Fraud_and_Abuse-student_s_copy
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Fraud_and_Abuse-student_s_copy

Course Number: HCA 580, Spring 2011

College/University: University of Louisiana...

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FraudandAbuse DefinitionsofFraudandAbuse Acts of providers that are deemed to have defrauded the government or abused the right to bill for services rendered The distinction between fraud and abuse is not always clear The degree of intent by the individual or entity under investigation is often the determining factor WhatisFraud? Fraud is defined as knowingly and willfully executing or attempting to execute, a...

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of FraudandAbuse DefinitionsofFraudandAbuse Acts providers that are deemed to have defrauded the government or abused the right to bill for services rendered The distinction between fraud and abuse is not always clear The degree of intent by the individual or entity under investigation is often the determining factor WhatisFraud? Fraud is defined as knowingly and willfully executing or attempting to execute, a scheme to defraud any health care benefit program or to obtain by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program CommonExamplesofFraud Billing for services not provided Billing for services as if performed by the physician when they were in fact performed by someone else Using an incorrect or inappropriate provider number in order to be paid Selling or sharing patients Medicare numbers Falsifying information on medical records, billing statements, or other statements to the government CommonExamplesofFraud Misrepresenting the diagnosis to justify payment Unbundling or exploding charges Paying or receiving remuneration or kickbacks for referrals Violation of federal and state statutes relating to self-referrals Billing based on what is often referred to as gang visits Inappropriate billing for teaching physicians CommonExamplesofFraud Misrepresenting the identify of the person receiving services Deliberately changing dates of service to circumvent correct coding edits Falsely applying for Medicare or Medicaid certification by falsification of address, or misrepresentation of credentials Reporting an incorrect place of service Ghost patients WhatisAbuse? Abuse may directly or indirectly result in unnecessary costs to a program such as Medicare or Medicaid, improper payment, or payment for services that fail to meet professionally recognized standards of care or that are medically unnecessary Typically, the physician or other health care professional has not knowingly and willfully misrepresented facts to obtain payment CommonExamplesofAbuse Performance of services considered by the carrier to be medically unnecessary Failure to document medical records adequately Unintentional, inappropriate billing practices such as misuse of modifiers Medicare limiting charge violations Failure to comply with a participation agreement Inadvertent filing of duplicate claims SourcesofInformationonFraudand Abuse Complaints from the public Disgruntled employees Third party payer reviews Competitors Medical boards Beneficiaries FraudandAbuseStatutes Federal False Claims Act Allows the government or citizens to bring civil action or criminal action against physicians and others filing fraudulent claims Provides for a civil penalty of $11,000 per false claim, plus three times the amount of damages that the government maintains No specific intent to defraud is required to file charges against a provider Criminal FCA provisions impose criminal penalties (imprisonment and criminal fines) QuiTamSuits A provision of the Federal False Claims Act whereby private citizens may bring suit on behalf of themselves and the government against fraudulent health care providers Qui Tam plaintiffs (called relators or whistle-blowers) may receive 10-30% of the total recovery Law provides protection to the whistle-blower against retaliation According to a report by HHS and the Department of Justice $87,335,798 was paid out to whistle-blowers in 2001 FraudandAbuseStatutes Stark I Stark legislation prohibited physicians from referring Medicare patients to a clinical lab in which he or an immediate family member has a financial responsibility Stark II OBRA 1993 extended Stark I to other designated health services and to Medicaid payments Stark III further defined penalties FraudandAbuseStatutes Stark IIs designated health services Clinical lab Physical therapy Occupational therapy Radiology Radiation therapy DME including parenteral/enteral nutrients Prosthetics Home health Inpatient/outpatient services FraudandAbuseStatutes The Anti-kickback Statute prohibits the knowing and willful solicitation or receipt of any remuneration (including anything of value) OR the knowing and willful offer to pay or payment of an remuneration, whether in direct or indirect, overt or covert in case or in kind for referring a patient for the furnishing of a service or purchasing, leasing, or ordering any item or service paid for under a federal health program FraudandAbuseStatutes There are criminal penalties and administrative sanctions for violating AKS to include fines, jail terms, and exclusion