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Extension for EPs participating in PQRS via EHR and QCDR
February 26, 2015February 26, 2015
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Former Houston Area DME Owner To Serve 7+ Years, Pay $1.6 M In Restitution For Health Care Fraud
February 9, 2015On February 2, 2015, U.S. District Judge Michael Schneider sentenced former Ivy Health Care Supply owner Vivian Yusuf to 7 years and 3 months in jail and ordered her to pay $1.6 million in restitution for her September 17, 2014 guilty plea to conspiracy to commit health care fraud.
In March 2011, Yusuf was indicted on charges of conspiracy to commit health care fraud, health care fraud, and aggravated identity theft. Investigators believe that Yusuf and her co-conspirators billed Medicare for more than $3.4 million for durable medical equipment (DME) that was neither medically necessary nor prescribed by a physician.
The guilty plea stemmed from Yusuf’s January 12, 2012 indictment for conspiracy to commit health care fraud, health care fraud, and aggravated identity theft for acts committed when she owned and operated Ivy Health Care Supply, a Houston-area durable medical equipment (DME) company based in Stafford, Texas.
According to information presented in court, from June 2007 to May 2009, Yusuf and Aghaegbuna “Ike” Odelugo, James Reese, and others unlawfully submitted false and fraudulent claims to Medicare of more than $3.4 million and defrauded Medicare of more than $1.6 million by marketing of power wheelchairs and accessories, as well as “ortho kits,” which primarily consisted of a bag of orthotic items, including braces, wraps, and supports, and a heat lamp or heat pad. As part of the scheme, the defendant and her co-conspirators illegally obtained protected health information, including names, dates of birth, and Medicare numbers from elderly individuals. Yusuf and her co-conspirators supplied approximately 790 beneficiaries located primarily in Texas and Louisiana with kits and power wheelchairs that the beneficiaries did not want and not prescribed or otherwise authorized by a physician. In some instances, physicians’ signatures were forged and false claims were submitted to Medicare in the names of Medicare beneficiaries who were deceased.
A fugitive for several years before her arrest June 3, 2014 at George Bush Intercontinental Airport in Houston, the Department of Health & Human Services Office of Inspector General (OIG) once listed her on its “Most Wanted List.”
According to OIG, Odelugo and Reese were indicted for their involvement in similar health care fraud schemes. Odelugo pleaded guilty to conspiracy to commit health care fraud, health care fraud, and money laundering and was sentenced to 72 months in federal prison. The loss to Medicare as a result of Odelugo’s scheme was approximately $9.9 million. Reese pleaded guilty to health care fraud and tax evasion and was sentenced to 180 months in federal prison. The loss to Medicare as a result of Reese’s scheme was approximately $8.6 million.
In the face of these continuing investigations and prosecutions, health care providers should continue to diligently work to comply with the False Claims Act and other federal and state health care fraud laws by tightening their internal controls and other compliance programs. As a key element of these efforts, health care providers should ensure that their human resources and other management carefully monitor employee, contractor and vendor complaints, concerns and other communications for potential signs of compliance concerns, retaliation or other indicators of the need to intervene to correct potential violations or other risks.
For More Information Or Assistance
If you need assistance reviewing or responding to these or other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 26 years experience advising health industry clients about these and other matters. Her experience includes advising hospitals, nursing home, home health, rehabilitation and other health care providers and health industry clients to establish and administer compliance and risk management policies; prevent, conduct and investigate, and respond to peer review and other quality concerns; and to respond to Board of Medicine, Department of Aging & Disability, Drug Enforcement Agency, OCR Privacy and Civil Rights, HHS, DOD and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. The scribe for the American Bar Association (ABA) Joint Committee on Employee Benefits annual agency meeting with the Department of Health & Human Services Office of Civil Rights, Ms. Stamer has worked extensively with health care providers, health plans, health care clearinghouses, their business associates, employers, banks and other financial institutions, and others on risk management and compliance with HIPAA and other information privacy and data security rules, investigating and responding to known or suspected breaches, defending investigations or other actions by plaintiffs, OCR and other federal or state agencies, reporting known or suspected violations, business associate and other contracting, commenting or obtaining other clarification of guidance, training and enforcement, and a host of other related concerns. Her clients include public and private health care providers, health insurers, health plans, technology and other vendors, and others. In addition to representing and advising these organizations, she also has conducted training on Privacy & The Pandemic for the Association of State & Territorial Health Plans, as well as HIPAA, FACTA, PCI, medical confidentiality, insurance confidentiality and other privacy and data security compliance and risk management for Los Angeles County Health Department, ISSA, HIMMS, the ABA, SHRM, schools, medical societies, government and private health care and health plan organizations, their business associates, trade associations and others.
