June 16, 2014
NHCAA SmartBrief Special Report
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NHCAA SmartBrief Special Report Part 2:
The June NETS Program
Health care anti-fraud professionals met in San Diego from June 10 to 12 for NHCAA's June NETS program, which addressed how to detect fraud schemes in several medical specialties, including laboratory and diagnostic services, radiology, physical therapy and durable medical equipment. NETS faculty provided case studies and discussed how to spot red flags and identify a wide range of fraud schemes. This NHCAA SmartBrief Special Report, the second in a two-part series, covers some of the topics featured in the June NETS program. Look for continued coverage of these topics in NHCAA SmartBrief.
Fraud and Abuse 
  • Ky. hospital settles allegations of unnecessary heart procedures
    The King's Daughters Medical Center in Ashland, Ky., agreed to pay almost $41 million to resolve allegations of fraudulently billing federal health care programs. The hospital is accused of performing unnecessary heart procedures from 2006 to 2011, including coronary stents and diagnostic catheterizations, and altering medical records submitted to Medicare and the state Medicaid program, according to prosecutors. The state will receive over $1 million of the settlement, which covers only civil fraud allegations. The Sacramento Bee (Calif.) (free registration)/The Associated Press (5/28) LinkedInFacebookTwitterEmail this Story
  • Doctor faces charges in alleged fraud related to foreign IUDs
    Yashica Robinson White, an obstetrician and gynecologist practicing in Alabama, was indicted on charges of health care fraud. White is suspected of fraudulently billing the state Medicaid program for $60,300 worth of foreign IUDs, for which she was reimbursed about $47,104, according to the indictment. The owners and operators of the companies that sold the IUDs were charged with selling counterfeit and misbranded drugs. WSFA-TV (Montgomery, Ala.) (5/27) LinkedInFacebookTwitterEmail this Story
  • Other News
  Government Regulation and Policy 
  • OIG report: CMS still lacks anti-fraud monitoring guidelines
    The CMS has still not provided adequate fraud detection procedures and anti-fraud guidelines for EHRs, according to the HHS Office of Inspector General's semi-annual report. The OIG repeated its January recommendation that the CMS give contractors proper guidance regarding EHR fraud identification and direct contractors to use audit logs. BeckersHospitalReview.com (6/3) LinkedInFacebookTwitterEmail this Story
  • CMS needs better post-payment review system, GAO says
    The CMS has made progress toward improving its claims review system but further action is needed, a Government Accountability Office review found. The CMS does not have a way to stop payment of suspicious claims, has not created uniform guidelines for recovery audit and other contractors, and should improve how it conducts prepayment reviews, the GAO found. McKnight's Long-Term Care News (5/23) LinkedInFacebookTwitterEmail this Story
  • New Medicare rules establish risk categories for DME suppliers
    Medicare has established limited-, moderate- and high-risk categories for durable medical equipment, prosthetics and orthotics suppliers as part of its new enrollment process in a continuing effort to combat fraud and abuse. This article outlines the requirements for each category, noting that all new enrollees, even those just adding a new branch, are in the high-risk category, which mandates fingerprinting and background checks. Current Medicare providers who joined the program before March 25, 2011, must re-enroll through the new screening process no later than March 23, 2015, according to this article. O&P Almanac (Adobe Flash required) (6/2014) LinkedInFacebookTwitterEmail this Story
  • Other News
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Technology Tools 
  • Half of states sharing prescription data via monitoring program
    The National Association of Boards of Pharmacy said 25 states have already joined its prescription monitoring program InterConnect. The initiative enables states to connect to a secure communication platform, share prescription drug data with one another and help health care professionals determine possible abuse or misuse of prescription treatments. The latest states to participate in the program are New Jersey, Idaho and Nevada. Health Data Management (5/30) LinkedInFacebookTwitterEmail this Story
  • Other News
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