Free e-Newsletters

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 52, December 28, 2011

• Four sentenced in home health care fraud scheme

  U.S. District Judge Joan A. Lenard of the Southern District of Florida sentenced two patient...

• One in three dialysis centers subject to Medicare penalties

  Nearly one third of 4,939 U.S. kidney dialysis centers will receive Medicare reimbursement...

• HIPAA Q&A: Police department mailings

  Q. We are a medical provider for a local police department and mail out various postcards and...

• Tip: Focus on critical relationships

  While it's certainly important to have a good relationship with your board of directors, remember...

Issue 51, December 21, 2011

• Eight charged in Philadelphia pill mill case

  A Philadelphia physician and members of his former staff illegally prescribed painkillers and...

• CMS rule would make drug, device makers' payments to doctor's transparent

  The Centers for Medicare & Medicaid Services released on December 14 its 121-page proposed rule...

• Q&A: Rights to employee's record

  Q: If an employee is hospitalized in the facility in which he or she works, does the manager of the...

• Survey: HEAT Provider Compliance Training Videos

  Survey: Have you found the HEAT Provider Compliance Training Videos available on the OIG website...

Issue 50, December 14, 2011

• Miami-area mental health company owners sentenced to prison for Medicare fraud

  A U.S. District Court judge sentenced the third member of a $205 million Medicare fraud scheme to...

• OIG releases compliance videos for healthcare providers

  The OIG released the first of 11 planned video and audio presentations designed to educate...

• Fourteen CA hospitals fined for immediate jeopardy violations

  Fourteen California hospitals have been ordered to pay fines totaling $850,000 for medical errors...

• Tip: Clarify conflicting documentation

  MLN Matters article SE1121 emphasizes that coders must consider all documentation from licensed...

Issue 49, December 7, 2011

• OIG semiannual report to Congress summarizes accomplishments, shortcomings

  Highlights of the OIG’s semiannual report to Congress for the six-month period ending in...

• HHS revises meaningful use deadline

  HHS recently announced an extension of the EHR meaningful use deadline that will allow entities to...

• Most providers not fully prepared for HIPAA audit

  Most healthcare organizations charged with HIPAA compliance are not fully prepared for a privacy...

• Q&A: Faxing PHI to a hybrid facility

  Q: Is faxing PHI to a long-term care facility that also operates an independent living facility and...

• Survey: HIPAA security audits

  Is your facility prepared for a HIPAA security audit? Yes, we are prepared. We are...

Issue 48, November 30, 2011

• HealthDataInsights posts new issues for medical necessity claims

  HealthDataInsights (HDI) added five new issues for medical necessity claims to its CMS-approved...

• HIPAA Q&A: Are annual HIPAA updates necessary?

  Q: Our HIPAA updates generally occur when a change occurs in a patient’s family (e.g...

• Medical database UpToDate linked to better hospital care

  Hospitals that subscribe to UpToDate, a popular clinical support system, show modest improvement in...

• Tip: Prepare proactively for OCR HIPAA audits

  Briefings on HIPAA has obtained a copy of the $9.2 million contract with KPMG, LLP, the company OCR...

Issue 47, November 23, 2011

• Data breach affects 4.9 million military patients

  The Department of Defense has offered one year of free credit monitoring to 4.9 million military...

• Sentence for 20,000 fraudulent office visits is 43 months, $1.8 million in restitution

  A U.S. magistrate in Newark has sentenced Yousuf Masood of Warren, NJ, to 43 months in prison for...

• CMS publishes Medicare compliance newsletters for second consecutive year

  CMS has published the second volume of its Medicare Quarterly Compliance Newsletters, one year...

• Compliance Q&A: Laboratory Reports

  Compliance Q&A: After meeting with physicians to review laboratory reports, patients often...

• Survey: HIPAA 5010 delay

  Will CMS’s delay of HIPAA 5010 enforcement to March 31, 2012 affect your organization’s...

Issue 46, November 16, 2011

• OCR privacy, security audits to include BAs

  The OCR revealed its plans for HITECH-required HIPAA privacy and security audits on its website...

• "Dr. HIPAA" dispenses more advice

  ”Doctor HIPAA”—also known as William R. Braithwaite, MD, PhD—was among the...

• Hospital margins in jeopardy as HIPAA 5010, ICD-10 deadlines loom

  Bruce Landes, MD, president and CEO of Southwest Physician Associates, a 1,500-member IPA in...

