2015

January 5, 2015 Hot Topics

FRAUD

1. “Cheat Sheets” used by nursing staff to access resident’s DNR/code status – Minnesota Department of Health investigators found neglect on the part of a Pioneer Care facility located in Fergus Falls, MN in an incident involving a resident who died without being given CPR. The state investigation finding of neglect was based partly on the facility’s informal system or “cheat sheet” maintained by the nursing staff to access each resident’s advance directive choice or “code status”.

Hot Topics – 12/29/2014

December 29, 2014 Hot Topics

LITIGATION

1. Production of Quality Assurance Committee documents under the Federal Nursing Home Reform Amendments (The Act), 42 U.S.C. Section 1396r: The Arizona Appellate Court, in Azore LLC v. The Honorable Edward Basset, reviewed the trial court’s order compelling Sunwest Choice Healthcare and Rehab, an Azore corporation, to produce emails, a consultant report and incident tracking logs associated with its quality assurance committee in a wrongful death action.

Hot Topics – 12/09/2014

December 9, 2014 Hot Topics

FRAUD

1. Hospice: The U.S. Department of Justice has filed a whistle-blower suit against Creekside Hospice II LLC and its holding company alleging that they knowingly submitted false claims for hospice care for patients who were not terminally ill and instructed staff to falsify records, billed for doctors visits that never occurred, and discouraged staff from documenting improvements in patient’s health and from permitting patients and families from revoking their election of hospice. This action was originally brought by two Creekside clinical managers under the whistleblower provisions of the Federal False Claims Act and the Nevada False Claims Act.

Hot Topics – 11/21/2014

November 21, 2014 Hot Topics

FRAUD

1. A new bill introduced by Representatives Ted Deutch (D-FL) and Peter Roskam (R-IL) called Stop Schemes and Crimes Against Medicare and Seniors Act (“SCAM”), if passed, would require Centers for Medicare & Medicaid Services (“CMS”) to “scrutinize” owners of long term care facilities for history of fraud violations by requiring CMS to perform checks using a variety of databases.

Hot Topics – 11/14/2014

November 14, 2014 Hot Topics

FRAUD

1. Exclusion: The Office of Inspector General for HHS settled the following cases alleging fraud due to the employment of an excluded individual:

Hot Topics – 10/27/2014

October 27, 2014 Hot Topics

FRAUD

1. Pharmacy: A NJ pharmacist, with a compounding pharmacy in Lakewood, NJ, pleads guilty to charges of conspiracy to violate the Anti-Kickback Statute (by paying more than $50,000 to a middle person to bribe physicians for referring pain cream prescriptions) and to committing healthcare fraud (by falsely representing the pain cream, which was not covered by many insurance companies including Medicare, as another medication in order to obtain reimbursement). The original complaint was filed by the U.S. Attorneys Office, District of New Jersey, in January 2014. Sentencing is scheduled for 1/20/2015 and carries a maximum penalty of five years in prison, $250,000 fine, and forfeiture of any proceeds derived from his offense. (United States of America v. Vladmir Kleyman, aka Pinchas Kleyman)

Hot Topics – 10/10/2014

October 10, 2014 Hot Topics

FRAUD

1. Two Whistle-Blower suits, under the False Claims Act, were brought by private citizens on behalf of the United States against Extendicare Health Services Inc, a corporation that operates 146 skilled nursing facilities. The actions alleged that Extendicare billed Medicare and Medicaid for materially substandard nursing services including insufficient staffing, inadequate catheter care and failure to follow appropriate protocols to prevent pressure ulcers and resident falls. The action further alleged that Extendicare billed Medicare for medically unreasonable and unnecessary rehabilitation therapy services. Extendicare agreed to pay $38 million in settlement and to enter into a 5 year Corporate Integrity Agreement with HHS-OIG. According to HHS-OIG, this is the department’s largest failure of care settlement with a chain-wide skilled nursing facility to date. See Justice News, U.S. Department of Justice, Office of Public Affairs, October 10, 2014; U.S. ex rel. Lovvom v. EHSI, et. al. C.A. 10-1580 (E.D. Pa) and U.S. ex rel. Gallick et al., v. EHSI et al., C.A. 2:13cv-092 (S.D. Ohio).

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Hot Topics – 10/03/2014 – Part – 2

October 3, 2014 Hot Topics

I. FRAUD

Health and Human Services issued a proposed rule on 10/03/2014 entitled “ Medicare and State Health Care Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements and Gainsharing”. The proposed rule will amend 42 CFR 1001.952 (Anti-Kickback Statute & Safe Harbors) by adding new protections, including:

Hot Topics – 10/03/2014 – Part – 1

October 3, 2014 Hot Topics

FRAUD

1. Two Detroit-area residents were arrested and charged with conspiracy to violate the Anti-Kickback Statute because of their alleged role in recruiting and referring Medicare beneficiaries to two Detroit-area home health agencies in exchange for monetary consideration. This case was investigated and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. See Justice News, Department of Justice, Office of Public Affairs: http://www.justice.gov/opa/pr/two-defendants-charged-connection-detroit-area-home-health-kickback-scheme