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This message has been cross posted to the following eGroups: Florida & SE Region community and Chief C & E Officer Health Care Network .
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TALLAHASSEE, FLORIDA (BNO NEWS) - Attorney General Bill McCollum announced on Friday that Florida's Medicaid Fraud Control Unit has recovered $400 million since 2007.

The Medicaid Fraud Control Unit is part of the Attorney General's Office and investigates and prosecutes physicians, pharmacists, hospitals, durable medical equipment suppliers and others suspected of defrauding the Medicaid program.

"Medicaid fraud is a heartless crime that drains away resources intended for our citizens who need medical assistance. Every single dollar we recover benefits not only those citizens, but also the Florida taxpayers who have funded the Medicaid program," said McCollum.

In 2009, the Medicaid Fraud Control Unit witnessed a record-breaking year in recoveries. This is a result of the three-year effort by the Attorney General's Office to increase recoveries from Medicaid fraud.

In 2007, the Complex Civil Enforcement Bureau, a section within the Medicaid Fraud Control Unit, was created to investigate and prosecute cases regarding alleged violations of the Florida False Claims Act when false claims were submitted to the Florida Medicaid program.

More:

http://channel6newsonline.com/2010/08/floridas-medicaid-fraud-control-unit-​has-recovered-400-million-since-2007/

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Eric Newman, Esq.
HCCA/SCCE
Social Media Manager

This message has been cross posted to the following eGroups: Long Term Care Network and Florida & SE Region community .
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Medicaid fraud investigators raid a Tallahassee home health care business.

The Attorney General's Office confirms that its Medicaid Fraud Control Unit served a search warrant at Gwen Andrews Home Care at 2510 Miccosukkee Road this morning.

 

A man who works nearby say the investigators showed up at about 8 am. By the time we arrived, we couldn't spot any investigators on scene.

A spokeswoman with the Attorney General's Office says the investigation has been going on for several months but could not disclose any more details.

More:

http://www.wctv.tv/news/headlines/101498474.html?ref=474

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Eric Newman, Esq.
HCCA/SCCE
Social Media Manager

This message has been cross posted to the following eGroups: Chief C & E Officer Health Care Network and Florida & SE Region community .
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More:http://southflorida.bizjournals.com/southflorida/stories/2010/07/26/daily62​.html
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Eric Newman, Esq.
HCCA/SCCE
Social Media Manager
Minneapolis, MN

This message has been cross posted to the following eGroups: Auditing and Monitoring Health Care Forum and Florida & SE Region community .
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Florida's attorney general says he's close to getting federal approval to look for over-billing in Medicaid. The waiver would apply to most claims, but wouldn't catch abuses by HMOs.

Attorney General Bill McCollum and Tom Arnold, secretary of the Agency for Health Care Administration, said during a news conference Wednesday that Florida is seeking a federal waiver to allow the attorney general's office to "mine" Medicaid data. Currently, federal law gives that power only to AHCA, which then must refer potential fraud to the attorney general.

Arnold said the change would provide "more eyes" to detect wrongdoing among providers in the part of Medicaid that pays each medical claim separately (called "fee-for-service"). The attorney general's Medicaid Fraud Control Unit would be able to look for abuses such as "upcoding" --- a tactic used to over-bill.

The announcement came about two weeks after WellCare, the state's largest Medicaid HMO, said it had agreed to pay $137.5 million as part of a long-running federal investigation into Medicaid and Medicare fraud. Also, during the past two weeks, a whistleblower has detailed widespread fraud by former WellCare executives. None of the top three accused of ordering the fraud has been criminally charged.

More:

http://articles.sun-sentinel.com/2010-07-07/business/fl-medicaid-ag-2010070​7_1_medicaid-fraud-control-unit-health-care-fraud-attorney-general-bill-m​ccollum

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Eric Newman, Esq.
HCCA/SCCE
Social Media Manager
Minneapolis, MN

This message has been cross posted to the following eGroups: Health Care System Forum and Florida & SE Region community .
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A federal judge ruled WellCare Health Plans Inc. can pursue claims against three top former executives, including former president and chief executive officer Todd Farha.

The ruling allows WellCare (NYSE: WCG), a Tampa company that provides managed care services for government-sponsored health care plans, to hold the former executives accountable for their conduct, Timothy Susanin, senior vice president and general counsel, said in a release.

The judge also dismissed all claims against WellCare's former and current directors, the release said.