Issue 45, November 9, 2011

• OIG makes alleged adverse events recommendations

  The OIG has found that Medicare’s system of hospital oversight missed opportunities to...

• Willful neglect potential for not completing risk assessment

  I was recently asked to complete a risk analysis on a priority and expedited basis for a covered...

• Medicare shared savings program: ACO final rule

  HHS and CMS published their final rule on the Federal Register for accountable care organizations...

• Compliance Q&A: Attorney request

  Q: A patient signed an authorization form eight months ago, and her attorney is now submitting it...

• Survey: Adverse Events

  How many adverse events does your hospital experience annually? 0–24...

Issue 44, November 2, 2011

• LIRR retirees, physicians face charges in disability fraud scheme

  Federal prosecutors in New York City have charged 11 defendants with participating in a scheme from...

• Proposal would require laboratories to give patients test results

  A proposed HHS rule released in September would give patients easier access to their laboratory...

• DOJ announces enforcement efforts against Florida "pill mills"

  Federal, state, and local authorities in Orlando and Tampa, FL, charged 22 individuals with...

• Tip: Plan ahead to determine financial responsibility for research-related injuries

  Clinical research can be complex with respect to billing, especially when a research participant is...

Issue 43, October 26, 2011

• ACO final rules ease requirements, reduce risks

  On October 20, federal health, trade, and anti-trust agencies released their long-awaited final...

• Thousands of medical records found on Detroit street

  Thousands of medical records were found along the side of a road in Detroit October 18, according...

• More than 2,000 patient records stolen

  A New England dermatology system with offices in four cities lost 2,200 patient records when...

• HIPAA Q&A: EMR access

  Q. May we allow hospital employees who have been granted access to PHI through the workforce...

• Survey: OIG Work Plan

  Normal 0 false false false EN-US X-NONE X-NONE...

Issue 42, October 19, 2011

• OIG announces HIPAA compliance Work Plan

  The OIG plans to focus on HIPAA compliance reviews of security controls in Medicaid programs and...

• Federal judge orders prison, restitution for Medicare fraud scheme

  A federal judge in Florida has sentenced Angel Gonzalez and Jorge Zamora, owners of Dynamic Therapy...

• Backup tapes with patient information missing from Delaware facility

  Nemours®, a children’s healthcare system with locations in Delaware, Florida, New Jersey...

• Next month in Briefings on Coding Compliance Strategies

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

Issue 41, October 12, 2011

• Columbia University settles False Claims suit

  The U.S. Attorney for the Southern District of New York has settled a $995,000 civil healthcare...

• Texas DME company owner found guilty of fraud, identity theft

  Juan De Leon Jr., 41, of Edinburg, TX, could face up to 12 years in federal prison for conspiracy...

• Detroit clinic owner receives 10 years for Medicare fraud

  A federal judge has sentenced Martin Tasis, one of the owners of a Detroit area clinic, to 10 years...

• Compliance Q&A: PHI and faxing to a wrong number

  Q: A fax containing PHI is sent to an incorrect fax number. Did the covered entity (CE) or business...

• Survey: Communicating with the board of directors?

  How often do you communicate with your organization’s board of...

Issue 40, October 5, 2011

• Home health provider to pay $65 million to resolve False Claims Act allegations

  LHC Group Inc. must pay $65 million plus interest for violating the False Claims Act by...

• 10 face Medicare fraud charges in Massachusetts

  Three Massachusetts grand juries have indicted 10 individuals for allegedly intentionally...

• Military health plan breach affects 4.9 million

  TRICARE, a military health plan, has reported one of the largest breaches of patient data on...

• TIP: Protect mobile devices from security risks

  With the widespread use of mobile devices, healthcare organizations must take steps to protect...

Issue 39, September 28, 2011

• Two Miami-area residents plead guilty in $25 million healthcare fraud scheme

  On September 26 two Miami-area residents pleaded guilty in U.S. District Court in Miami for their...

• Why data security is crucial today

  SAN FRANCISCO – Ali Pabrai said it best at the fifth national HIPAA Summit West at the Grand...

• HIPAA Summit West highlights

  Check out some talking points from the presenters at the fifth national HIPAA Summit West hosted...

• Compliance Q&A: HIPAA violation?

  Q. An outpatient physical therapy clinic verifies a patient’s benefits prior to his or her...

• Survey: How many direct-reports do you have?

  Survey: How many direct-reports do you have?

