of a Medicare billing...
Tip: Automatic logoff
Tip: Automatic logoff

Issue 28, July 21, 2010

Medicare Fraud Strike Force arrests 94 in largest Medicare fraud bust
The Medicare Fraud Strike Force charged 94 people for their alleged participation in various...
Detroit physical therapist and medical assistant plead guilty to Medicare fraud
Two Detroit citizens pleaded guilty in U.S. District Court for their roles in a Medicare home...
Regional healthcare fraud prevention summit series kicks off in Miami
Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen...
Q&A: Patient information on the internet
Q: One of my colleagues made a website accessible to invitees only. He plans to upload a...

Issue 27, July 14, 2010

IL physician-owned group enters into $7.3M settlement with OIG
The Office of Inspector General (OIG) entered into a $7.3 million settlement with a physician-owned...
Whistle blown on six of Chicago's Rush University Medical clinic physicians
Six physicians from Chicago’s Rush University Medical Clinic entered into a $1.5 million...
CA cardiac company to pay US $3.6M for fraudulent billing
National Cardio Labs LLC will pay $3.6 million to resolve allegations of fraudulently billing...
Tip: Auditing vs. monitoring
Tip: Auditing vs. monitoring

Issue 26, July 7, 2010

Volunteers needed!
Volunteers needed!
CA radiology clinic pays $647,000 to resolve False Claims violations
The Oaks Diagnostics, Inc., owners of Advanced Radiology of Beverly Hills, paid the federal...
Virginian EMT convicted for role in $1.4 million healthcare fraud
A Virginia U.S. District Court jury convicted an EMT working for Angel Care Ambulance Company for...
TN company owner convicted in psychiatric Medicare and Medicaid fraud scheme
A federal jury convicted Lorne Allan Semrau of three counts of submitting false and fraudulent...
Q&A: Uninsured patients
Q: Can a hospital waive collection of charges to an indigent, uninsured individual?
Survey: Joint ventures
Does your facility have any joint venture arrangements?

Issue 25, June 30, 2010

Detroit therapy clinic owner and VP convicted in $23M Medicare fraud scheme
A Detroit federal jury convicted the owner and the vice president of a physical therapy clinic for...
Coming soon in Briefings on Coding Compliance Strategies
This month in Briefings on Coding Compliance Strategies
Seven Houston home healthcare employees charged in alleged Medicare fraud scheme
Seven Houston-area citizens were indicted for their alleged participation in a $5 million Medicare...
Houston DME workers charged in adult urinary incontinence fraud scheme
A Houston federal grand jury charged Bassey Essien and Ebong Akpan for multiple counts of...
Tip: Medical necessity
Tip: Medical necessity
Tip: Quality of care
Tip: Quality of care

Issue 24, June 23, 2010

Health Alliance of Greater Cincinnati, two hospitals, and physician group to pay US $2.6 million
The Health Alliance of Greater Cincinnati, two of its member hospitals, and University Internal...
Indianapolis physician indicted on improper injection and drug prescription charges
An Indianapolis grand jury indicted former physician Kamal Tiwari for defrauding Medicare, Indiana...
Houston physician and DME company owner plead guilty to $2.8M Medicare fraud scheme
A Houston-area physician and a durable medical equipment (DME) owner pleaded guilty in U.S...
Q&A: Are business associates covered entities?
Q: Does the HITECH Act classify all business associates as covered entities?
Survey: Summer daze
Survey: Summer daze

Issue 23, June 16, 2010

This month in Briefings on Coding Compliance Strategies
Coming soon in Briefings on Coding Compliance Strategies
OIG reports $3 billion in fraud and abuse recoveries in Semi-annual Report to Congress
On June 14, the Office of Inspector General (OIG) and Department of Health and Human Services...
Cochlear implant company to pay US for alleged False Claims violations
A Colorado-based cochlear implant manufacturer will pay $880,000 to resolve anti-kickback statute...
Attorney General and HHS secretary urges education and fraud and abuse avoidance for Medicare beneficiaries
On June 8, Attorney General Eric Holder and Secretary of Health and Human Services (HHS) Kathleen...