A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. You can get more information about her health industry experience here. If you need assistance responding to concerns about the matters discussed in this publication or other health care concerns, wish to obtain information about arranging for training or presentations by Ms. Stamer, wish to suggest a topic for a future program or update, or wish to request other information or materials, please contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.
If you or someone else you know would like to receive future updates about developments on these and other concerns from Ms. Stamer, see here.
About Solutions Law Press
Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources including:
- Community Health Systems Professional Services Corporation & 3 Affiliated NM Hospitals Agree to $75 Million False Claims Act Settlement Use New State Ebola Protocol Table In Ebola Prevention & Management Planning
- Unpatched and Unsupported Software Triggers Latest HIPAA Security Breach Resolution Agreement
- Congress Sends Bill To Fast Track FDA Ebola Treatment Review & HHS Declaration Gives Ebola Treatment Manufacturers Special Immunity
- Former Center Texas Medical Center CFO Faces 5 Years After Guilty Plea To EHR Incentive Fraud Reminder To Manage Incentive Compliance
- Preparing Privacy Compliance For Emergencies-Ebola Crisis Prompts HHS OCR To Share Guidance On HIPAA Privacy in Emergency Situations
- IRS Issues Ebola-Related Tax Relief
- Columbia to Pay $9 Million Plus To Settle DOJ/HHS False Claims Charges For Submitting Inaccurate Cost Reports and Mischarging Federal Grants
- OIG Warns Pharma Manufacturers to Prevent Copayment Coupon Use for Part D Drug Purchases
- 10/10 Kidney Foundation Professional Symposium Offers 7.5 Hours CME/CEUs
- Parkview Hospital To Pay $800K To Settle HIPAA Charges After Retiring Physician Blows The Whistle
- Whistleblower To Get $17M+ of Omnicare $124M False Claims Settlement
- Health Care & Other HIPAA Covered Entities Should Review New Reports As Part of HIPAA Risk Management Efforts
- CMS Proposes Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Pre-Authorization Rule
- Medicare Fraud Strike Force Nails 90 Individuals For Almost $260 Million In False Billing Including 16 Doctors
- Columbia to Pay $9 Million Plus To Settle DOJ/HHS False Claims Charges For Submitting Inaccurate Cost Reports and Mischarging Federal Grants
- OIG Warns Pharma Manufacturers to Prevent Copayment Coupon Use for Part D Drug Purchases
- Parkview Hospital To Pay $800K To Settle HIPAA Charges After Retiring Physician Blows The Whistle
- Whistleblower To Get $17M+ of Omnicare $124M False Claims Settlement
- Health Care & Other HIPAA Covered Entities Should Review New Reports As Part of HIPAA Risk Management Efforts
- CMS Proposes Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Pre-Authorization Rule
- Encrypt Mobile Devices & Clean Up Management Documentation Key HIPAA Compliance Messages In New HIPAA Settlements
- Small Smiles Dental Centers Excluded As Federal Health Program Provider For 5 Years
- Latest OCR Resolution Agreement Hits Public Health Department, Shows Needs To Stay Up-To-Date
- NLRB Helps Union Force Another Health Care Employer To Recognize & Bargain With Union
- Federal Health Care Fraud Enforcement Recouped Record $4.3 Billion in FY 2013
- Former Houston Texas Physician Gets 70 Month Prison Sentence For Fraud Conviction
- Euless Healthcare Corporation Owner, Associates Face Conspiracy And Health Care Fraud Charges For Alleged Submission Of $700,000+ In Fraudulent Health Care Claims
- Former Manager 9th Employee Sentenced For Involvement In Maxim Medicare False Claims Action
- Medical Identity Theft/Fraud Convictions Highlight Need For Health Care Providers To Safeguard Health Information, Guard Against Fraud Schemes
- Detroit-Area Foot Doctor Pleads Guilty to Medicare Fraud Scheme
- Merck To Pay $950 Million To Settle Vioxx® Off-Label Marketing Charges
