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HEADLINES
Wednesday, June 11, 2008

CCH® Health Care Compliance Integrated Library
The Health Care Compliance Integrated Library delivers the latest information on health law. The Library includes seven invaluable titles:
  • Civil False Claims and Qui Tam Actions - An essential tool for bringing or defending Qui Tam action.
  • Clinical Research Compliance Manual: An Administrative Guide - Essential guidance on the laws and regulations affecting clinical research and trials.
  • Defending and Preventing Health Care Fraud and Abuse Cases: An Attorney's Guide - Clear, expert guidance on protecting against charges of health care fraud and abuse.
  • Health Care Fraud and Abuse Compliance Manual - Giving health care providers a clear perspective on fraud and abuse laws, written in plain-language.
  • Health Law and Compliance Update - Find the latest information on emerging issues. Each section is authored by an expert in the area and includes in-depth analysis of the latest health law and compliance issues.
  • Hospital Contracts Manual - Expert, current know-how in dealing with numerous hospital contract scenarios.
  • Hospital Law Manual - Health Law expertise covering treatment and payment issues in the delivery of health care services.

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Health Care Compliance Integrated Library

Reimbursement Advisor

Health Care Compliance Professional’s Manual June 2008

The Health Care Compliance Professional’s Manual is updated quarterly by experienced compliance practitioners and Health Care Compliance Association board members ensuring that the information is always accurate and current. The June 2008 update includes the following new chapters:

  • New Chapter on The 2008-2010 Implementation of the Deficit Reduction Act, written by Brian G. Flood, JD, CIG, CHC, AHFI, CFS.
  • Revised Chapter on Equal Employment and Labor Standards Laws, edited by William P. Schurgin, JD.
  • Revised Chapter on Corporate Integrity Agreements and Certification of Compliance Agreements, edited by Shawn Y. DeGroot, CHC, CCEP.

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Receivables Report

Journal of Health Care Compliance

The May-June 2008 issue of the Journal of Health Care Compliance included the following feature articles:

  • Government/Industry Roundtable Focuses on Quality of Care Oversight by the Board of Directors, by John Falcetano
    • This article discusses the findings of the December 2007 compliance industry and OIG roundtable on longterm care board of director’s oversight of quality of care.
  • The State of the Anti-Markup Rule Regarding Diagnostic Tests, by Kathy J. Tayon
    • This article takes a closer look at the 2008 Medicare Physician Fee Schedule final rule, which among other things amends 42 C.F.R. Section 414.50 prohibiting the marking up of certain diagnostic tests when billing for these tests.
  • The State of the Anti-Markup Rule Regarding Diagnostic Tests, by Kathy J. Tayon
    • This article takes a closer look at the 2008 Medicare Physician Fee Schedule final rule, which among other things amends 42 C.F.R. Section 414.50 prohibiting the marking up of certain diagnostic tests when billing for these tests.
  • A Structured Approach to Developing an Effective Internal Audit Program for Billing and Coding, by Michael Miscoe
    • This article discusses how to develop and implement an effective coding and billing audit program through the use of a structured four-phased process.

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Headlines

Revised Form 990 may be "audit road map," expert says

Revised Form 990, Return of Organization Exempt from Income Tax, touted by the Internal Revenue Service (IRS) as increasing transparency in the nonprofit sector, also may be an "audit road map," Joseph A. Rieser, Partner, Arent Fox, LLP, told nonprofit professionals at an April 3, 2008, program presented by Arent Fox and the Reznick Group in Washington, D.C. He called the level of detail now required by the IRS on Form 990 "striking." CCH Exempt Organizations Reports, Issue No. 406, Report 406, May 12, 2008. Full Story

IRS EO officials discuss hospital questionnaires

The goal of the IRS Exempt Organization (EO) Division's hospital compliance project is to provide the IRS with a better picture of how tax-exempt hospitals operate, according to Geoffrey Campbell, IRS Tax-Exempt/Government Entities (TE/GE) tax law specialist. Campbell spoke at the American Bar Association Section of Taxation meeting on May 9, 2008, in Washington, D.C. CCH Exempt Organizations Reports, Issue No. 407, Report 407, June 9, 2008. Full Story

Medicaid regulations will impede trauma care, Waxman warns

Pending cuts in Medicaid payments to hospitals will hamper hospitals’ ability to care for injured people in the event of a major catastrophe, such as a terrorist attack, according to House Oversight and Government Reform Committee Chairman Henry Waxman (D-Calif.), who held two hearings on the subject in early May. CCH Washington Bureau, May 8, 2008. Full Story

Court affirms price-fixing determination against physician group

The Federal Trade Commission's (FTC's) determination that a physician group's activities with respect to its fee-for-service, or nonrisk, arrangements with payors constituted horizontal price-fixing unrelated to any procompetitive efficiencies was supported by substantial evidence, according to the Fifth Circuit Court of Appeals. The FTC correctly found that the physician group, North Texas Specialty Physicians (NTSP), violated the antitrust laws by collectively negotiating with health plans on behalf of its member physicians in an attempt to obtain higher fees. North Texas Specialty Physicians v. FTC, 5th Cir., May 14, 2008, Health Care Compliance Reporter p800,510. Full Story

Pharmacy chain settles Medicaid fraud claims

Walgreen Co. ("Walgreens"), a national chain of retail pharmacies, has agreed to pay the U.S., 42 states,and Puerto Rico $35 million to settle allegations of Medicaid prescription drug fraud, state and federal officials announced. The settlement resolves claims initiated by a whistleblower who alleged that Walgreens substituted different versions of prescribed drugs solely to increase its reimbursement rate. U.S. Attorney, Northern District of Illinois, Press Release, June 4, 2008. Full Story

SNF quality safeguards are insufficient, OIG says

Current mechanisms used to detect, monitor, and correct quality of care problems in skilled nursing facilities (SNFs) are insufficient because of procedural inefficiencies, communication breakdowns, and inconsistent citing of deficiencies and application of remedies, according to the HHS Office of Inspector General (OIG). OIG Testimony, May 15, 2008, Health Care Compliance Reporter p530,669. Full Story

EHR demonstration will improve quality of care

More than 30 communities have applied for a new demonstration project that will provide Medicare incentive payments to primary care physician practices that use certified electronic health records (EHRs) to improve the quality of patient care, according to HHS. HHS Press Release, May 19, 2008. Full Story
On The Front Lines

Medical identity theft: Patient access first in line to manage the nation's fastest growing crime

by Laura J. Merisalo, Contributing Editor

Medical identity theft is a dangerous and fast-growing crime. Current estimates are that up to 250,000 patients have been victims of medical identity theft, and some estimate that the number of victims may be even higher, affecting as many as 500,000 patients. Full Story
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