Thursday, February 4, 2016

Check Out OIG’s Newly Updated List of Corporate Integrity Agreements to Understand Recent Compliance Issues

In keeping up on the latest compliance issues, reporting issues, and the government's view on health care law issues, one of a health care lawyer's regular tasks is to review the latest compliance agreements reached by Office of Inspector General (OIG) for Health and Human Services. 

OIG negotiates corporate integrity agreements (CIA) with health care providers and other entities as part of the settlement of Federal health care program investigations arising under a variety of civil false claims statutes. Providers or entities agree to the obligations, and in exchange, OIG agrees not to seek their exclusion from participation in Medicare, Medicaid, or other Federal health care programs. This is also usually part of an agreement not to pursue or file criminal charges.

We also have clients review them in order for them to understand the government's view on various business practices in health care. If your business is interested, here is the OIG's posted list of corporate integrity agreements.  They are in PDF and can be downloaded and reviewed. 

CIAs have many common elements, but each one addresses the specific facts at issue and often attempts to accommodate and recognize many of the elements of preexisting voluntary compliance programs.

A comprehensive CIA typically lasts 5 years and includes requirements to:
 1. hire a compliance officer/appoint a compliance committee;
 2. develop written standards and policies; 
 3.  implement a comprehensive employee training program; 
 4.  retain an independent review organization to conduct annual reviews; 
 5.  establish a confidential disclosure program; 
 6.  restrict employment of ineligible persons; 
 7.  report overpayments, reportable events, and ongoing investigations/legal proceedings;      and 
 8.  provide an implementation report and annual reports to OIG on the status of the entity's compliance activities.

Keep compliant and make sure that your health care entity does not end up on this list.

Posted by Tracy Green, Esq. 

Wednesday, February 3, 2016

West Virginia Physician Pleads Guilty to Federal Illegal Prescribing and Health Care Fraud

The number of prescribing cases filed in federal courts increases especially in areas that have been hit hard by prescription drug addiction.  Last month, on January 7, 2016, Jose Jorge Abbud Gordinho, M.D., of West Virginia, pleaded guilty in federal court to illegally prescribing the pain medication hydrocodone. Dr. Gordinho also pleaded guilty to defrauding Medicare and Medicaid by submitting materially false claims for medical services that were not medically necessary.

United States District Judge Irene C. Berger set Dr. Gordinho’s sentencing for April 26, 2016, in Beckley. Dr. Gordinho faces up to 10 years in federal prison, a $1,250,000 fine, and restitution to Medicare and Medicaid. Additionally, as part of the plea agreement, he will permanently surrender his DEA Certificate of Registration, ensuring that he will no longer be permitted to prescribe controlled substances. The sentence will be determined by Judge Berger and will depend on numerous factors and advisory guidelines.

Dr. Gordinho admitted that he routinely prescribed pain pills for illegitimate purposes and in a manner that was outside the bounds of medical practice. Dr. Gordinho further admitted that he defrauded Medicare and Medicaid when he sought and received payment for office visits, services, and prescriptons related to his illegal prescribing practices.

Wednesday, January 27, 2016

Drug Medi-Cal Fraud Case Set for Trial in May 2016 For Alleged Submission of False Claims for Alcohol and Drug Treatment and Counseling for Students

Trial is set for May 10, 2016 in federal court in Los Angeles regarding the operation of a Caliornia Drug Medi-Cal provider Atlantic Health Services, formerly known as Atlantic Recovery Services (ARS) in which eight individuals were indicted and charged with health care fraud and aggravated identity theft.

The Drug Medi-Cal programs in the schools was a unique program and there may be very good defenses to this case given the County contracts, the approval of billing and submissions in the past, the State agency that regulated these programs and upon which the programs relied, and the aggressive tactics that Medi-Cal used when it decided to cut these programs.  

The overall allegation was that ARS submitted more than $50 million in fraudulent bills to a California state program for alcohol and drug treatment services for high school and middle school students that, in many instances, were not provided or were provided to students who did not have substance abuse problems. 

The eight defendants are all former employees of ARS, which received contracts to provide substance abuse treatment services through the Drug Medi-Cal program to students in schools in Los Angeles County. 