Issue 38, September 21, 2011

• OCR's new head: Leon Rodriguez

  HHS named Leon Rodriguez the new leader of the government’s HIPAA privacy and security...

• CMS releases final rule on Medicaid RACs

  In February, the Centers for Medicare and Medicaid Services (CMS) delayed its expected April 1...

• Fake physician pleads guilty in $1.2M fraud scheme

  A fake physician who treated more than 1,000 people in two states, collected approximately $1.2...

• Next month in Briefings on Coding Compliance Strategies

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

Issue 37, September 14, 2011

• News: HHS announces new lab/HIPAA rules, new OCR director

  Patients may have easier access to lab results under a proposed rule announced by Department of...

• News: Feds nab 91 suspects in Medicare billing scheme totaling $295M

  Federal authorities September 7 detailed an eight-city sweep by the Medicare Fraud Strike Force...

• News: Home healthcare facility to pay $150M for false billings

  A home healthcare organization will pay a $20 million fine and a $130 million civil settlement for...

• HIPAA Q&A: HITECH and HIPAA

  Q: How did the Health Information Technology for Economical and Clinical Health Act (HITECH...

• Survey: In starting an internal investigation, do you notify your in-house counsel right away?

  Survey: In starting an internal investigation, do you notify your in-house counsel right away?

Issue 36, September 7, 2011

• California medical billing company to pay $4.6 million in settlement to resolve false claims charges

  A provider of billing services for physicians, hospitals, and other healthcare providers will pay...

• Nurse pleads guilty in $25 million healthcare fraud scheme

  A Miami-area registered nurse admitted August 31 that she participated in a $25 million Medicare...

• OCR submits HITECH HIPAA reports to Congress

  The Department of Health & Human Services (HHS) submitted two reports to Congress as required...

• TIP: HIPAA and HITECH facts you should know

  Game-changer. On February 17, 2009, President Obama signed into law the $787 billion American...

Issue 35, August 31, 2011

• News: Woman faces 10 years in prison for Medicare fraud scheme

  A Detroit-area occupational therapist pleaded guilty August 25 for her role in a Medicare fraud...

• News: Detroit-area clinic owner sentenced to prison for Medicare fraud

  An owner of three Detroit-area clinics was sentenced to four years in prison August 25 attempting...

• News: President of DME company sentenced to 12 ½ years for Medicare and Medicaid fraud

  A U.S. District Judge in Florida August 23 sentenced Ben Bane, 64, to 12 ½ years in federal...

• HIPAA Q&A: PHI on website

  Q. One of my colleagues made a website accessible to invitees only. He plans to upload a...

• Corporate Compliance survey

  Survey: Does your facility have an up-to-date breach notification policy in place?

Issue 34, August 24, 2011

• OIG report: Questionable billing by suppliers of lower limb prostheses

  Medicare inappropriately paid $43 million for lower limb prostheses that did not meet certain...

• Feds convict four in $4.7 million Louisiana Medicare fraud scheme

  A federal jury convicted a Louisiana durable medical equipment (DME) company owner, a physician...

• TIP: Top-down, bottom-up approach for incident response

  Adam Greene, former senior health information technology and privacy advisor at OCR and now partner...

Issue 33, August 17, 2011

• OCR data breach tally passes a milestone

  Covered entities (CE) have reported breaches of unsecured protected health information affecting...

• OCR's HIPAA audit hot-button topics revealed

  HIPAA compliance auditors contracted by the Office for Civil Rights (OCR) will determine whether...

• Federal government intervenes in false claims lawsuit against healthcare corporation

  The U.S. Department of Justice (DOJ) has intervened in a case against Nurses’ Registry and...

• Q&A: Medical information at school

  Q. Our facility includes a medical unit that serves a pediatric population. This campus includes a...

• Survey: Is your compliance officer also your HIPAA privacy officer?

  Survey: Is your compliance officer also your HIPAA privacy officer?

Issue 32, August 10, 2011

• Twenty-six indicted for massive healthcare fraud scheme

  Twenty-six individuals have been indicted for their participation in a large-scale healthcare fraud...

• HIPAA auditor breaches patient information, more than 4,500 affected

  The company hired by the Office for Civil Rights to conduct nationwide HIPAA privacy and security...

• Tip: Screen new employees

  The OIG suggests that hospitals carefully screen all new employees. This screening could include a...