Penalties can be $50,000 per kickback claim and three times the amount of remuneration Safe Harbor laws protect certain payment and business practices that otherwise might be subject to AKS http://oig.hhs.gov/fraud/safeharborregulations.asp Relationshipswiththe PharmaceuticalandMedicalDevice Industries Physician-industry collaboration can produce important medical advances However, some drug and device companies have used sham consulting agreements to buy physician loyalty to their products Physicians should evaluate the link between the services that he/she can provide and the compensation that will be received ExamplesofKickbacks/Selfreferrals Universal Health Services Intercare Health Systems Rush University Medical Center Kerlan Jobe Orthopedic Clinic South Texas Health System HIPAA HIPAA added substantial funding for fraud and abuse activities for several of the agencies concerned with fraud and abuse Most of the funding allows the hiring of additional investigators and other enforcement personnel HIPAA increases penalties for fraud and abuse and offers incentives payable to informants HIPAA authorizes the Department of HHS to offer Medicare beneficiaries a bounty or reward to report any fraudulent practices HIPAA HIPPA has many other provisions: The Act specifically defines upcoding The Act requires mandatory exclusions from Medicare for 5 to 10 years for certain offenses The Act describes the level of intent that has to be proved before a physician can be convicted The Act establishes penalties for any physician who certifies unneeded home health care The Act provides for Medicare or Medicaid exclusions to apply to all federal health care programs (TRICARE, VA, etc.) KnowsorShouldKnow The government applies the concept of Know or Should Know meaning that ignorance is not a legitimate argument for why a fraudulent or abusive act took place The provider should know if information was posted in Coding Clinic (ICD-9-CM and HCPCS) CPT Assistant ICD-9-CM or CPT codebooks Carrier or intermediary bulletins, manuals or memos EnforcementAgenciesandStatutes A number of enforcement agencies are involved with fraud and abuse actions: Department of Justice FBI CMS OIG DEA Medicare carriers State attorney generals IRS EnforcementAgencies OIG one of the agencies most involved. It provides to oversight CMS, FDA, NIH, CDC Agencies under OIG Office of Evaluation and Inspection Office of Counsel to the Inspector General Office of Audit Services Office of Investigations Office of Budget OIG Each year, the OIG publishes a Work Plan which identifies major areas of concern which will be investigated The Work Plan identifies problem areas by type of provider: hospital, physicians, home health, durable medical equipment, nursing homes, etc. OIGWorkPlanExamples Hospitals Oversight of Joint Commission organizations Prospective payment system updates Inpatient outlier and other charge issues Consecutive inpatient stays Medical necessity of psychiatric stays and rehabilitation stays Inpatient rehabilitation payments Coronary artery stents Diagnostic testing in emergency room Outpatient prospective payment systems Outpatient rehab services MS-DRG payment limits Hospital reporting of restraint-related deaths OIGWorkPlanExamples Physicians Consultations Coding of E&M services Use of modifier 25 Long distance physician claims Care plan oversight Billing for diagnostic tests Radiation therapy services Place of service errors Use of modifier with NCCI edits Services and supplies incident to physicians services Ordering physicians excluded from Medicare OIGsVoluntaryDisclosure Protocol In 1998, the OIG unveiled an expanded and simplified program for health care providers to voluntarily report fraudulent conduct affecting Medicare, Medicaid and other federal health care programs The program is called Provider Self-Disclosure Protocol This program does not protect the provider from civil or criminal action but the self-reporting of wrong doing could be a mitigating factor in the OIGs recommendations to prosecuting agencies OIGsVoluntaryDisclosure Protocol The protocol offers a step-by-step explanation of how a provider should proceed in reporting and assessing the extent of wrongdoing and how the OIG will go about verifying irregularities StateLaws Many states have enacted legislation to curb fraudulent practices and false claims NewInitiatives Recovery Audit Contractor program (RAC) Began in March 2005 as a 3 year demo project in New York, California, and Florida Now expanding nationwide as of 2011 The RAC program is designed to find and correct improper Medicare payments paid to health care providers participating in fee-for-service Medicare NewInitiatives 96% of the improper payments identified by the RACS in 2007 were overpayments; 4% were underpayments In FY 2007, overpayments collected were $124.6 million in Florida; $120.1 million in California and $112.5 million in New York - a total of $356.2 million NewInitiatives Health Care Fraud Prevention and Enforcement Action Team (HEAT) HEAT is an effort to enhance collaboration between the Departments of Health and Human Services and the Department of Justice created in 2009 HEAT is jointly led by the Deputy Attorney General and HHS Deputy