FierceHealthPayer Anti Fraud: This Week's Headlines

fiercehealthpayerantifraud

HHS misses key opportunities for improper payment recovery

May 16, 2016

While it generally complied with federal improper payment reporting requirements, the Department of Health and Human Services fell short in several key areas, according to an independent audit conducted by Ernst & Young LLP.

OIG to physicians: Be careful whom you do business with

May 16, 2016

In a new "Eye on Enforcement" video, the Office of Inspector General warns physicians to be wary of taking payments from other providers, highlighting a kickback concern the government has targeted over the last several years.

Feds probe relationship between drugmakers, pharmacy benefit managers

May 12, 2016

Federal prosecutors are investigating contracts between three pharmaceutical companies and unnamed pharmacy-benefit managers, an indication the federal government is increasing its scrutiny of potential False Claims Act violations within the agreements, according to the Wall Street Journal.

Medicare contractors relying more on data analytics to investigate fraud

May 10, 2016

Although the number of fraud and abuse investigations initiated by Medicare benefit integrity contractors declined between 2012 and 2013, contractors leaned heavily on predictive analytics to identify fraudulent billing, according to a report released by the Office of Inspector General.

Senate report reignites concerns about physician-owned distributorships

May 10, 2016

Surgeons who have a financial interest in medical device companies are far more likely to perform certain surgeries, according to an updated report that calls for increased scrutiny of the financial arrangements on physician-owned distributorships by the Senate Finance Committee.

MORE NEWS

Former VA Doc, Whistleblower Says OIG Report On Care Delays Is A Farce

fiercehealthcare;
September 18, 2014 | By Katie Sullivan


Experts and doctors once involved in the Department of Veteran Affairs (VA) healthcare system said they don't believe the agency's Inspector General's report captured the impact delays in care had on veteran deaths during a heated hearingin front of the House Committee on Veterans' Affairs this week.

Sam Foote, M.D., the whistleblower who exposed the care delays within the VA system, wants an independent review of delays in care at the Phoenix VA, CNNreported. Foote, who retired from the VA after 25 years of service, said the inspector general's report downplayed data manipulation that he thinks contributed to the death of more than 40 veterans. "In my opinion, this was a conspiracy, possibly criminal, perpetrated by senior Phoenix leaders," Foote said duringtestimony Wednesday.
Rep. Jeff Miller (R-Fla.), chairman of the House Committee on Veterans' Affairs, was disappointed the report didn't bring more issues to light. "It's absolutely inexplicable and outrageous that the IG's Phoenix report failed to clearly make these distinctions," he said in a statement at the hearing.

The report, released in August, said there was no conclusive link to the death at the facility to long wait times. To date, the VA inspector general opened wait time manipulation investigations at 93 sites, only 12 of which have been completed,CNN reported.

However the media attention and reforms since the allegations made a huge impact on the current VA treatment system, Katherine L. Mitchell, M.D., medical director of the Iraq and Afghanistan post-deployment center within the Phoenix VA Health Care System, testified.

"It has been amazing to see the changes within our institution over the last several months which have enabled us to rapidly address many of the needs of veterans in our system to a degree that would not have been possible prior to April 2014," Mitchell said during the hearing. "Problems with care consult backlogs, scheduling difficulties, and the EWL [electronic waitlist] have been significantly reduced or resolved."

To learn more:
- here's the CNN article
- check out Miller's statement
- read Foote's testimony
- here's Mitchell's testimony

Related Articles:
OIG report: No evidence delays in care caused VA deaths
House, Senate leaders deadlock on VA fix
Procter & Gamble's McDonald vows to reaffirm VA values
House approves bill that allows veterans to bypass VA for medical care
Anticipated bill would improve VA wait times
Secret VA wait list reveals 40 vets died while awaiting treatment
18 more vets dead as legislators pen VA reform bill
Investigation into VA wait lists expands to more hospitals
Shinseki resigns as VA secretary amid scandal
Preliminary report: Delay in care rampant through VA healthcare system
VA scandal: Healthcare execs may face criminal charges
VA scandal: Audit reveals 57,000 vets awaiting medical appointments

Thank You Ms Sullivan and Fierce Healthcare.

OIG: State Medicaid Fraud Unit Recovers $181 Million (Tenessee

Fierce Health Finance has;
OIG: State Medicaid Fraud Unit Recovers $181 Million
April 29, 2013 | By Ron Shinkman


Tennessee's Medicaid fraud control unit clawed back $181 million in illegal provider payments and obtained more than 100 criminal convictions and civil settlements between the 2009 and 2011 fiscal years, according to a new report by the U.S. Department of Health & Human Services' Office of the Inspector General.

