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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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In addition to regularly featured columns such as HIPAA, auditing and monitoring, and the anti-kickback statute, the July-August 2008 issue of the Journal of Health Care Compliance includes the following articles:

• “New Enforcement Powers and Incentives Aimed at Medicaid Fraud Enacted by the DRA,” written by Connie Raffa, JD, LLM, discusses the requirements mandated by the Deficit Reduction Act that have enhanced Medicaid enforcement actions and suggest ways a Medicaid provider can protect itself.
• “Corporate Criminal Liability and Cooperation – What Does the Government Expect Now?” written by Gabriel L. Imperato, examines the Sarbanes-Oxley Act, Sentencing Guideline amendments, and the Thompson and McNulty Memoranda issued by the Department of Justice.
• “Compliance Considerations in Working with Third-Party Billing Companies,” written by Karen L. Collier, focuses on important issues providers should consider when outsourcing its billing and coding functions, including contracting and compliance issues.
• “Paying Twice: Medicare Claims for Same-Day Readmissions,” written by Nancy C. McCabe and Anita J. Bhatia, provides an in-depth analysis of related versus unrelated admission and the impact on reimbursement.

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Member groups of the Internal Revenue Service's (IRS's) Advisory Committee on Tax Exempt and Government Entities (ACT) met in open session on June 11, 2008, and made recommendations that would affect the administration of exempt organizations, as well as other topics that fall under the Tax Exempt and Government Entities Division's regulatory umbrella. Addressing what may have been the most controversial topic at the meeting, the ACT Exempt Organizations group recommended that the IRS proceed cautiously on the issue of corporate governance by Internal Revenue Code Sec. 501(c)(3) charities. Bonnie Brier, General Counsel of The Children's Hospital of Philadelphia and co-project leader for ACT's Exempt Organizations group, commented that good governance was more a factor of the organization's individual leadership, not its governance policies. She also said it was unclear whether prescribing specific requirements results in greater tax compliance, noting that studies of for-profit organizations were inconclusive. While it was clear that the IRS would be involved in best practices for exempt organizations, Brier said that the agency must strike a balance between forging requirements and supporting a unique, diverse, vibrant, and flexible charitable sector. CCH Washington Bureau, June 11, 2008. Full Story

Over 27,000 health care providers that received Medicare payments during calendar year (CY) 2006 had payroll and other federal tax debts totaling over $2 billion, according to the Government Accountability Office (GAO). The GAO's analysis of data provided by CMS and the Internal Revenue Service (IRS) revealed abusive and potentially criminal activity. The GAO selected 25 Medicare providers with significant tax debt for more in-depth investigation and found that: (1) some providers diverted payroll taxes withheld from employees for other purposes; (2) individuals associated with some of these providers used payroll taxes withheld from employees for personal gain, while failing to pay their federal taxes; and (3) some providers received Medicare payments despite having quality of care issues. GAO Report, No. GAO-08-618, June 13, 2008. Full Story

A bill entitled "Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008," that promotes the nationwide adoption of a health information technology (HIT) infrastructure has been approved in a voice vote by the House Committee on Energy and Commerce. Provisions of the bill include: (1) incentives for the widespread adoption and use of electronic health records through the creation of three separate competitive grant programs; (2) creation of a demonstration program to integrate HIT into the clinical education of health care professionals, providing $10 million from 2009 through 2011 to fund the project; and (3) additional privacy and security provisions related to protected health information. In addition, the bill promotes the use of electronic health records for each person in the United States by 2014. Statement of Congressman John D. Dingell, Chairman, Committee on Energy and Commerce, June 25, 2008; AMA Press Release, June 4, 2008. Full Story

The HHS Office of Inspector General (OIG) Semi-Annual Report to Congress announced expected recoveries of $2.2 billion for the first half of fiscal year (FY) 2008 as a result of efforts to combat fraud, waste, and abuse in Medicare and other HHS programs. Approximately half of that amount represented audit-related recoveries; the other half consisted of investigation-related recoveries. Also during the reporting period, from October 1, 2007, through March 31, 2008, the OIG reported: (1) exclusions of 1,291 individuals and entities for fraud and abuse involving federal health care programs; (2) 293 criminal prosecutions for crimes against HHS programs, and (3) 142 civil actions, including False Claims Act cases, unjust enrichment suits, civil money penalties law settlements, and administrative recoveries related to provider self disclosure matters. Areas of recent focus for the OIG have included: oversight of Medicare Part D; public health emergency preparedness and response; oversight of food, drug and medical device safety; integrity of information technology and systems; and ethics program oversight and enforcement. OIG Semi-Annual Report, June 12, 2008, Health Care Compliance Reporter, 540,051. Full Story