Secretary and is dedicated to prevent fraud and enforce current anti-fraud laws in the U.S. The Medicare Fraud Strike Force teams are a key component of HEAT NewInitiatives The first Medicare Fraud Strike Force was launched in 2007 as part of the South Florida Initiative, a joint investigative and prosecutorial effort again fraud and abuse among DME supplies and HIV infusion therapy providers in South Florida There are strike forces in a total of seven cities Miami, Los Angeles, Detroit, Houston, Brooklyn, Tampa and Baton Rouge Cases in Baton Rouge NewInitiatives Data from May 7, 2007 through September 30, 2010 show the following results from the strike force initiative: 465 cases charging 829 defendants who collectively billed the Medicare program more than $1.9 billion 481 of these pleaded guilty and 48 others were convicted and 358 defendants were sentenced to imprisonment for an average term of 44 months OutcomeofGovernmentsEfforts For fiscal year 2010, the OIG won or negotiated about $21 billion in judgments and settlements; Medicaid was reimbursed $11.6 billion; the Medicare Trust fund received another $9.4 billion in recoveries The 93 United States Attorneys and their assistants are the nations principal prosecutors of federal crimes including health care fraud In 2010, the USAO received 1116 new criminal matters involving 2,095 defendants and had 1,787 health care frau criminal cases pending, involving 2,977 defendants The USAO filed criminal charges in 488 cases involving 931 defendants, and obtained 726 federal health care fraud related convictions OutcomeofGovernmentsEfforts In 2010, the USAO received 1,116 new criminal matters involving 2,095 defendants and had 1,787 health care frau criminal cases pending, involving 2,977 defendants The USAO filed criminal charges in 488 cases involving 931 defendants, and obtained 726 federal health care fraud related convictions The USAO opened 942 new civil health care fraud investigations and had another 1,130 civil health care fraud cases pending A significant part of the civil divisions efforts have been directed to pharmaceutical fraud Exclusions One important mechanism for safeguarding the care provided to program beneficiaries is through exclusion of providers and suppliers who have engaged in the abuse or neglect of patients or fraud from participation in Medicare, Medicaid and other Federal health care programs During FY 2010, HHS/OIG excluded a total of 3,340 individual and entities Examples of exclusion actions SpecificRiskAreas Coding risk areas Misrepresenting diagnoses or procedures Assigning code for higher level of service than the service provided Medically unnecessary diagnostic tests Billing for teaching physicians Discrepancies between physicians and hospital codes Unbundling SpecificRiskAreas Transfers billed as discharges Credit balance reporting MS-DRG assignment examples of problem MS- DRGs Pulmonary edema Septicemia Renal failure Respiratory infections with CCs Circulatory disorders with acute MI and cardiovascular complications, discharged alive SpecificRiskAreas Medical Necessity Pertinent diagnosis code on claim Physicians order containing the reason for the test Physician documentation of need for service Non-covered services Code linkage SpecificRiskAreas Supplies of Durable Medical Equipment on March 3, 2008, Inspector General Daniel Levinson announced that the OIG issued a report that found that there were still problems with DME companies OIG inspectors found many suppliers that were not located at the addresses on file or not open during reasonable business hours SpecificRiskAreasDMEscont Medicare paid $21 million to these companies in the year ending June 30, 2007 Los Angeles appears to be a hotspot for supplier problems 13 % of supplies did not have physical facilities 9% did not post signs or hours of operation StrategiestoMinimizeRisk Dont assume you have nothing to worry about Dont commit a crime Institute a Corporate Compliance Program

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University of Louisiana at Lafayette - HCA - 580
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the one who review question will post this weekend 1h master kongW x * 2 W x confucious Confucious is a very important person in XXXX W x mater in terms of class, he was a h bronze is expensive, very stature of kong zi has it. 1900. lots of japanese and k
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University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & TermsDec. 6, 20101. L Xn h(real name: Zhu Shrn h; 18811936)2. The True Story of Ah Q (A Q Zhng Zhun h 3. Lo Sh h 4. Rickshaw, a.k.a. Camel Xingzi 5. Zhng Tiny h)6. The Marvelous Knight of Shanghai (Yngjngbng Q Xi h 7. B Jn h 8.
University of North Carolina School of the Arts - CHIN - 252
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University of North Carolina School of the Arts - CHIN - 252
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University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & TermsNov. 3-5, 2010the Su h dynasty (581 618 CE)1. Yng Jin hhSu Wnd h(r. 581 603 CE)overthrow the state he was servingh ) )h 7hr hh())) )h r X1 X) )X ) RLo X ) ) )hh r ) ) h,)h r h, )700 (r. 604 618 CE))h,2.