Issue 22, June 9, 2010

2010 Compliance Officer Salary Survey Results: Part two
This is the second article in a two-part series detailing the results of the Compliance Monitor...
Heart device manufacturer and two hospitals to pay nearly $4M in False Claims suit
A Minnesota-based heart device manufacturer, St. Jude Medical Inc., and two hospitals will pay...
Houston physician and two citizens convicted in Medicare fraud scheme
A federal jury in the Southern District of Texas convicted Howard Grant, MD, and two Houston...
Detroit physical therapist and patient recruiter sentenced in separate Medicare fraud cases
U.S. District Court Judge Denise Page Hood in the Eastern District of Michigan sentenced a physical...
Q&A: Census takers want PHI
Q: I am the records manager at a behavioral health facility, and I have received calls from census...
Survey: Vendor compliance
Survey: Vendor compliance

Issue 21, June 2, 2010

2010 Compliance Officer Salary Survey Results: Part one
This is the first article in a two-part series detailing the results of the Compliance Monitor 2010...
Seventeenth defendant convicted in $15 million Medicare fraud scheme
In California, a $15 million Medicare fraud scheme case has finally come to an end after the 17th...
Intercare Health Systems to pay $10 million for False Claims Act violation
Intercare Health Systems Inc. (Intercare), former owner of City of Angels Medical Center (City of...
Illinois pediatrician pleads guilty to healthcare fraud, surrenders medical license
An Illinois pediatrician pleaded guilty in U.S. District Court to a $64,000 healthcare fraud...
Tip: Elements of a performance plan
Tip: Elements of a performance plan

Issue 20, May 26, 2010

Next week in CM: Salary survey results part one
Next week in CM: Salary survey results part one ffffffffff...
Hospital group and former member to pay $108 million for Medicare and Medicaid fraud
The Health Alliance of Greater Cincinnati and one of its former member hospitals, The Christ...
CA patient recruiter sentenced in DME fraud scheme
Maria Nela Moreno will serve 366 days in prison and pay $110,000 in restitution for her role in a...
Houston DME owner pleads guilty to Medicare fraud
A Houston area durable medical equipment (DME) company owner pleaded guilty in U.S. District Court...
Q&A: HITECH and third-party insurance policies
Q: Does the Health Information Technology for Economic and Clinical Health (HITECH) Act supersede...
Survey: Stark Law changes
Survey: Stark Law changes

Issue 19, May 19, 2010

Final week to take 2010 Compliance Officer Salary Survey
Compliance Monitor is conducting its annual Compliance Officer salary survey, and we would...
Nine hospitals settle allegations of falsely billing kyphoplasty procedures
Nine hospitals in seven states will pay the United States more than $9.4 million combined to...
Miami injection and infusion clinic owner arrested on Medicare fraud allegations
Miami HIV infusion clinic owner, Flor Crisologo, was indicted for her alleged role in a $23 million...
Sixth person pleads guilty to $14.5 million Detroit home healthcare fraud scheme
The sixth individual pleaded guilty to his involvement in a $14.5 million home healthcare Medicare...
Tip: Policy and procedure inclusions
Tip: Policy and procedure inclusions

Issue 18, May 12, 2010

Injection and Infusion clinic consultant convicted for role in $5.8 million Medicare fraud scheme
U.S. District Court Judge Donald L. Graham convicted David Marrero, of Miami, of defrauding...
USCC proposes amending Federal Sentencing Guidelines
USCC proposes amending Federal Sentencing Guidelines
Los Angeles DME owner sentenced to prison for Medicare fraud scheme
A Los Angeles durable medical equipment (DME) company owner will serve 55 months in prison and pay...
Houston residents plead guilty to healthcare fraud, supplying kickbacks
Two patient recruiters and an employee at a Houston durable medical equipment (DME) company pleaded...
Q&A: Leaving voice mail messages
Q: May ambulatory surgery center (ASC) staff members leave preoperative messages on patients&rsquo...
Survey: Clinical trials
Survey: Is your facility involved in clinical trials?