- Texas Physicians Get New Option For Resolving Some Medical Board Complaint
- Broad-Reaching Prosecution Of Individuals Participating In Operations Of Companies Convicted Of Fraud Shows Risks Of Participation
- Hospitals Can Expect CMS To Add Hospital Incident Reporting To Surveys In Response To OIG Report
- Quality, Recordkeeping & Unprofessional Conduct Lead Reasons For Medical Board Discipline of Physicians
- DEA Cautions Practitioners Must Restrict Delegation of Controlled Substance Prescribing Functions, Urges Adoption of Written Policies & Agreements
- If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile here. For important information concerning this communication click here.THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TO U.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS. ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.
©2015 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press. All other rights reserved.
Community Health Systems Professional Services Corporation & 3 Affiliated NM Hospitals Agree to $75 Million False Claims Act Settlement
February 3, 2015Franklin, Tennessee based Community Health Systems Professional Services Corporation (CHSPSC) and three of its New Mexico affiliate hospitals- Eastern New Mexico Medical Center in Chaves County, Mimbres Memorial Hospital and Nursing Home in Luna County and Alta Vista Regional Medical Center in San Miguel County (collectively CHS) will pay the United States $75 million to settle Justice Department allegations that CHS violated the False Claims Act by illegally donating funds to county governments to use to fund the 25 percent “matching share” of the now discontinued New Mexico Sole Community Provider (SCP) program. The Justice Department action and resulting settlement highlight both the rising role of whistleblowers in helping Federal and state officials uncover potential False Claims Act or other health care fraud allegations and the Federal government’s continuing commitment to investigate and prosecute health care fraud charges against hospitals and other health care providers.
The Justice Department announced on February 3, 2015 that CHS had agreed to settle charges made by the Justice Department in United States ex rel. Baker v. Community Health Systems Professional Services Corporation, et al., Civ. Action No. 05-279 (D. N.M.). , that CHS violated the False Claims Act by providing illegal donations to New Mexico to use to pay its required portion of the SCP funding.
The New Mexico SCP program provided supplemental Medicaid funds to hospitals in mostly rural communities using a mix of federal and state funding. Under the program, the federal government reimbursed the state of New Mexico for approximately 75 percent of its health care expenditures under the SCP program provided that New Mexico provide state or county funds, and not impermissible “donations” from private hospitals, to fund the remaining 25 percent “matching” share of SCP program payments. Congress enacted the prohibition against the use of private hospital funds to fund the state’s required matching share of SCP program payments to curb possible abuses and ensure that states have sufficient incentive to curb rising Medicaid costs.
According to the Justice Department, CHS violated the False Claims Act from August 1, 2000 to December 31, 2010, by knowingly causing the state of New Mexico to present false claims to the United States for payments made to CHS under the SCP program by making improper donations to Chaves, Luna and San Miguel counties, which were then used by the counties, and later the state, to obtain federal matching payments. The government alleged that CHS concealed the true nature of these donations to avoid detection by federal and state authorities. The Justice Department additionally claimed that as a result of its scheme, CHS received SCP payments which were funded by the United States in the amount of three times CHS’ “donations.”