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & TermsNov. 29, 20101.Dn Hung h2. bin wn h , change literature 3. The Romance of the Three Kingdoms (Sn Gu Zh Yny E to Lu Gunzhong h (early Mng) 4. The Outlaws of the Marsh (Shu H Zhun h h (early Mng) 5. The Journey to the West (X Yu
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & TermsNov. 15-17, 20101. Five Dynasties period (five dynasties in the north, ten in the south; 907 960 CE)This is to be distinguished from the Six Dynasties Period, 220 581 CE, between the Hn and the Su six dynasty-tang- song-five dy
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & TermsNov. 17-19, 20101. tij h 2. yl h 3. S Sh h 4. D Xu h 6. Lny h 7. Mngz h(the ultimate terminus) (record of sayings) (The Four Books) (The Great Learning) (The Doctrine of the Mean)5. Zhng Yng h(The Analects) (Mencius) (The Tho
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & TermsNov. 19-22, 20101. x h , play, game, joke, dramatic performance 2. zj h 3. chunq h(flourished in Yun dynasty; continued to be written throughout the Mng)plays (flourished in Mng and early Qng dynasties)(flourished from mid-Qn
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & Terms Nov. 1-3, 20101. L Zh h 300p z Y 6 zY zY i 6 06 Y z o6 6 zY z Y ( S w h X 3 w ) , w ~ cfw_ j : X 3 w zY pzY , w zYhX 3 w X 3 w X 3 w X 3 w X 3 w 2X 3 w X 3 w X 3 w X 3 w X 3 wS V V j: ] c j : c j j : c j : c j : e e e e
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names &Terms Oct. 68, 2010 Daoist Classics: 1. Loz h (a.k.a. Dodjng h ) be passive, no desire self-transformation is futile most popular book 2. Zhungz h 3. Liz h 4. Snz Bngf Military Texts: (Master Sns Treatise on Warfare) When the enemy adv
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & TermsOct. 1113, 20101. S Qn h(Warring States rhetorician and statesman; legendary inventor of thevertical alliance concept)2. Lu h (capital of the Zhu royal domain; loc. modern-day Luyng h ) 3. S Di h , S L h 4. Zhu Xinwng 5. Shng
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & TermsOct. 13-15, 20101. Q Yun h 2. L So h 3. Ch C (fl. c. 300 BCE)Encountering Sorrow (Q Yuns autobiographical complaint) Songs of Ch (Chinas second oldest surviving poetry collection, afterShjng; contains L So) 4. All the world i
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & Terms Oct. 15-20, 2009 5. yu xi h (knight errant, wandering swashbuckler)He does things for justice not fot himself. l z d L 6. y b d Qn X (to refuse on principle to recognize Qn as emperor: to refuse to bow to superior might) The si
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & TermsOct. 25, 20101. Mng Jingn B O B O B O B O B O ( e i 5 B O B a B O B O B O B a B O B O B O a B O B O B O ; Bi a Bi a Bi a 6 Bi a Bi a Bi a Bi a N Bi a Bi a Bi a 6 ;(m 5 i u u u : ;(m i5 u u u u B :; uB B B B OM u u u uB B B B OM
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & Terms Fri., Sept. 3, 2010 1h 13h 14h 25h 26h 30 w w w w x w 2 The founder of every dynasty is portrayed as virtuous and the last The stories of fall of Xia Shang Zhou are similar. In the end of the story: King meets h founder of ever
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & Terms Fri. Sept. 10, 2010 Sep-october :relation between all these states Remember: the geographic location relative to each other P67, special things happened to them, the name of state I. Names of Spring and Autumn Period States 1. Zh
University of North Carolina School of the Arts - CHIN - 252
Chinese 252 Names & Terms Sept. 20-22, 2010 (Lord M of Qn; a.k.a. Prince Rn Ho 1. Qn Mgng h West of all other states)Chu: south of all other states 40 years reign 2. Bi-l X h sageadvisorofQinMuGong runawaytothestateofchubecausehedoesnothaveanysucceess.
University of North Carolina School of the Arts - CHIN - 252
Fall,2009Chinese 252 Review Quest ions, Series 1, Part A 1. How m any t ones are t here in m odern st andard Chinese? 4 2. The great m ajorit y of Chinese charact ers have t wo com ponent s. What are t hese t wo c om ponent s called, and what is t he fun
University of North Carolina School of the Arts - CHIN - 252
Fall,2010Chinese 252 Review Questions, Series 1, Part B1. Of the following states, which four were not among the central states and were regarded by people of those states as semi-barbaric: Jn, Qn, Ch, L, Q, W, Yu, Zhng, Sng 2. When Chngr (Lord Wn of Jn
University of North Carolina School of the Arts - CHIN - 252
Fall,2009Chinese 252 Review Questions, Series 1, Part B1. Of the following states, which four were not among the central states and were regarded by people of those states as semi-barbaric: Jn, Qn, Ch, L, Q, W, Yu, Zhng, Sng 2. What is the difference be