Issue 17, May 5, 2010

Build an internal investigations team
Build an internal investigations team
AstraZeneca to pay $520 million for allegedly marketing off-label drug uses
Delaware based pharmaceutical giant AstraZeneca LP and AstraZeneca Pharmaceuticals LP will pay $520...
Schwarz Pharma pays $22 million to settle false claims allegations
Schwarz Pharma Inc. agreed to pay the United States $22 million to resolve allegations that it did...
DME owner, operator, and patient recruiter plead guilty to Medicare fraud
Three Houston-area residents pleaded guilty in U.S. District Court for their roles in a Medicare...
Tip: Designate a compliance committee
Tip: Designate a compliance committee

Issue 16, April 28, 2010

Coming soon in Briefings on Coding Compliance Strategies
Coming soon in Briefings on Coding Compliance Strategies
Father, son duo face healthcare fraud charges
Ernesto Angel Montaner, his son Erensto Angel Montaner, and co-conspirator Jose Antonio Varona...
Injection and infusions physician and patient recruiter sentenced for Medicare fraud
A Detroit-area physician and patient recruiter will serve prison time and pay millions in...
Miami trio face fines, jail time for roles in HIV/Aids infusion clinic fraud scheme
Three Miami residents pleaded guilty to a $5.8 million Medicare fraud scheme stemming from their...
Q&A: HITECH insurance policies
Q: Does HITECH supersede our contracts with third-party health insurance policies if the patient...
Survey: Summer fun
Survey: Summer fun

Issue 15, April 21, 2010

Obama asks HHS to expand hospital visitation rights to gay and lesbian couples and others
On April 16, President Obama issued a memo to the Health and Human Services (HHS) agency...
New York's Medicaid Fraud Control Unit prosecutes state record of 148 criminals in 2009
New York Attorney General Andrew M. Cuomo announced that his Medicaid Fraud Control Unit (MFCU...
Injections and infusions clinic recruiter sentenced to prison for Medicare fraud
Detroit resident, Wayne Smith, will serve 27 months in prison and jointly pay $4.9 million in...
Two Houston residents file false claims for hurricane damaged DME
A federal jury convicted two Houston residents of Medicare fraud conspiracy involving durable...
Tip: Relevant audit findings
Tip: Relevant audit findings

Issue 14, April 14, 2010

Volunteers needed!
Volunteers needed!
CM Clarification: Satilla Regional Medical Center responds to DOJ allegations
Satilla Regional Medical Center responds to DOJ allegations
Detroit pain management clinic owner to pay more than $9M in Medicare fraud scheme
U.S. District Judge, Sean F. Cox sentenced Suresh Chand to 81 months in prison and to jointly pay...
Los Angeles DME owner pleads guilty to Medicare fraud scheme
A Los Angeles durable medical equipment (DME) owner and operator pleaded guilty to submitting...
Injection and infusion clinic owners will pay fines, serve jail time for defrauding Medicare
Two Miami residents who ran an injections and infusions clinic in Canton, MI will each serve three...
Q&A: Releasing patient information to the media
Q: Can hospitals notify the media about a patient’s condition without patient authorization?
Survey: Compliance teammates
Survey: Compliance teammates

Issue 13, March 31, 2010

California DME facility owner sentenced to nine years in prison for Medicare fraud
California U.S. District Judge John F. Walter sentenced Los Angeles durable medical equipment (DME...
U.S. intervenes in Georgia false claims suit
The Department of Justice (DOJ) is interceding in a lawsuit against a Georgia medical center and...
NC governor announces new Medicare waste and fraud prevention plan
North Carolina governor Beverly Perdue announced a plan last week that will potentially save tens...
Detroit physician and patient recruiter convicted of healthcare fraud
Alan Silber, MD, and patient recruiter Hassan Reeves face prison sentences and fines after a...
Florida woman sentenced in Michigan for $10.7 million fraud scheme
A Florida woman who set up false medical clinics in the Detroit area was sentenced to eight years...
Device manufacturer pays FDA $296M for not reporting safety issues
Medical device manufacturer Guidant LLC pleaded guilty in a US District Court in St. Paul, MN, for...
Join the Physician's Round Table
Join the Physician’s Round Table
Tip: Adhere to U.S. sentencing guidelines
Tip: Adhere to U.S. sentencing guidelines
Q&A: Visiting patients after viewing PHI
Q: An emergency department (ED) nurse at a hospital and trauma center saw the name of an...
Survey: Healthcare reform act
Survey: Healthcare reform act