The prosecution leading to the settlement provides yet another example of the role of whistleblowers in helping the governing identify and prosecute fraud. The False Claims Act qui tam rules allow individuals to bring a lawsuit on behalf of the government and to share in the proceeds of the suit. The act also permits the government to intervene in and take over the lawsuit, as it did in this case as to some of Baker’s allegations. The United States did not intervene in Baker’s allegations as to SCP payments made to two other affiliated New Mexico hospitals, Carlsbad Medical Center and Lea Regional Medical Center. Today’s settlement also resolves these other allegations. Baker will receive $18,671,561 as his share of the government’s recovery.
In addition, the action and its settlement also affirms the Federal government’s continuing commitment to find and prosecute health care providers that it perceives violate the False Claims Act or other Federal health care fraud laws.
“Congress expressly intended that states and counties use their own money when seeking federal matching funds in order to encourage them to join the federal government in ensuring that Medicaid funds are spent on the needs of beneficiaries,” said Acting Assistant Attorney General for the Justice Department’s Civil Division Joyce R. Branda. “When private hospitals violate the rules against hospital donations funding the state share, that important protection of the Medicaid program is destroyed.”
“Hospitals that make provider donations with the expectation that they will receive a windfall from the Medicaid program threaten the integrity of the Medicaid program and will be held accountable,” said Special Agent in Charge Mike Fields for the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) Dallas region.
In the face of these continuing investigations and prosecutions, health care providers should continue to diligently work to comply with the False Claims Act and other federal and state health care fraud laws by tightening their internal controls and other compliance programs. As a key element of these efforts, health care providers should ensure that their human resources and other management carefully monitor employee, contractor and vendor complaints, concerns and other communications for potential signs of compliance concerns, retaliation or other indicators of the need to intervene to correct potential violations or other risks.
For More Information Or Assistance
If you need assistance reviewing or responding to these or other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 26 years experience advising health industry clients about these and other matters. Her experience includes advising hospitals, nursing home, home health, rehabilitation and other health care providers and health industry clients to establish and administer compliance and risk management policies; prevent, conduct and investigate, and respond to peer review and other quality concerns; and to respond to Board of Medicine, Department of Aging & Disability, Drug Enforcement Agency, OCR Privacy and Civil Rights, HHS, DOD and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. The scribe for the American Bar Association (ABA) Joint Committee on Employee Benefits annual agency meeting with the Department of Health & Human Services Office of Civil Rights, Ms. Stamer has worked extensively with health care providers, health plans, health care clearinghouses, their business associates, employers, banks and other financial institutions, and others on risk management and compliance with HIPAA and other information privacy and data security rules, investigating and responding to known or suspected breaches, defending investigations or other actions by plaintiffs, OCR and other federal or state agencies, reporting known or suspected violations, business associate and other contracting, commenting or obtaining other clarification of guidance, training and enforcement, and a host of other related concerns. Her clients include public and private health care providers, health insurers, health plans, technology and other vendors, and others. In addition to representing and advising these organizations, she also has conducted training on Privacy & The Pandemic for the Association of State & Territorial Health Plans, as well as HIPAA, FACTA, PCI, medical confidentiality, insurance confidentiality and other privacy and data security compliance and risk management for Los Angeles County Health Department, ISSA, HIMMS, the ABA, SHRM, schools, medical societies, government and private health care and health plan organizations, their business associates, trade associations and others.
A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. You can get more information about her health industry experience here. If you need assistance responding to concerns about the matters discussed in this publication or other health care concerns, wish to obtain information about arranging for training or presentations by Ms. Stamer, wish to suggest a topic for a future program or update, or wish to request other information or materials, please contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.
If you or someone else you know would like to receive future updates about developments on these and other concerns from Ms. Stamer, see here.
