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HEADLINES
Wednesday, June 11, 2008
Click on a headline below for the
full story.
On
The Front Lines
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Health
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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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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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