The report concluded that during that time period, the state's fraud unit obtained 96 criminal convictions--52 of which were for healthcare fraud and 15 for theft of patient funds--and settled 22 civil cases.

Moreover it recovered more than $10.2 million as a result of criminal actions, and obtained another $171.4 million through civil actions.

The OIG was critical of the fraud unit in two instances: The unit investigated one case that did not involve Medicaid fraud, and it failed to report to the OIG criminal convictions involving non-healthcare providers.

Meanwhile, federal fraud cases in Tennessee recently encountered a major setback. Last month, a federal appeals court in Nashville threw out convictions involving more than $94 million in Medicare fraud, reported the Tennessean. According to the federal appeals court, the two cases centered on payment issues, not enrollment, and therefore should have been resolved through an administrative process, the article noted.

For more:
- read the report
- read the Tennessean article

Related Articles:
9 southern states remain Medicaid expansion holdouts
Tavenner reaffirms CMS will look into improper billing by EHR users
HHS clawed back $4.2B from healthcare fraud
Senate issues anti-fraud recommendations


Thank You Fierce Health Finance and Mr Shrinkman.

We're thinking they Might have clawed back more, if they'd gotten All the Medicaid Fraudsters.


Medical Publishing Co. Calls Bullshit

Healthcare Grants To Lobbyists Appear To Be A Violation Of Federal Law

Clearing The Air has;

Investigations Begin: Healthcare Grants Provided To Lobbyists Appear To Be A Violation Of Federal Law

Wednesday, July 11, 2012

Investigations begin: Healthcare grants provided to lobbyists appear to be a violation of federal law

http://thehill.com/blogs/healthwatch/lobbying/237015-hhs-inspector-general-says-grants-may-have-illegally-funded-lobbying
excerpt:

and that the CDC (grant provider) might have led recipients to believe lobbying was appropriate, despite a federal ban on using grant money for political activism.

Some materials the CDC provided to grant recipients “appear to authorize, or even encourage, grantees to use grant funds for impermissible lobbying,” Levinson wrote.

Sen. Susan Collins (R-Maine) raised concerns in May about the grant program, which was designed to promote wellness and prevention. Collins questioned whether the grants had funded political activism, possibly in violation of federal law. 

The HHS inspector general looked into the grants at the request of congressional staff and found the same red flags.

Now let's look at just one of the thousands of grants RWJF provided to lobbyists:

http://www.rwjf.org/pr/product.jsp?id=14912

excerpt:

Two features about the program are significant: (1) the Foundation encouraged its grantees to be activists; (2) advocacy was emphasized to bring about policy change. The program relied heavily on three major health voluntary organizations: the American Cancer Society; the American Heart Association and the American Lung Association. They provided financial support and, in particular, funds to help lobbying efforts which the Foundation could not support directly. In addition to insight on the effects of advocacy, this chapter offers a window into the role of coalitions in bringing about social change.
So RWJF, a tax-exempt non-profit, provided $99,000,000.00 to the three aforementioned non-governmental organizations and instructed them to "be activists" to "bring about policy change" in other words lobby for legislative action. In the grant verbiage RWJF offers an explanation as to the reason for the grant, RWJF could not directly lobby (support directly) for change, but they felt they could funnel money to surrogate lobbyists and be in compliance. According to the HHS inspector that does not appear to be the case, and investigations / penalties could soon begin.......what say you RWJF?

Thank You CTA

THIS, from the RWJF pdf/booklet:

Through the SmokeLess States® Program, The Robert Wood Johnson Foundation has supported the work of the state tobacco-control coalitions across the Nation. The program ranks among the largest investments ever made by the Foundation, with $99 Million authorized since 1992 - more than a fifth of the Foundation's $420 Million portfolio of grants designed to reduce tobacco use in the United States. 

Quit Smoking? With RWJF's Grant Makers?

DSM-IV-TR BILLING CODE 292:00
http://behavenet.com/nicotine-withdrawal

POOF! Presto Chango, You are Incurably, Psychiatrically, Legally Insane, forever.

And there go your Civil Rights, Forever, ALL OF THEM.

SOCIAL CHANGE?

PG 2: SEC 3: CBHS INTEGRATION - CHANGE AGENT UN-CONVENTION

"The networking took place at the scenic Crystal Springs Golf Course and Event Center in Burlingame. More than 175 Change Agents attended. The 2 day event included presentations, story telling about Change Agent team development and experiences, as well as a discussion around shared vision for system change."