Issue 12, March 24, 2010

NJ hospital to pay United States $6.35 million for alleged Medicare fraud
A New Jersey hospital will pay the United States $6.35 million for allegedly inflating charges to...
MI medical center owner defrauds Medicaid, goes on shopping spree
Deborah D’Anna, owner of Palmer Park Medical Center (Palmer) in Michigan, faces fines and...
DME owner pleads guilty to one count of Medicaid fraud
A Maryland man pleaded guilty, in the Circuit Court of Baltimore City, to fraudulently billing the...
Tip: Avoid the consequences of substandard care
Tip: Avoid the consequences of substandard care
CMS' revised Medicare Fraud & Abuse fact sheet
CMS’ revised Medicare Fraud & Abuse fact sheet

Issue 11, March 17, 2010

Detroit physician guilty of Medicare fraud
After a three week trial, a Detroit federal jury found Jose Castro-Ramirez, MD, guilty for his role...
Obama addresses new Medicare and Medicaid anti-fraud plan
On March 11, President Obama ordered a crackdown on Medicare and Medicaid waste and fraud while...
Three IL rehab employees indicted on healthcare fraud charges
Illinois federal law enforcement officials indicted a chiropractor, physician, and billing employee...
Q&A: Waiving collections of uninsured patients
Q: Can my hospital waive collection of charges to an indigent, uninsured individual?
Survey: Economic effects on compliance jobs
Survey: Economic effects on compliance jobs

Issue 10, March 10, 2010

LA clinic owner guilty of defrauding Medicare
A US District Court jury in Los Angles convicted the owner of a sham medical clinic of 22 counts of...
Florida home health agency owner faces fines, jail time for defrauding Medicaid
A Florida man faces up to five years in prison and a $5,000 fine if found guilty of defrauding the...
Boston man embezzles more than $1M from medical center
Richard P. Webb of Boston pleaded guilty in U.S. District Court to embezzling more than $1 million...
Tip: Improving patient care through compliance
Although compliance officers don’t directly treat patients, they still affect patients&rsquo...

Issue 9, March 3, 2010

NY hospital pays $2.9M to resolve false claims allegations
Brookhaven Memorial Hospital Medical Center in Long Island, NY, will pay $2.92 million to resolve...
NY hospital pays $2.9M to resolve false claims allegations
Brookhaven Memorial Hospital Medical Center in Long Island, NY, will pay $2.92 million to resolve...
Three DME facility employees plead guilty to Medicare fraud
Three Houston residents pleaded guilty in U.S District Court for their roles in defrauding Medicare...
Three DME facility employees plead guilty to Medicare fraud
Three Houston residents pleaded guilty in U.S District Court for their roles in defrauding Medicare...
LA federal jury convicts woman in power wheelchair fraud scheme
A Los Angeles federal jury convicted Maria Nela Moreno of defrauding Medicare by recruiting...
Q&A: Breach of a minor's record
Q: Whom should we notify if a minor’s record is breached? For example, a grandparent who...
Survey: Internal investigations effectiveness
Due to technical problems, we were unable to record the responses to last week’s question...

Issue 8, February 24, 2010

MA hospital pays $2.8 million to settle false claims
Mercy Hospital Inc. (d/b/a/ Mercy Medical Center) of Springfield MA will pay the United States...
Drug company pays $3.5 million to resolve allegations of improperly administering pills
To resolve allegations of the False Claims Act, Eon Labs Inc. will pay the United States $3.5...
Detroit home healthcare owner faces fine, prison time for fraud scheme
Detroit-area resident Muhammad Shahab pleaded guilty in a U.S. district court house to one count of...
Tip: Following up an investigative violation
An internal investigation will help you and your organization identify potential liabilities or...
Medicare Membership Program
Get answers to your questions and Medicare compliance guidance from the experts all year long. Join...

Issue 7, February 17, 2010

Three TX residents charged in DME Medicare, Medicaid fraud scheme
A federal jury convicted two owners of a Texas DME company and one orthotist for their roles in a...
Whistleblower acquitted of felony charges
A Texas jury acquitted a nurse whistleblower of felony charges alleging she misused official...
Seattle men charged in identical Medicare fraud schemes
A grand jury indicted two unrelated Seattle men of running identical false claims schemes resulting...
Q&A: Notifying patients of breach
Q: Please explain how to respond when patients request the identity of staff members who accessed...
Survey: Internal investigations unit
Does your facility have an internal investigations...

