Resident Suspected of Altering Performance Records</h1> <article> <h1>Resident Suspected of Altering Performance Records</h1> <p>Fri, 03 Sep 2010 10:48:00 GMT</p> Dr. Eric George Batterson of the University of Michigan Health System is accused of accessing computers without authorization to alter his performance records.<br /><br />Batterson allegedly used a program that tracks the typing of a computer's user. He used this information to obtain passwords for computers and e-mail accounts so he could alter his performance records and lower the performance records of his colleagues. Batterson's activities were discovered when employees realized that their computers and e-mails had been accessed without their permission.<br /><br />A preliminary court hearing is scheduled for Sept. 29. Batterson is charged with "nine counts each of unauthorized access of computers and using computers to commit a crime, as well as one count of possessing a Taser."<br /><br /><br />Source: <em>annarbor.com</em><br /><a href="http://www.annarbor.com/news/man-accused-of-illegally-accessing-records-at-u-of-m-hospital/">http://www.annarbor.com/news/man-accused-of-illegally-accessing-records-at-u-of-m-hospital/</a><div class="blogger-post-footer"></div> </article> <article> <h1>Watch out for H.E.A.T.</h1> <p>Fri, 03 Sep 2010 10:26:00 GMT</p> The Obama Administration will be increasing the HEAT to help combat healthcare fraud. The US Attorney General and Secretary of Health of Human Services created the Healthcare Enforcement Action Team (HEAT) in 2009 to investigate cases of fraud. HEAT strike teams are currently present in seven cities. The increase will expand HEAT presence to twenty metropolitan areas.<br /><br />The HEAT strike teams are responsible for targeting and investigating healthcare fraud cases, something that the FBI and Department of Justice have not been able to handle on their own. Billions of dollars are currently being wasted due to fraudulent claims. The Obama Administration hopes that the success of HEAT will help to prevent and recover these claims, so that money can be better spent on improving quality and controlling costs for Medicare beneficiaries.<br /><br /><br />Source: <em>Lexology</em> (log-in required)<br /><a href="http://www.lexology.com/library/detail.aspx?g=d1c31f72-1a22-41dd-a1b6-84a7f2c46d61&utm_source=Lexology%20Daily%20Newsfeed&utm_medium=Email&utm_campaign=Lexology%20subscriber%20daily%20feed&utm_content=Lexology%20Daily%20Newsfeed%202010-09-03&utm_term">http://www.lexology.com/library/detail.aspx?g=d1c31f72-1a22-41dd-a1b6-84a7f2c46d61&utm_source=Lexology%20Daily%20Newsfeed&utm_medium=Email&utm_campaign=Lexology%20subscriber%20daily%20feed&utm_content=Lexology%20Daily%20Newsfeed%202010-09-03&utm_term</a><div class="blogger-post-footer"></div> </article> <article> <h1>Former CEO of LA Hospital Sentenced for Role in Billing Scheme</h1> <p>Thu, 02 Sep 2010 09:52:00 GMT</p> On August 31, Rudra Sabaratnam, former CEO of the now-defunct City of Angels Medical Center in Los Angeles, CA was sentenced to two years in prison and ordered to pay $4.1 million in restitution for his role in a Medicare and Medi-Cal billing scheme (<em>US v. Sabaratnam</em>).<br /><br />Sabaratnam, along with former board chairman Robert Bourseau, paid an employee of a homeless recruitment center in the "Skid Row" district of Los Angeles to refer homeless patients to the City of Angels Medical Center for unnecessary inpatient treatment so that the facility could bill Medicare and Medi-Cal. Bourseau was sentenced earlier this year for his role.<br /><br />Often reports of fraudulent Medicare billing involve physicians and other providers. This case serves as a reminder that corruption and abuse of power can occur at all levels of healthcare delivery -- from the provider to the administrator.<br /><br /><br />Source: <em>BNA</em><div class="blogger-post-footer"></div> </article> <article> <h1>Court Allows HHS to Recover over $300k in Claims</h1> <p>Tue, 24 Aug 2010 13:58:00 GMT</p> The US Court of Appeals for the Eleventh Circuit ruled that the US Department of Health and Human Services was entitled to recover $311,263 in claims filed by Florida Medical Center of Clearwater, Inc. (FMC). FMC had argued that the government suffered no loss or injury as a result of the claims and that repayment of the claims would constitute an excessive fine, which is barred by the Eighth Amendment.<br /><br />The court sided with HHS, stating that the amount was simply a recovery of losses, and not a fine. <br /><br />Dr. Surindar S. Bedi was president and majority owner of FMC, despite being subject to a 10 year exclusion from Medicare due to a previous violation. FMC's application to CMS did not disclose Bedi's affiliation. The court ruled that CMS was allowed to recover the payments not because of Bedi's standing, but because FMC's application omitted information about Bedi in its application.<br /><br />This case emphasizes the importance of checking the Medicare Exclusion list to ensure that providers are in good standing, and that appropriate disclosures are made, should a provider be found on this list.<div class="blogger-post-footer"></div> </article> <article> <h1>MSPs Should Be on the Lookout for ACOs</h1> <p>Mon, 23 Aug 2010 10:23:00 GMT</p> A new acronym (ACO) to keep on our radar screen. The goal of such organizations is to keep patients healthy AND be cost-efficient. According to <em></em>BNA<em></em>, accountable care organizations "are designed to keep patients healthy and out of intensive care settings, while simultaneously shifting reimbursements to pay based on the achievement of top performance goals that drive improved patient outcomes and cost-effectiveness."<br /><br />The Centers for Medicare & Medicaid Services (CMS) is working on draft regulations that will define what constitutes an ACO. The CMS-regulated ACO program is set to begin in 2012. Currently, there are some ACO models are emerging from Physician Group Practice organizations.<br /><br />The purpose of the ACO program is to reward providers with higher reimbursement if they attain positive patient outcomes and are successful at promoting patient wellness. The idea is that it is more costly to reimburse providers for the treatment of illnesses; therefore, quality healthcare can be made more cost-efficient if they strive for the maintenance of patients' good health.<br /><br />It will be interesting to see whether or not MSPs are asked to assist with monitoring "top performance goals" as part of the final ACO rules.<br /><br /><br />Source: <em></em>BNA<em></em><div class="blogger-post-footer"></div> </article> </main></body></html>