Issue 31, August 3, 2011

• Whistleblowers share their story

  Learn what two coders did when they realized the query process at Johns Hopkins Bayview Medical...

• CA physician sentenced to 18 months in prison for falsely billing cancer medications

  Glen R. Justice, MD, 66, of Corona del Mar, CA, was sentenced to 18 months in federal prison for...

• Q&A: Consent for lab report copies

  Q: After meeting with physicians to review lab ¬reports, patients often request a copy of the...

• Survey: Accounting of disclosures final rule

  Did you or someone at your facility submit comments to CMS about the “HIPAA Privacy Rule...

Issue 30, July 27, 2011

• Patient recruiter pleads guilty in $25 million Medicare fraud scheme

  Vicente Guerra-Nistal, 54, a patient recruiter for Miami healthcare agencyABC Home Health Care...

• MA pharmacist pleads guilty to fraudulent prescription billing scheme

  Ernest McGee, 40, a pharmacist in Dorchester, MA, pleaded guilty to one count of conspiracy to...

• UCLA Health System settles with OCR for $865,500

  The Department of Health and Human Services entered into its third largest settlement for...

• Tip: Protect patient information with system safeguards

  Hospitals should ensure that passwords are required to access all systems, databases, and...

Issue 29, July 20, 2011

• Next month in Briefings on Coding Compliance Strategies

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

• OIG examines improper Medicare wheelchair claims

  During the first half of 2007, Medicare spent $95 million on claims for power wheelchairs that were...

• FL physical therapy company owner pleads guilty to Medicare fraud scheme

  Jorge Zamora, a Miami-area resident and owner of a physical therapy company in Lakeland, Fla...

• Two plead guilty to $25 million healthcare fraud scheme

  Lisandra Alonso, 33, and Luisa Morciego, 39, each pleaded guilty to one count of conspiracy to...

• Q&A: Notice of Privacy Practices

  Q: Must patients receive a paper copy of our Notice of Privacy Practices during every...

• Survey: Compliance training

  How often does your facility provide compliance training and education for facility employees?

Issue 28, July 6, 2011

• Man arrested on false claims charges

  The U.S. Attorney General's office arrested a Delaware County mental health worker accused of...

• Former hospital executive sentenced to prison for healthcare fraud

  A former chief financial officer who pleaded guilty to bilking about $200,000 from hospitals in...

• Miami psychiatrist pleads guilty for role in $200 million Medicare fraud scheme

  Dr. Alan Gumer, 64, of Tamarac, Fla., pleaded guilty to one count of conspiracy to commit...

• NC couple sentenced to 24 months for healthcare fraud and tax offenses

  Ruben D. McLain, 40, and Michelle Judge McLain, 38, were each sentenced to 24 months in prison and...

• OCR hires contractor for HIPAA audit plan

  The Office for Civil Rights (OCR) has hired an organization to implement its HITECH-required HIPAA...

• Brooklyn neurologist pleads guilty to Medicare fraud scheme

  Leonard Langman, MD, a neurologist who owned and operated a Brooklyn, NY, medical clinic, pleaded...

• Q&A: Voice mail disclaimer

  Q. A health plan representative called our ¬clinic and said she could not include protected...

• Tip: Safeguarding data from unauthorized individuals

  Conduct a walk-through, both during and after business hours, to help identify weaknesses through...

• Survey: OIG audits

  The OIG is expanding the number of probe audits it performs. How concerned are you about an OIG...

Issue 27, June 29, 2011

• Miami doctor sentenced to more than 19 years in prison for Medicare fraud scheme

  Rene De Los Rios, 72, was sentenced to more than 19 years behind bars for his part in a $23 million...

• Q&A: Voice mail disclaimer

  Q: A health plan representative called our ­clinic and said she could not include...

• Survey: OIG audits

  The OIG is expanding the number of probe audits it performs. How concerned are you about an OIG...

Issue 26, June 29, 2011

• Physical therapy clinic employees plead guilty to defrauding Medicare

  Three employees of Solstice Wellness Center, Brooklyn-area physical therapy clinic, pleaded guilty...

• Houston DME company owners plead guilty to Medicare fraud

  The owners of two separate Houston-area durable medical equipment (DME) companies admitted to...

• Tip: Monitor social media

  Compliance officers should be auditing and monitoring social media.

Issue 25, June 22, 2011

• DOJ to intervene in stent fraud lawsuit

  The U.S. Department of Justice ordered a four-year-old whistleblower lawsuit involving two health...

