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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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CMS has proposed changes to the Medicare Part B payment policy to ensure that payment systems are updated to reflect changes in medical practice and the relative value of services delivered by physicians to beneficiaries under the 2009 Medicare Physician Fee Schedule (MPFS). Under Medicare law, CMS is required to reduce 2009 Physician Fee Schedule by 5.4 percent. The CMS proposed rule would provide for additional improvements to the Physician Quality Reporting Initiative (PQRI), including: (1) a final set of quality measures to be selected from 175 measures that fall into four broad categories; (2) increasing the number of conditions covered by measures groups to nine; (3) two new reporting periods to provide eligible professions with additional options for reporting PQRI data; and (4) accepting PQRI data via clinical registries and electronic health records systems. CMS Proposed Rule, 73 FR 38501, July 7, 2008. Full Story

Only July 15, 2008, Congress overrode President Bush's veto of legislation that would stave off a 10.6 percent reduction in Medicare physician payments that was to take effect on July 1 and increase physician pay by 1.1 percent in 2009. In addition to physician payment changes, the “Medicare Improvements for Patients and Providers Act of 2008” (MIPAA) (H. 6331) will decrease payments to Medicare Advantage (MA) plans. The override vote was 70 to 26 in the Senate and 383 to 41 in the House. The Senate had passed the legislation with a veto-proof 69 to 30 after the House passed the bill with a veto-proof margin of 355 to 59. CCH Washington Bureau, July 9, 2008 Full Story

Projected payments under the outpatient prospective payment system (OPPS) for calendar year (CY) 2009 are expected to rise to $28.7 billion, and projected payments for services at ambulatory surgery centers (ASC) will be $3.9 billion in CY 2009, according to an advance release of a CMS Proposed rule. The increase in the OPPS includes a 3.0 percent annual inflation update for most services. Current law does not allow for an inflation update to the ASC payment rate. Hospitals that fail to report data on seven quality measures in CY 2008 will only receive a one percent inflationary increase for services provided in CY 2009. Four new quality measures will be added for CY 2009, which hospitals must report if they want to receive the full inflation increase in CY 2010. CMS Advance Notice of Proposed Rulemaking, July 3, 2008. Full Story

A health care system that would provide $10 gift certificates to patients whose service expectations were not met would not be providing prohibited remuneration, according to an Office of Inspector General (OIG) advisory opinion. Under the health care system's proposed gift card plan, $10 gift cards from local vendors, such as restaurants and theater chains, would be provided to patients with complaints about service shortfalls, including excessive wait times, cancelled appointments, delayed meals, excess noise, housekeeping, dietary concerns, equipment problems, and loss of personal items. The gift cards would not be redeemable for health care items or services at places like pharmacies or durable medical equipment suppliers. The health care system would track the issuance of gift cards under the program to make sure that no one patient receives more than $50 worth of gift cards within one year and to identify service areas that need improvement. In addition, the gift card program would not be advertised. OIG Advisory Opinion, Doc. No. 08-07, June 27, 2008, Health Care Compliance Reporter, 500,186. Full Story

The attorney-client privilege waiver policy at the Department of Justice (DOJ), the “McNulty Memorandum,” is coming under pressure to be revised, following communication between Deputy Attorney General Mark Filip and members of the Senate Judiciary Committee. In a letter response, Sen. Arlen Specter (R-Pa.), ranking member of the committee, expressed concern about the delay in enacting legislation while the DOJ continued to act under the McNulty Memo. Among his concerns were individuals incurring enormous attorneys' fees, including appellate litigation, while the guidelines were analyzed, vague revisions that did not address the waiver of privilege, and potential for future modifications by subsequent attorney generals. Response Letter of Sen. Arlen Specter to Deputy Attorney General Mark Filip, July 10, 2008. Full Story

A mother and her two daughters, the owners of four Miami-based healthcare corporations, were sentenced to prison for their roles in schemes to defraud the Medicare program for unnecessary medicine, durable medical equipment (DME) and home health care services. The family owned two DME companies, a home health company, and an assisted living facility. Under the scheme, patients were paid cash kickbacks for use of their Medicare cards, were falsely diagnosed with chronic obstructive pulmonary disease, and were prescribed unnecessary aerosol medications. In addition, co-conspirator pharmacies were paid more than $14 million based on the submission of claims for medically unnecessary aerosols. DOJ News Release, June 27, 2008. Full Story

Deputy Administrator Herb Kuhn assured lawmakers that CMS is working to prevent fraudsters from using the identification of deceased physicians to obtain payment on false Medicare claims. At a Senate Homeland Security and Government Affairs Investigations Subcommittee hearing, Kuhn said that CMS will be working with the Social Security Administration (SSA) to make sure this problem, estimated to have cost the program about $100 billion, does not continue. CCH Washington Bureau, July 9, 2008. Full Story

An analysis of the new Schedule H (IRS Form 990) and proposed instructions: Are hospitals ready for increased disclosures? Part I

By Albert Y. Lin, LLM, CPA, Health Care Compliance Advisory Board Member

An ounce of prevention is worth a pound of cure. Borrowing from Benjamin Franklin's proverb and the oft-repeated mantra of health care professionals, a thorough understanding of the newly-finalized Schedule H (Hospitals) to Form 990, Return of Organization Exempt from Federal Income Tax, may save the compliance officer and hospital tax advisors a lot of stress when the first full Schedule H is due in 2010 for the 2009 calendar year activities. Subsequent to the original release of the redesigned Form 990 on December 20, 2007, draft instructions followed on April 7, 2008, and the Internal Revenue Service (IRS) Exempt Organizations Division solicited public comments through June 1, 2008. This Article focuses on the new Schedule H, which, while deceptively brief at four pages, results from demands for more transparency and consistency in reporting exactly how hospitals fulfill the general charitable purposes requirement for tax-exempt hospitals. The new Schedule H itself is broad; the underlying 2008 Schedule H Form 990 Instructions - Draft (“Draft Instructions”)and accompanying Worksheets, designed to help calculate requested figures related to charity care and community benefit, contain far more instructive guidance. The Draft Instructions should be finalized later in 2008 as the IRS disseminates the public comments. Full Story