Monthly Newsletter

February 2024 Monthly Newsletter

Valentine's Day Sale!  20% off Now through February 23, 2024

Right of Access & Release of Information Compliance

New course with Option to Certify as a Right of Access Specialist.

Many workforce members have direct or indirect interactions with patients, caregivers, family members, payers and/or law enforcement. This responsibility spans between providers, nurses, practice managers, compliance officers, front desk/intake staff, patient financial services, medical billing, filing appeals or responding to a payer audit, in addition to responding to authorizations requesting medical record information.

Workforce compliance to Federal and State privacy rules will help mitigate risk of a HIPAA breach and lower risk of a complaint filed to the Office of Civil Rights (OCR) triggering an investigation resulting in potential penalties, settlements or even criminal charges against your organization.

Click Here - Register by February 23, 2024 to get the introductory sale price.

OCR Webinar - Guidance to Hospitals & Long-Term Care

Webinar February 6, 2024: Obligations to Ensure Religious Non-Discrimination in Patient Visitation

On January 25, 2024 the Office for Civil rights (OCR) issued a guidance to Hospital and Long-Term Care (LTC) facility administrators.  Under CMS regulations, hospitals, long term care facilities, and critical access hospitals, are prohibited from restricting, limiting, or otherwise denying visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability and are required to have written visitation policies, procedures, and practices regarding such prohibitions. OCR enforces the bar on religious discrimination in these regulations.

Read the Press Release.  Attend the OCR Webinar – To Register, Click Here.

CMS Webinar: Medicare Cost Report e-Filing System

The Medicare Cost Report E-Filing Systems (MCRef) webinar is being held on Wednesday, February 14, 204 from 1:00 – 2:30 pm East Coast time.  This webinar targets institutional Medicare Part A providers and other entities filing cost reports.  You must Register to attend with CMS.

Need more hands-on Cost Report training?  Ask the Cost Report Experts March 12-13, 2024 and the Medicare Cost Report Camp.  Earn 12 NASBA CPEs, and 18 AIHC CEUs by attending this exciting 2024 live event. This 2-day training is for those with a basic knowledge of the preparation of Medicare cost reports, with some experience either gathering information for cost reports or actively preparing cost reports for an institutional healthcare organization.  Download the information packet, register online.

New Model to Advance Integration in Behavioral Health

Model designed to deliver person-centered, integrated care to Medicaid and Medicare populations with moderate to severe mental health conditions and/or substance use disorder (SUD)

The Centers for Medicare & Medicaid Services (CMS), announced a new model on January 18, 2024 to test approaches for addressing the behavioral and physical health and health-related social needs for Medicaid and Medicare beneficiaries.

The Innovation in Behavioral Health (IBH) Model will launch in Fall 2024 and is anticipated to operate for eight years in up to eight states. The goal is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorder by connecting them with the physical, behavioral, and social supports needed to manage their care. The model will also promote health information technology (health IT) capacity building through infrastructure payments and other activities.

Download the Fact Sheet. CMS Model Overview & Design.  Register for the Psychiatric Coding & Documentation Compliance 2024 short course.

Health and Public Health Cybersecurity Gateway is for Small Clinic or Large Healthcare Systems

The increasing sophistication of cyber threats demands a united front - The Healthcare and Public Health (HPH) Cybersecurity Gateway is designed to be a consistently evolving, comprehensive, and accessible hub easing your access to information, programs, and resources to enhance cybersecurity practices across the healthcare industry.  The Cybersecurity Performance Goals (CPGs) are healthcare specific, voluntary and designed to help healthcare organizations prioritize implementation of high-impact cybersecurity practices. 

Click Here for more information, launch a tour and download the CPGsClick Here for HIPAA privacy/security online training with option to certify.

Data to Drive Decision Making Cross-Cutting Initiative

CMS’ Data CCI Project to Drive Person-Centered Care

A new The Data to Drive Decision Making Cross-Cutting Initiative (Data CCI) update has been released by the Centers for Medicare & Medicaid Services (CMS) on January 25, 2024.  Download the new Fact Sheet to learn more.

Endangering Patients and Fraudulently Billing for Spinal Surgery

Red Flags Ignored when Hiring this Neurosurgeon

A former patient of Dr. Jason Dreyer filed a qui tam complaint in Federal court, alleging that MultiCare Health System knowingly endangered patient safety and falsely and fraudulently billed Medicare, Medicaid, and other federal health care programs for spinal surgery procedures performed at MultiCare Deaconess Hospital (Deaconess). 

Dr. Dreyer practiced at Providence St. Mary’s Medical Center in Walla Walla, Washington, a hospital owned and operated by Providence Health & Services (Providence).  In 2019, amidst allegations that he was performing medically-unnecessary surgeries, harming patients, and falsifying diagnoses, Providence permitted Dr. Dreyer to resign. following Dr. Dreyer’s resignation from Providence, MultiCare hired him to perform neurosurgery services at Deaconess.  The Complaint alleges that during MultiCare’s hiring process, it became aware of concerns and “red flags” about Dr. Dreyer and his surgical judgment from his time at Providence, but, recognizing that he was a “workhorse”, made the decision to hire him and allow him to begin seeing patients and performing surgery at Deaconess Hospital in July 2019.  Read more about this False Claims Act (FCA) whistleblower case.

Former CEO Sentenced to More Than 10 Years in Prison

Whittier Health Clinic’s former CEO, Vincenzo Rubino, was sentenced to more than 10 years in prison and is ordered to pay $3,815,478 in restitution and entered a money judgment of $2,308,028.  Rubino founded, owned and operated Santa Maria’s Children and Family Center, a Whittier-based medical clinic based registered as a non-profit public benefit corporation and enrolled as a Family Planning, Access, Care and Treatment (Family PACT) provider run through Medi-Cal.

The center submitted fraudulent claims totaling nearly $5 million to the Family PACT program for family planning services that were never provided, often using the information of patients who were recruited at off-site locations with offers of free diabetes testing.  The Medi-Cal program paid more than $2.3 million dollars on the fraudulent claims, as well as an additional approximately $1.5 million to a pharmacy and laboratory for claims stemming from referrals from Santa Maria based on the same services that were never delivered. Read more about this case.

Doctor Agrees to 7-Year Exclusion

Excluded for 7 Years for Allegedly Prescribing Medically Unnecessary Drugs

Dr. Lloyd Costello is being excluded from all Federal health care programs for seven years Federal health care programs for seven years, according to the Office of Inspector General (OIG).  Allegations have been settled with the OIG that Costello furnished prescription drugs to patients substantially in excess of their needs and of a quality which failed to meet professionally recognized standards of health care. It is also alleged that Costello knowingly caused Medicare Part D claims to be filed for a pattern of prescriptions for controlled substances that he knew or should have known were not medically necessary. Read more about this case.

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