Recent growth in the number of physician self-referrals, physician-owned specialty hospitals and ambulatory surgical centers (ASCs), and imaging services performed in physician offices and independent diagnostic testing facilities (IDTFs) has resulted in higher utilization of services, increased costs, and treatment of more profitable patients in specialty hospitals and ASCs than in general hospitals, according to a report released by the Robert Wood Johnson Foundation on June 24, 2008. The report addresses: (1) the prevalence and growth of self-referral to physician-owned specialty facilities; (2) factors leading to physician self-referral and the creation of physician-owned specialty facilities; and (3) the effects of physician self-referral and physician-owned specialty facilities on the quality, cost, access and organization of health care. Robert Wood Johnson Foundation Report, Research Synthesis Report No. 15, "Physician self-referral and physician-owned facilities," June 2008. Full Story

Effective December 2, 2008, hospices participating in the Medicare and Medicaid programs must meet new requirements for infection control, quality assessment and performance improvement programs, and qualifications of hospice aides, homemakers, social workers and therapists, according to a CMS Final rule. Rules addressing the following areas have been amended: (1) the deadlines and requirements for initial and comprehensive patient assessments; (2) criminal background checks on all workers who have direct contact with patients or access to patient records; (3) patient records must additional documents; (4) all patient information must be protected from loss or unauthorized use, and all providers must comply with HIPAA; and (5) patient records must be kept for six years after the death or discharge of the patient unless state law requires a longer period. Final rule, 73 FR 32087, June 5, 2008, Health Care Compliance Reporter 700,069. Full Story

After the House overwhelmingly approved legislation to block a 10.6 percent physician pay cut scheduled to take effect on July 1, 2008, the Senate narrowly rejected it. The Medicare Improvements for Patients and Providers Act of 2008 (HR 6331) would have "an unfair cut in the reimbursement rate for doctors who treat Medicare beneficiaries, Senate Finance Committee ranking member Charles Grassley (R-Iowa) said. The 355-to-59 vote in the House was veto-proof, but the Senate fell one vote shy of the 60 needed to pass the bill under expedited rules. CCH Washington Bureau, June 27, 2008. Full Story

CMS has announced plans to launch a ranking system of nursing homes, giving each nursing home a "star" rating. The system is designed to provide patients and their families an easy to understand assessment of nursing home quality. The ratings will be posted on CMS's Nursing Home Compare Web site by the end of 2008. A sample screen shot of the proposed star ratings is available on the CMS Web site at http://www.cms.hhs.gov/PressContacts/10PRfivestar.asp. CMS Press Release, June 18, 2008. Full Story

Recent results of the Hospital Quality Incentive Demonstration (HQID) show substantial improvement in hospital inpatient care, according to CMS. The demonstration, which was launched in October 2003 by CMS and the Premier Inc. Healthcare Alliance, involves about 250 hospitals in 36 states. HQID was designed to test new payment systems under Medicare that would improve the safety, quality, and efficiency of care delivered in hospitals. The top-performing 112 hospitals earned a total of $7 million in incentive payments for substantial and continual advancement in quality of care. CMS has awarded more than $24.5 million over the first three years of the HQID project and extended the project for an additional three years, through September 2009. CMS Press Release, June 17, 2008. Full Story

What providers must know when appealing RAC audit findings

by Paul W. Kim, J.D., MPH, Contributing Editor

Section 306 of the Medicare Modernization Act of 2003 (MMA) instructed CMS to identify both Medicare overpayments and underpayments through the use of new agents called recovery audit contractors (RACs). Launched in March of 2005, the three-year RAC pilot project focused only on California, Florida, New York, Massachusetts, and South Carolina health care providers and suppliers. Because of the enormous success experienced by the RACs in these states, Sec.302 of the Tax Relief and Health Care Act of 2006 directed CMS to expand the RAC audits into all states by 2010. CMS is implementing the RAC program nationwide beginning this summer. Despite complaints and concerns raised by the medical community in the states affected by the RAC reviews through the conclusion of the demonstration in March of 2008, CMS remains very supportive of the results of the RAC audits. According to CMS, the RACs overall have identified almost 440 million in overpayments. What CMS does not state, because CMS does not know yet, is how much of the 440 million will withstand administrative and judicial review. Unfortunately, until Congress or CMS reacts to the outrage of the medical community, providers and suppliers need to brace themselves for allocating and expending sufficient resources to address these RAC audits. Full Story