Issue 6, February 10, 2010

Medical manufacturer Atricure to pay U.S. $3.76 million
Atricure Inc. will pay the United States $3.76 million to resolve allegations that the medical...
Detroit infusion clinic manager submits $2.3 million in fraudulent Medicare claims
Infusion clinic owner, Dulce Briceno, will face 63 months in prison for her roll in a $2.3 million...
OH hospital faces federal charges on healthcare fraud
Ohio’s Christ Hospital and the federal government reached a settlement agreement on a...
Tip: Conducting "walk-around" interviews
A great way to obtain information about the risks facing your organization is to conduct a...

Issue 5, February 3, 2010

CA couple indicted for DME fraud scheme
A Los Angeles married couple will serve time in prison for their participation in a $1 million...
Patient recruiter faces time, fines for Medicare fraud
A retired nurse faces a maximum prison sentence of 10 years and a fine of $250,000 for her role in...
Leaders in government and healthcare join forces at National Summit on Healthcare Fraud
The Department of Justice issued a press release detailing the June 28 National Summit on...
Q&A: Covered entities and BA contracts
Q: Are covered entities and business associates (BAs) required to revise their BA contracts to...
Survey: Healthcare fraud budget plan
Do you feel President Obama’s FY 2011 budget plan effectively addresses healthcare fraud...
Audio conference survey follow-up: Thank you!
Thank you to all who participated in last week’s Compliance Monitor survey on audio...

Issue 4, January 27, 2010

Survey: What compliance issue do you want to hear more of?
Compliance Monitor wants to hear from you, our readers, to see which compliance topic you want to...
L.A. medical center owners falsely treat homeless, pay $10M
Two former owners of the Los Angeles City of Angels Medical Center (City of Angels) paid $10...
Texas nurses indicted for fraud, embezzlement
Texas nurses Brandon Allen Ray and Stewart Powers face sentencing for charges of healthcare fraud...
Detroit physical therapist pleads guilty to fraud
Detroit physical therapist Jessica Vigil pleaded guilty in U.S. District Court for her role in a...
Tip: Enforcing disciplinary standards
A difficult, but major part of your compliance program is creating and implementing disciplinary...

Issue 3, January 20, 2010

Thirteen Detroit residents indicted on Medicare fraud charges
Federal agents from the Department of Health and Human Services (HHS), Office of Inspector General...
Johnson & Johnson faces U.S. suit for paying kickbacks to nursing home pharmacy
The United States filed a civil False Claims Act complaint against Johnson and Johnson (J&J...
Anesthesiologist falsifies medical research, faces fines and jail time
A federal judge charged Scott Reuben, chief of acute pain at Bay State Hospital in Springfield, MA...
Q&A: Faxing patients' medical records
Q: Is it permissible to fax patient medical records between physicians without patient...
Survey: Non-compliant peers
Have you ever caught a coworker breaking compliance regulations? Yes, and I reported...

Issue 2, January 13, 2010

MO nursing homes and owner pay $1.6 million for false claims
Five Missouri nursing homes operated by Texas corporation, Cathedral Rock, and its majority owner...
NYC and Justice Department intervene in neglectful psychiatric center suit
New York City’s Attorney’s office and the Justice Department’s Civil Rights...
St. Louis doctor faces ten year prison sentence and $250,000 fine
A St. Louis ear, nose, and throat specialist faces ten years in prison and a $250,000 fine if...
HCCA releases 2009 healthcare fraud survey results
The Health Care Compliance Association (HCCA) released results of their 2009 survey of compliance...
Tip: Effective compliance program elements
The Office of Inspector General (OIG) issues an annual, autumnal Work Plan detailing various...

Issue 1, January 6, 2010

OIG: Medicare paid $112 million for improper wheelchairs claims
A recent OIG review of claims submitted to Medicare for wheelchairs revealed that three out of five...
MI home health services provider will pay $9.5 million to settle false claims suit
Visiting Physicians Association, a Michigan-based home health services provider, agreed to pay $9.5...
MN hospital to pay $846,000 for improper admissions
Wheaton Community Hospital and Stanley Gallagher, MD, (collectively WCH) agreed to pay $846,000 to...
Q&A: Notice of Privacy Practices
Q: If a facility updates its Notice of Privacy Practices (NPP), is it necessary to redistribute the...
Q&A: Notice of Privacy Practices
Q: If a facility updates its Notice of Privacy Practices (NPP), does it have to redistribute the...
Survey: New Year's resolution
How long until you drop your New Year’s resolution?