We'd suggest you get informed about What a Change Agent is.

http://www.cpusa.org/cpusa-constitution/

There Is NO alternate construction which can be applied to a Change Agent, in light of this:

San Francisco's DBT: COMMUNISM, SWALLOW IT!

Change Agents are the cpusa, ....... They're about Destroying Your Civil Rights, ALL of Them. 

RWJF Grants. Quit Smoking. Get Professional Help. Let's try the document bag again, shall we?

pg 1: RAMS also provides training/consultation on cultural issues in clinical practice to other agencies, collaborates with mental health institutions and Universities in China, Hong Kong, Japan and Russia and hosts International Exchange Clinical Training Programs.

That would be Communist China and Russia. 

This is not McCarthyism. This is SFDPH/CBHS Documentation, and you, in All 50 States, got the Bill to produce SF's Ideology of what constitutes a state of Mental Health verses a Sick Mind.

We have More SFDPH CBHS Change Agent in our files. We'll get to it.

And BTW: That pesky little thing about Civil Rights?

Read the Law. But then what can you expect from Change Agents?

US 18C13 Sec 241 & 242

And you need This post too, since SF's RAMS is heavily involved in the CHANGE.

RAMS: Cultural Crapulence In San Francisco

Read the Performance Audit Memo at the end. $16.3 Million to institute System CHANGE.

OIG: Weak Medicaid Claims Data Fails To Recover Overpayments

Fierce Healthcare has;

OIG: Weak Medicaid Claims Data Fails To Recover Overpayments

April 25, 2012 — 1:20pm ET | By Karen M. Cheung 

Missing or inaccurate Medicaid billing data is holding back contractors from pinpointing providers overpaid by Medicaid and therefore hindering recoveries, the Office of Inspector General reaffirmed its concerns about the weak results from Medicaid Integrity Contractors (MIC) in a report Monday.

The problems with the quality of data and analysis, conducted by review MICs and the Centers for Medicare & Medicaid Services, lead to poorly identified audit targets, the OIG said in the report. CMS assigned auditors to 161 targeted providers with a potential $33.5 million in overpayments. However, as of Feb. 1, audit MICs completed only 127 of them, worth $285,629 in overpayments. Thirty-four of the audits were never completed.

What's more, the OIG said an average of 10 months lapsed from the time CMS assigned the audits to when audit MICs reported their findings to CMS.

CMS, however, defended itself and said it is improving audit target selection by improving the quality of the data that MICs can access for conducting data analysis. CMS also redesigned its audit assignments approach by instructing audit MICs to focus on collaborative projects.

This isn't the first time that OIG has been critical of CMS, suggesting that the recovery programs are slow and ineffective. OIG last month also called on CMS to use a reliable methodology for adjusting the national Medicare fee-for-service error rate. OIG said if CMS overturned Comprehensive Error Rate Testing (CERT) denials in its error rate calculations, it would have decreased the estimated value of reported errors in 2009 and 2010 by approximately $2 billion each year.

For more information:
- here's the OIG report (.pdf)Related Articles:
OIG: Medicare, Medicaid anti-fraud program is ineffective 
5 states top Medicaid fraud list, States recover $1.7B
Millions in Medicaid overpayments uncollected due to faulty auditing
State regulators pull back on Medicaid audits
OIG: CMS missing accurate Medicare error data
OIG critiques deployment of Medicaid integrity contractors

RELATED STORIES

• Georgetown University, hospitals audited for Medicare overpayments
• Hospitals retrain staff on Medicare compliance after OIG audits
• OIG: Nursing homes ill-prepared for disasters
• Brigham and Women's overbilled Medicare $1.5M
• Millions in Medicaid overpayments uncollected due to faulty auditing
• OIG: CMS missing accurate Medicare error data
• OIG: Home health claims add up to $432M improper Medicare payments
• Inadequate training, staff errors lead to Medicare overpayments at Jefferson, other hospitals
• OIG: Home health has 'limited' oversight, reporting
• CMS inaction leaves system holes for fraud, abuse

Thank You Fierce Healthcare and Ms Cheung

But take heart Citizens. Your CMS is On the Case, and all you have to do is sit back and let the Experts handle it.





Medicare Fraud Detection System Disappoints 

"To date, the $77 million computer system, which went online in mid-2011, had prevented exactly one bad claim by late last year. That totaled $7,591."

Obama Taps Dr Seuss To Run CMS