About Solutions Law Press
Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources including:
- Use New State Ebola Protocol Table In Ebola Prevention & Management Planning
- Unpatched and Unsupported Software Triggers Latest HIPAA Security Breach Resolution Agreement
- Congress Sends Bill To Fast Track FDA Ebola Treatment Review & HHS Declaration Gives Ebola Treatment Manufacturers Special Immunity
- Former Center Texas Medical Center CFO Faces 5 Years After Guilty Plea To EHR Incentive Fraud Reminder To Manage Incentive Compliance
- Preparing Privacy Compliance For Emergencies-Ebola Crisis Prompts HHS OCR To Share Guidance On HIPAA Privacy in Emergency Situations
- IRS Issues Ebola-Related Tax Relief
- Columbia to Pay $9 Million Plus To Settle DOJ/HHS False Claims Charges For Submitting Inaccurate Cost Reports and Mischarging Federal Grants
- OIG Warns Pharma Manufacturers to Prevent Copayment Coupon Use for Part D Drug Purchases
- 10/10 Kidney Foundation Professional Symposium Offers 7.5 Hours CME/CEUs
- Parkview Hospital To Pay $800K To Settle HIPAA Charges After Retiring Physician Blows The Whistle
- Whistleblower To Get $17M+ of Omnicare $124M False Claims Settlement
- Health Care & Other HIPAA Covered Entities Should Review New Reports As Part of HIPAA Risk Management Efforts
- CMS Proposes Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Pre-Authorization Rule
- Medicare Fraud Strike Force Nails 90 Individuals For Almost $260 Million In False Billing Including 16 Doctors
- Columbia to Pay $9 Million Plus To Settle DOJ/HHS False Claims Charges For Submitting Inaccurate Cost Reports and Mischarging Federal Grants
- OIG Warns Pharma Manufacturers to Prevent Copayment Coupon Use for Part D Drug Purchases
- Parkview Hospital To Pay $800K To Settle HIPAA Charges After Retiring Physician Blows The Whistle
- Whistleblower To Get $17M+ of Omnicare $124M False Claims Settlement
- Health Care & Other HIPAA Covered Entities Should Review New Reports As Part of HIPAA Risk Management Efforts
- CMS Proposes Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Pre-Authorization Rule
- Encrypt Mobile Devices & Clean Up Management Documentation Key HIPAA Compliance Messages In New HIPAA Settlements
- Small Smiles Dental Centers Excluded As Federal Health Program Provider For 5 Years
- Latest OCR Resolution Agreement Hits Public Health Department, Shows Needs To Stay Up-To-Date
- NLRB Helps Union Force Another Health Care Employer To Recognize & Bargain With Union
- Federal Health Care Fraud Enforcement Recouped Record $4.3 Billion in FY 2013
- Former Houston Texas Physician Gets 70 Month Prison Sentence For Fraud Conviction
- Euless Healthcare Corporation Owner, Associates Face Conspiracy And Health Care Fraud Charges For Alleged Submission Of $700,000+ In Fraudulent Health Care Claims
- Former Manager 9th Employee Sentenced For Involvement In Maxim Medicare False Claims Action
- Medical Identity Theft/Fraud Convictions Highlight Need For Health Care Providers To Safeguard Health Information, Guard Against Fraud Schemes
- Detroit-Area Foot Doctor Pleads Guilty to Medicare Fraud Scheme
- Merck To Pay $950 Million To Settle Vioxx® Off-Label Marketing Charges
- Texas Physicians Get New Option For Resolving Some Medical Board Complaint
- Broad-Reaching Prosecution Of Individuals Participating In Operations Of Companies Convicted Of Fraud Shows Risks Of Participation
- Hospitals Can Expect CMS To Add Hospital Incident Reporting To Surveys In Response To OIG Report
- Quality, Recordkeeping & Unprofessional Conduct Lead Reasons For Medical Board Discipline of Physicians
- DEA Cautions Practitioners Must Restrict Delegation of Controlled Substance Prescribing Functions, Urges Adoption of Written Policies & Agreements
- If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile here. For important information concerning this communication click here.
THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TO U.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS. ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.
©2015 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press. All other rights reserved.