The schools included various sites operated by Soledad Enrichment Action and public schools in Montebello, California, Bell Gardens, Californina, Lakewood, and the Antelope Valley. ARS submitted claims for payment to the Drug Medi-Cal program for at least ten years and ARS shut down in April 2013, when California suspended payments to the company.

Monday, January 25, 2016

OIG Exclusion and Reinstatement of Excluded Individuals and Entities

One of the collateral consequences of criminal convictions for health care professionals is exclusion by the Office of Inspector General (OIG). The OIG exclusion list should be reviewed to confirm that the individual or entity is on it.

We have also seen individuals who were excluded and did not know it due to issues such as being in default of student loans.

One issue to understand is that reinstatement of excluded entities and individuals is not automatic once the specified period of exclusion ends. Those wishing to again participate in the Medicare, Medicaid (Medi-Cal) and all Federal health care programs must apply for reinstatement and receive authorized notice from OIG that reinstatement has been granted.

We have handed numerous reinstatement requests. OIG runs a background and one of the key issues is whether the individual or entity has been following the exclusion rules. We advise people to calendar 90 days before reinstatement period ends since the process can be started at that time. 

Sunday, January 24, 2016

Pennsylvania Physician And One Other Plead Guilty To Health Care Fraud Charges Arising From Writing A Fraudulent Prescription in Another Person's Name

Writing a prescription in another person's name is a fraudulent prescription. When that visit or prescription in the other person's name is billed to Medicare or insurance, then there is also health care fraud. When a Schedule II drug is involved, there is also a potential drug count.

On January 15, 2016,  Dr. John Terry and Stephen Heffner, Jr. pleaded guilty before Chief United States District Court Judge Christopher C. Conner in Williamsport, Pennsylvania.

According to the plea agreement, in April 2013, Dr. Terry caused Medicare to be billed for fraudulent prescriptions intended for Mr. Heffner knowing that Mr. Heffner was not his patient and that the Oxycodone was not actually intended for Mr. Heffner but for Dr. Terry’s patient, David Hatch of New York.  Medicare paid for the prescription received by Mr. Heffner but actually delivered to Mr. Hatch.

Saturday, January 23, 2016

Riverside Woman Convicted in Federal Court of Stealing Identities of Residents of Medical Facility in Long Beach. Reason Facilities Need Strong HIPAA and Privacy Procedures.

One of the reasons medical facilities should have strong HIPAA policies and procedures, as well as enforcement and training, is to prevent employees or third parties from taking medical information for other improper or illegal purposes.

Last week, Bridgette Jackson of Riverside, California was convicted in federal court after a jury trial on federal identity theft charges for possessing the identities of more than 50 patients of a residential medical facility in Long Beach formerly known as the Hillcrest Care Center. She was convicted of conspiring to possess more than 15 identities, possessing more than 15 identities, and aggravated identity theft.

Ms. Jackson’s aunt, who testified against her at the trial, was an employee at the Hillcrest Care Center and had access to all of the patient files. According to the testimony at trial, Ms. Jackson approached her aunt and asked for personal identifying information of patients. Ms. Jackson’s aunt copied or wrote down personal identifying information and provided it to Ms. Jackson on three separate occasions. 

Ms. Jackson then used that information to help others file false tax returns in the names of the patients and keep the refunds for themselves. When law enforcement executed a search warrant on Ms. Jackson’s residence, officers seized approximately 56 Hillcrest medical records, along with almost 70 other identity profiles, which included names, social security numbers, and dates of birth of individuals other than Ms. Jackson. Law enforcement also seized over 50 prepaid debit cards in names of people other than Jackson.

After the jury verdict was reached, United States District Judge Manuel L. Real scheduled a sentencing hearing for March 7. At that time, Jackson will face a mandatory minimum sentence of two years in federal prison and a statutory maximum sentence of 17 years.   In an unrelated case, Ms. Jackson pled guilty last year to conspiring to commit credit card fraud in the United States District Court in Riverside and faces up to five years when she is sentenced in that case on March 28.

Attorney Commentary:  The black market for patient identity exists. Low paid clerical or medical workers can be susceptible to third parties (here a family member) seeking information. In addition, health care facilities' computer systems are now being targeted. Having a HIPAA audit and compliance is key so the facility does not face civil liability by the patients or OIG fines for the HIPAA violations.

Posted by Tracy Green, Esq.
Work: 213-233-2260


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