• Technology to help CMS identify potential fraud

  Starting July 1, CMS will begin using innovative predictive modeling technology to fight Medicare...

• NY Medicaid Inspector General's job in question

  New York's Medicaid Inspector General Jim Sheehan may resign within 30 days, according to an...

• Houston woman admits to healthcare fraud

  Simone Ball, 24, owner of Preferred Plus Medical Supply in Houston, pleaded guilty to one count of...

• Q&A: E-mailing PHI

  Q: Is it considered a breach if a covered ­entity ­requests that an individual send...

• Survey: OIG audits

  The OIG is expanding the number of probe audits it performs. How concerned are you about an OIG...

• Next month in Briefings on Coding Compliance Strategies

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

Issue 24, June 15, 2011

• AL woman arrested for stealing patient records

  U.S. Postal Inspectors arrested an Alabaster, AL woman on charges that she stole identifying...

• FL radiology clinic settles anti-kickback allegations

  Midtown Imaging LLC, a radiology clinic, and its former owners have agreed to pay $3 million to...

• Pharmaceutical manufacturer pays $25 million to resolve off-label marketing charges

  Novo Nordisk Inc., a Danish pharmaceutical manufacturer, agreed to pay $25 million to resolve...

• Tip: develop a social media policy

  Having a clear policy on social media use can help head off problems at your organization.

Issue 23, June 8, 2011

• OIG posts Medicare fraud training video

  OIG has posted a video recording of the May 18  Health Care Fraud Prevention...

• OIG recoveries expected to top $3 billion

  The OIG expects to recover $3.4 billion from its investigations, audits, and other reviews of...

• Miami nurse convicted of submitting false claims for insulin injections

  A federal jury found in Miami found Armando Santos, a registered nurse, guilty of five counts of...

• Q&A: Disclosing all personnel that have access to medical records

  Q:Can I obtain a list of the names of hospital staff members who may have inappropriately accessed...

• Survey: HEAT Provider Compliance Training

  Do you plan to watch the video recording of the May 18 Health Care Fraud Prevention and Enforcement...

Issue 22, June 1, 2011

• HITECH accounting of disclosures rule released

  On May 27 the Department of Health & Human Services (HHS) published a HITECH-required proposed...

• HHS plans to review existing rules

  On Thursday, May 26, the Department of Health and Human Services (HHS) announced its plans to...

• Houston patient recruiter convicted of DME fraud scheme

  Marion Beverly Metoyer, a patient recruiter for a Houston durable medical equipment (DME) company...

• Tip: Regulate access to electronic medical records.

  Employees should only access information when they have a legitimate need to do so.

Issue 21, May 25, 2011

• Quest agrees to California's largest false claims settlement

  Quest Diagnostics, California’s largest provider of medical laboratory testing, will pay $241...

• Owner of Houston-are DME company sentenced to prison for fraud scheme

  Doris Vinitski, a Houston-area resident and owner of Onward Medical Supply, was sentenced to serve...

• Owner of FL medical equipment company will serve three years in prison for fraud scheme

  Homero Izquierdo Ruiz, 46, of Miami, pleaded guilty to two counts of healthcare fraud and received...

• Q&A: Patient stories on the internet

  Q: I've been struggling with HIPAA authorization requirements regarding website postings of...

• Survey: HIPAA training methods

  Which method do you most frequently use to train staff on the HIPAA Privacy Rule?

• Next month in Briefings on Coding Compliance Strategies

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

Issue 20, May 18, 2011

• OIG reports cite weakness in OCR and ONC efforts to protect ePHI

  The HHS Office of the Inspector General (OIG) released two reports May 17 questioning the efforts...

• Medicaid fraud investigation exposes a murder-for-hire plot

  Investigators looking into allegations of Medicaid fraud against a New Jersey physician instead...

• NY physical therapist admits to defrauding Medicare

  A Brooklyn physical therapist pleaded guilty for his role in submitting false claims to Medicare...

• Tip: Prepare an incident response

  Even organizations that have great policies and procedures and train diligently should still have a...

Issue 19, May 11, 2011

• Owners of a Detroit-area HIV infusion clinic convicted of Medicare fraud scheme

  Martin and Joaquin Tasis, owners of a Detroit-area medical clinic, and co-conspirator Leoncio...

• Pharmaceutical manufacturer pays $44.3 million to resolve kickback allegations

  Pharmaceutical manufacturer Serono Laboratories Inc. will pay $44.3 million to resolve False Claims...