Farha, along with Paul Behrens, former chief financial officer, and Thad Bereday, former general counsel, resigned in 2008, a few months after a raid by state and federal law enforcement authorities at the Tampa headquarters, part of an investigation of health care fraud.

WellCare has since paid $80 million to settle charges it defraud the Florida Medicaid program and $10 million in a separate settlement with the Securities and Exchange Commission.

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Eric Newman, Esq.
HCCA/SCCE
Social Media Manager
Minneapolis, MN

This message has been cross posted to the following eGroups: Florida & SE Region community and Chief C & E Officer Health Care Network .
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Amid all the shouting over health care reform this year, one issue has united the left and right: outrage over the scale and brazenness of health care fraud. But as pundits and politicians rage, the man in charge of managing Florida's Medicaid program thinks the problem has been overstated.  "We need to make sure every penny is used appropriately," said Tom Arnold, secretary of the Agency for Health Care Administration.  But to people who say Florida may be losing $2 billion, $3 billion or more a year to fraud? Not likely, he said.  "I feel strongly that $2 billion figure is not accurate," he said. "It's way overly simplistic."

More:  http://www.palmbeachpost.com/money/fraud-estimates-may-be-overstated-ahca-c​hief-says-693092.html

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Eric Newman, Esq.
HCCA/SCCE
Social Media Manager
Minneapolis, MN

Does your Company have a policy that permits related employees to work at the same company?  If so, are there any restrictions?  For example, related employees cannot be employed in the same direct line of supervison.  How are related employees defined ( parent, step-parent, sister, grandchild, etc.)?

Thanks
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LindaHolmes
Compliance Support Manager
Georgia Power Company
AtlantaGA
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Does any one have written protocols for requirements when a patient has reviewed their medical records and believes there is an error that needs to be corrected? Can you refer me to the appropriate Florida statutes that address this? I know I've seen it-just can't find it.
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WendyDell
Health Information/Compliance Manager
Microspine Medical Plaza
DeFuniak SpringsFL
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Good morning.

Export.gov a division of The Department of Commerce, is hosting a free information seminar relating to FCPA on June 16, please see details below:

The Foreign Corrupt Practices Act 2009:

How to Compete Successfully and Stay Out of Trouble

A Florida District Export Council initiative, in partnership with the U.S. Commercial Service

Lunch and refreshments provided by Baker & McKenzie and World Compliance

 

Date & Time: Tuesday, June 16, 2009 8:00 AM – 4:00 PM

 

Location:        Nova Southeastern University

Huizenga School of Business & Entrepreneurship, Room 2097
Carl De Santis Building
3301 College Avenue
Davie, FL 33314

http://www.export.gov/eac/show_detail_trade_events.asp?EventID=29556


Please feel free to reach out to me if you have questions.

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Ryan Morgan
ryanm@...
World Compliance
Sales and Alliances, USA and the Caribbean
Miami FL
United States

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This message has been cross posted to the following egroups: Florida / SE Region community and Long Term Care Network.
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In the 2009 MPFS released in November CMS noted that it was declining to Change the Conditions of Participation for CORFs (Comprehensive Outpatient Rehabilitation Facility) and Rehab Agencies regarding the time frame for certification of the Plan of Care.

BACKGROUND: Under Rehab Agencies, the COPs require a 30 Plan of Care certification cycle.  Under CORF COP, there is a 60 day Plan of Care Requirement.  Updated Medicare documentaiton requirements released this year (Transmittal 88) have revised the Plan of Care requirement for ALL outpatient rehab venues to 90 days.

The 2009 MFPS specifically notes that they will decline to change the Conditions of Participation to conform to updated Medicare documentation requirements, thereby providing a real inconsistency in regulations, which can no longer be considered a technical problem.

Rehab providers under Part A (rehab agencies, CORFs) face an compliance situation.  Most rehab providers extended Plan of Care certification to 90 days, without understanding the implications that a 30 requirement brings under the COP.

As a member of the FCSO POE Advisory Boards for Part A and Part B, I have notified them, provided the technical references, and asked that they devise a communication to deliver to affected Florida providers, so that they are not unwittingly shocked during an updated survey and certification visit from the State. 

Just wanted to get the ball rolling on a topic.  Glad to chat with anyone who is interested in rehab.

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Nancy Beckley, MS, MBA, CHC
Bloomingdale Consulting Group, Inc
President
Valrico FL
United States
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