OIG posts 5 reports and news about enforcement actions - 7/19

Good morning to all from Washington, DC. Today OIG posts five reports and news about enforcement actions. As always, you can use the links provided to go directly to the new material.   ------------------------------------------------------------------------------   CGS Administrators, LLC, Paid Unallowable Lower Limb Prosthetics Claims (A-06-12-00055) http://go.usa.gov/jWGH   CGS Administrators, LLC (CGS) (operating in Tennessee), paid $6 million for 4,260 lines of service for lower limb prostheses in 2010 and 2011 that did not meet local coverage determination (LCD) requirements.  At the time that CGS paid these lines of service, it did not have edits in place to evaluate whether they met all the LCD requirements.  In 2012, the Centers for Medicare & Medicaid Services (CMS) issued a technical direction letter that instructed CGS and the other Durable Medical Equipment Medicare Administrative Contractors to put in place claim edits for all requirements set forth in the lower limb prosthetics LCD.   We recommended that CGS:   (1) Recover $6 million in identified overpayments for lines of service for lower limb prostheses that did not meet LCD requirements in 2010 and 2011 and   (2) Monitor the edits it developed in response to CMS’s March 2012 technical direction letter to ensure that the edits are functioning correctly.    CGS concurred with our recommendations and described corrective actions that it had taken or planned to take. ------------------------------------------------------------------------------   Medicare Compliance Review of University of Kansas Hospital for Calendar Years 2009 and 2010 (A-07-11-01105) http://go.usa.gov/jW7k   The University of Kansas Hospital (the Hospital) (operating in Kansas) complied with Medicare billing requirements for 38 of the 79 inpatient and outpatient claims we reviewed.  However, the Hospital did not fully comply with Medicare billing requirements for the remaining 41 claims, resulting in net overpayments totaling $254,000 for calendar years 2009 and 2010.  Overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of Medicare claims.   ------------------------------------------------------------------------------   Medicare Compliance Review of Via Christi Hospital for Calendar Years 2009 and 2010 (A-07-11-01099) http://go.usa.gov/jW7P   Via Christi Hospital (the Hospital) (operating in Kansas) complied with Medicare billing requirements for 39 of the 67 inpatient and outpatient claims we reviewed.  However, the Hospital did not fully comply with Medicare billing requirements for the remaining 28 claims, resulting in net overpayments totaling $170,000 for calendar years 2009 and 2010.  Overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of Medicare claims. ------------------------------------------------------------------------------   Wing Memorial Hospital Did Not Always Bill Correctly for Evaluation and Management Services Related to Diagnostic or Therapeutic Procedures and Supartz Injections (A-01-12-00519) http://go.usa.gov/jW7G   Wing Memorial Hospital (the Hospital) (operating in Massachusetts) complied with Medicare billing requirements for 47 of the 156 claims reviewed.  However, the Hospital did not fully comply with Medicare billing requirements for the remaining 109 claims, resulting in overpayments of approximately $104,000 for the period January 2, 2009, through March 2, 2012.  Overpayments occurred primarily because the Hospital staff did not fully understand Medicare requirements for separately billable evaluation and management (E&M) services and did not have the necessary education to code the correct level of E&M service. ------------------------------------------------------------------------------   Meritus Medical Center Refunded Overpayments for Physician Claims With Place-of-Service Coding Errors For 2009 Through 2012 (A-01-12-00531) http://go.usa.gov/jW7z   We verified that Meritus Medical Center (the Hospital) (operating in Maryland) submitted 17,000 claims with overpayments of $568,000 for physician services for calendar years 2009 through 2012.  The Hospital, billing on behalf of its wound care facility physicians, incorrectly coded these claims by using nonfacility place-of-service codes for services that were actually performed in the Hospital’s wound care center.  The Hospital refunded the overpayments.     ------------------------------------------------------------------------------    July 18, 2013; U.S. Department of Justice Owner of Los Angeles-area DME Company Pleads Guilty to Conspiring to Defraud Medicare and Medi-Cal http://go.usa.gov/burG ------------------------------------------------------------------------------   July 18, 2013; U.S. Attorney; Southern District of New York United States Settles Medicare Billing Fraud Lawsuit with Multi-Specialty Health Care Provider for $1 Million http://go.usa.gov/burG ------------------------------------------------------------------------------   July 18, 2013; U.S. Attorney; District of New Jersey South Jersey Doctor Sentenced To Two Years in Prison for Fraud Scheme Involving Home Health Care for Elderly Patients http://go.usa.gov/burG ------------------------------------------------------------------------------   July 18, 2013; U.S. Attorney; District of Maryland 16 Defendants Charged In a Commercial Burglary Ring and Drug Conspiracy http://go.usa.gov/burG  ------------------------------------------------------------------------------   July 18, 2013; U.S. Attorney; Eastern District of Missouri Local Physician, Clinic and Nurse Practitioner Indicted On Health Care Fraud Charges http://go.usa.gov/burG ------------------------------------------------------------------------------   July 17, 2013; U.S. Attorney; Southern District of New York Manhattan U.S. Attorney Announces Charges against Eight Individuals in Connection with $2.3 Million Bribery and Kickback Scheme to Secure Business from a Medical Cost-Management Company http://go.usa.gov/burG   ------------------------------------------------------------------------------   July 17, 2013; U.S. Attorney; Middle District of Pennsylvania Williamsport Resident Sentenced To 70 Months on Federal Tax Charges http://go.usa.gov/burG ------------------------------------------------------------------------------   State Enforcement Actions Updated http://go.usa.gov/buYC ------------------------------------------------------------------------------   That’s all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov I hope your week has gone well and you are able to enjoy the upcoming weekend.   Marc Wolfson – Office of External Affairs OIG’s privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp Follow us on Twitter: http://twitter.com/OIGatHHS Inquiries? Contact us: Public.Affairs@oig.hhs.gov Manage your OIG subscriptions: update your preferences or unsubscribe Questions about this service? Support@GovDelivery.com This email was sent to buzzhairs.health@blogger.com using GovDelivery, on behalf of the U.S. Dept. of Health & Human Services · 200 Independence Avenue SW · Washington DC 20201 · 1-877-696-6775