• Two Miami-area corporations plead guilty to $200 million Medicare fraud scheme

  American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc., pleaded...

• Q&A: Rehiring an employee that was fired for a violating patient confidentiality

  Q: An employee is terminated for violating patient confidentiality. The organization later...

• Survey: Health law concerns

  Which of the following health laws concerns you the most?

• Next month in Briefings on Coding Compliance Strategies

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

Issue 18, May 4, 2011

• Survey: More employees disciplined for social media activities

  The number of employees disciplined for their activities on social networking sites is on the rise...

• Large patient information breach list reaches 265

  The number of entities reporting breaches of unsecured PHI affecting at least 500 individuals to...

• Former non-profit owner to serve 12 years for fraud scheme

  Shirlene Reese Boone of Murfreesboro, NC, will serve 12 years in prison followed by three...

• Tip: Incorporate your compliance program into your performance plan

  When evaluating the performance of managers and supervisors, factor in adherence to the elements of...

Issue 17, April 27, 2011

• CVS pays $17.5 million to resolve false claims allegations

  CVS Pharmacy Inc. agreed to pay the United States and 10 states $17.5 million to resolve...

• Three Miami-area residents headed to jail for $23 million Medicare fraud scheme

  Two Miami-area medical assistants and a physician assistant will serve time in prison for their...

• Ohio pharmaceutical company pays $8 million to resolve kickback allegations

  Cardinal Health Inc. agreed to pay $8 million to resolve claims that it violated the False Claims...

• Q&A: Whiteboards and HIPAA

  Q: Is it permissible to list patients by name on whiteboards in the nursing units?

• Survey: Health law concerns

  Which of the following health laws concerns you the most?

Issue 16, April 13, 2011

• Rex Healthcare to pay $1.9M to settle fraud claims

  Rex Healthcare in Raleigh, NC has been ordered to pay the federal government $1.9 million, plus...

• Dallas hospital files Medicare fraud suit against a hostile takeover bidder

  Dallas-based Tenet Healthcare Corp. filed a Medicare fraud lawsuit that accuses Community Health...

• Nurse pleads guilty in Medicare fraud scheme

  A registered nurse employed by a Houston healthcare company pleaded guilty last week in...

• Owners of a mental health corporation plead guilty to $200 million fraud scheme

  Two Miami-area residents and owners of a mental healthcare corporation pleaded guilty to submitting...

• Miami doctor convicted in $23 million Medicare fraud scheme

  A jury convicted Miami physician Rene De Los Rios of five felony counts for his role in a $23...

• 2 FL medical office workers face fraud charges

  Two medical office workers in south Florida have been indicted on HIPAA violations and related...

• Tip: Review your compliance program

  An effective compliance program should incorporate periodic (at least annual) reviews to determine...

Issue 15, April 13, 2011

• Q&A: Responding to subpoena requests

  Q: Should we provide a complete copy of a patient’s record when a subpoena requests...

Issue 14, April 6, 2011

• Miami physician sentenced for Medicare fraud

  Fred Dweck, a Miami-area doctor, will serve 24 months in prison for his role in a Medicare fraud...

• Los Angeles woman pleads guilty to participating in a $6.2 million Medicare fraud scheme

  Carolyn Ann Vasquez of Los Angeles pleaded guilty to using fraudulent medical clinics and the...

• CMS explains new provider enrollment provisions

  CMS has issued MLN Matters Article MM7350 to explain how the new provider enrollment provisions...

• Tip: When and how to use compound authorizations

  An authorization to use or disclose protected health information (PHI) may be combined with another...

Issue 13, March 30, 2011

• DME sales rep admits to stealing medical supplies

  Joseph Raymond, 39, of Orchard Park, NY, admitted to stealing medical supplies and equipment from a...

• CMS published screening requirements final rule and FAQs

  CMS has issued a final rule to implement provisions of the Patient Protection and Affordable Care...

• Physician arrested for conspiring to distribute controlled substances

  The Greater Palm Beach Health Care Fraud Task Force arrested Selwyn Carrington, MD, 57, of Miami...

• Q&A: Accounting for tumor registry disclosures

  Q: We are required to report information, including patient account numbers and diagnosis codes, to...

• Survey: Have you had RAC recoupments related to an automated audit?

  Have you had RAC recoupments related to an automated audit?

Issue 12, March 23, 2011

• MA hospital settles billing violations using the self-disclosure protocol

  Saints Medical Center in Lowell, MA, will pay $579,000 to settle alleged Medicare billing...

• Medicare fraud efforts in Detroit have identified $120 million in fraudulent payments

  Since May 2009, the Department of Justice (DOJ) and HHS have charged 120 Detroit-area defendants...

• OCR needs $5 million more in FY 2012 for HIPAA enforcement

  The OCR, the enforcer of the HIPAA privacy and security rules, is asking for an increase of $5.6...

• Tip: Use the New York model to develop a compliance program

  New York has a mandatory compliance program model already in place, and the federal government is...

• Next month in Briefings on Coding Compliance Strategies

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

Issue 11, March 16, 2011

• Health Net, Inc., involved in potential HIPAA breach affecting 1.9 million patients

  For the second time in less than a year, health insurance giant Health Net, Inc., is involved in a...

• Miami physician sentenced to 41 months in prison for $2.3 million fraud scheme

  Jerry A. Spiegel, MD, of Boynton Beach, FL, will serve 41 months in prison followed by three years...

• Houston-area DME company owner convicted of healthcare fraud

  A federal jury convicted Sunny Robinson, 42, owner of Houston-area durable medical equipment (DME...

• Q&A: Discussing a family member's medical problems

  Q: I work in patient financial services at a hospital. Like me, several of my coworkers have...

• Survey: Spring fever

  What is your favorite part about spring?

• This month in Briefings on Coding Compliance Strategies

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

Issue 10, March 9, 2011

• Sen. Grassley introduces new Medicare and Medicaid fraud legislation

  Senator Chuck Grassley introduced legislation to build on key reforms to fight fraud in Medicare...

• Las Vegas woman pleads guilty to acting as the straw owner of fraudulent DME company

  Jummal Joy Ibrahim, 55, of Las Vegas pleaded guilty to falsely representing to Medicare that she...

• Infusion clinic owner, physician sentenced to prison for $2.3 million fraud scheme

  An owner and a physician associated with a Detroit-area infusion therapy clinic will serve 120...

• Tip: Get support from the top

  One crucial element of a good compliance program is having a supportive board and senior management.

Issue 9, March 2, 2011

• Illinois Blue Cross agrees to pay $25M to settle false claims charges

  Blue Cross Blue Shield of Illinois will pay the United States and the state of Illinois $25 million...

• MGH pays $1M and enters into a CAP to settle potential HIPAA violations

  The General Hospital Corporation and Massachusetts General Physicians Organization, Inc., (Mass...

• HHS imposes first CMP for a HIPAA violation, Cignet will pay $4.3M

  The HHS Office for Civil Rights (OCR) imposed a civil money penalty (CMP) of $4.3 million to Cignet...

• Q&A: What is esMD?

  Q: What is esMD and how can my hospital sign up?

• Survey: Electronic submission of medical documentation

  Are you interested in electronically submitting medical documentation to government auditors?

Issue 8, February 23, 2011

• Medicare Fraud Strike Force charges 111 in the country's largest healthcare fraud takedown

  The Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged...

• Twenty FL residents charged with participation in $200 million Medicare fraud scheme

  Twenty southern Florida residents were indicted for various healthcare fraud, kickback, and money...

• DME office manager pleads guilty to Medicare fraud

  The office manager of a Los Angeles durable medical equipment (DME) company pleaded guilty today to...

• Tip: Go beyond HIPAA training requirements

  Your HIPAA training content should include privacy and security, but you should also train your...

Issue 7, February 16, 2011

• New York City Health and Hospitals Corp. privacy breach affects 1.7 million

  The New York City Health and Hospitals Corporation (HHC) must notify 1.7 million patients, hospital...

• Georgia hospital system pays $2.7 million to settle inappropriate billing charges

  St. Joseph’s/Candler Health System (SJCHS) agreed to pay $2.7million to settle allegations...

• Medical assistant sentenced to 3 years in prison for Medicare fraud scheme

  Guy Ross, 51, a Detroit-area medical assistant, will serve 36 months in prison and pay $472,000 in...

• Q&A: Voice mail

  Q: May a preadmission nurse leave messages (e.g., “This is a reminder that your surgery is...

• Survey: HIPAA training

  Do you plan to revisit HIPAA training methods in light of the increased enforcement?

Issue 6, February 9, 2011

• Eight nurses sentenced for Medicare fraud

  Eight Miami-area nurses will serve time in prison for their roles in an $18.7 million Medicare...

• Medicaid managed care plan pays $26 million to settle false claims charges

  CareSource, CareSource Management Group Co., and CareSource USA Holding Co. have agreed to pay the...

• Medicaid managed care plan pays $26 million to settle false claims charges

  CareSource, CareSource Management Group Co., and CareSource USA Holding Co. have agreed to pay the...

• OIG posts list of the most-wanted healthcare fugitives

  The Office of Inspector General (OIG) of the Department of Health & Human Services launched the...

• Tip: Train your entire staff on HIPAA issues

  Your full workforce needs privacy and security training, says Kate Borten, CISSP, CISM. That...

Issue 5, February 2, 2011

• Former Temple University department chairperson indicted on fraud charges

  Joseph Kubacki, MD, former chairperson of the ophthalmology department at the Temple University...

• HHS outlines new Affordable Care Act rules to fight healthcare fraud

  HHS announced new rules authorized under the Affordable Care Act which will allow the government to...

• Q&A: What happens if the recovery auditor does not meet the 60 day requirement?

  Q: What happens if the recovery auditor does not meet the 60 day requirement?

• Survey: Value-based purchasing

  Have you reviewed CMS’ proposed rule on value-based purchasing under the Inpatient...

Issue 4, January 26, 2011

• Healthcare fraud prevention and enforcement efforts recover record $4 billion

  The government’s healthcare fraud and abuse efforts netted more than $4 billion in fiscal...

• Medical device company pays $16 million to resolve kickback charges

  St. Jude Medical Inc. agreed to pay the United States $16 million to resolve allegations that the...

• Health Net fined $55,000 for data breach

  Health Net, Inc. agreed to pay the Vermont government $55,000 to resolve charges that the...

• Tip: Safeguard against incidental disclosures

  What the Department of Health and Human Services (HHS) considers a reasonable safeguard against...

Issue 3, January 19, 2011

• Next month in Briefings on Coding Compliance Strategies

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

• Medical supply company owner sentenced to three years for Part D fraud

  Renier Vicente Rodriguez Fleitas, 60, of Miami-Dade County, will serve 37 months after pleading...

• Behavioral counseling company owner sentenced to prison for fraud scheme

  Edward Birts, 51, will serve more than five years in federal prison without parole and pay more...

• Staff members at UMC Tucson fired for inappropriately accessing medical records

  University Medical Center in Tucson, AZ, fired three clinical support staff members and a...

• Q&A: Investigating a doubtful privacy violation

  Q: What is the appropriate response when a really difficult patient who complained incessantly...

• Survey: Snooping in medical records

  Have you ever had to discipline an employee for inappropriately accessing medical records?

Issue 2, January 12, 2011

• DME company owner, physician sentenced for Baton Rouge-area fraud scheme

  Dahlia V. Kirkpatrick, MD, and Emmanuel M. Komandu, the owner and operator of Alpha Medical...

• Medical billing company pays $565,000 to settle healthcare fraud allegations

  MSO Washington, Inc., a medical practice management and billing service company, and Charles...

• MA and NC announce 2010 Medicaid fraud recoveries

  The Massachusetts Medicaid Fraud Division recovered $66 million in 2010, according to a press...

• Tip: Mitigate harmful effects following a patient privacy complaint

  Investigating privacy complaints and applying sanctions are important aspects of compliance, but...

Issue 1, January 5, 2011

• This month in Briefings on Coding Compliance Strategies

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

• Detroit Medical Center pays $30 million to settle False Claims Act allegations

  Detroit Medical Center agreed to pay the United States $30 million to settle allegations that it...

• Seven hospitals to pay more than $6.3 million to resolve False Claims Act allegations related to kyphoplasty

  Seven hospitals agreed to pay the United States a total of more than $6.3 million to settle...

• Q&A: How should providers prepare for Medicaid RACs?

  Q: How should providers prepare for Medicaid RACs?

• Survey: Anti-kickback and EMTALA comments

  Will you take up the OIG and CMS on their offer to submit comments about the anti-kickback statute...

Issue 1, January 5, 2011

• Federal agencies seek input on anti-kickback statute and EMTALA rules

  In two separate Federal Register issues, the Office of Inspector General (OIG) and CMS solicited...

Issue 14, April 13, 2011

• Survey: How often do you read the Federal Register?

  How often do you read the Federal Register?