Rachel, FYI Medical Newswire) A Coral Gables, FL eye surgeon got slapped with nearly five years in prison for billing Medicare for services he never supplied. According to U.S. Attorney Marcos Daniel, Dr. Gustavo Coll submitted about $1 million worth of claims for diagnostic tests and laser eye surgeries he never performed. A federal judge sentenced him May 19 to 57 months in prison and ordered him to pay nearly $800,000 in restitution, a $50,000 fine and a $9,000 special assessment.
Coll's case wasn't helped by the fact that, according to the court, he committed perjury during the trial and put Medicare patients at risk by performing medically unnecessary laser eye procedures. Lesson Learned: The toll on patients exacted by medically unnecessary procedures can push a health care provider's punishment for fraud to the high end of the range. May 27, 2003, 16:13 David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 612-237-1966 -----Original Message----- From: Rachel Foerster [mailto:[EMAIL PROTECTED] Sent: Thursday, June 05, 2003 1:22 AM To: WEDI SNIP Transactions Workgroup List Subject: RE: Payors not compliant effective on provider David, you're assuming that the penalty for Medicare fraud includes imprisonment when the law may only allow for fines..... Rachel Foerster -----Original Message----- From: David Frenkel [mailto:[EMAIL PROTECTED] Sent: Wednesday, June 04, 2003 12:14 PM To: WEDI SNIP Transactions Workgroup List Subject: RE: Payors not compliant effective on provider Marsha, Unfortunately you have to have pretty flagrant violations to get prison time for healthcare abuse. A surgeon last year in Seattle was convicted for Medicare fraud of close to $1 million. He received no prison time just probation with community service in Nepal. Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 612-237-1966 -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Wednesday, June 04, 2003 11:39 AM To: WEDI SNIP Transactions Workgroup List Cc: WEDI SNIP Transactions Workgroup List Subject: Re: Payors not compliant effective on provider This is not a HIPAA Myth, look at ... Section 1176 of the Act establishes civil monetary penalties for violation of the provisions in part C of title XI of the Act, subject to several limitations. Penalties may not be more than $100 per person per violation of a provision, and not more than $25,000 per person per violation of an identical requirement or prohibition for a calendar year. With certain exceptions, the procedural provisions in section 1128A of the Act, ''Civil Monetary Penalties,'' are applicable to imposition of these penalties. Section 1177 of the Act established penalties for any person that knowingly misuses a unique health identifier, or obtains or discloses individually identifiable health information in violation of this part. The penalties include: (1) A fine of not more than $50,000 and/or imprisonment of not more than 1 year; (2) if the offense is ''under false pretenses,'' a fine of not more than $100,000 and/or imprisonment of not more than 5 years; and (3) if the offense is with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, a fine of not more than $250,000 and/or imprisonment of not more than 10 years. We note that these penalties do not affect any other penalties that may be imposed by other federal programs. Will HHS be this severe on October 17th ? I don't imagine so, but it is all laid out for them to use to enforce the Rule. Here in Arizona you'd get to wear a lovely pinky-orange jumpsuit, live in a tent, and pay for your meals! I know the prospect of living in a tent here is making me quite diligent in getting our customers compliant. Marsha Verizon Information Technologies Managed Care Division Phoenix, AZ Home of the Back To Back NL West Champion ARIZONA DIAMONDBACKS Phone - 602.678.6042 Fax - 602.678.6331 E-mail - [EMAIL PROTECTED] Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. "William J. Kammerer" To: "WEDI SNIP Transactions Workgroup List" <[EMAIL PROTECTED] <[EMAIL PROTECTED]> et.com> cc: Subject: Re: Payors not compliant effective on provider 06/04/2003 09:12 AM Please respond to "William J. Kammerer" Is this more HIPAA hysteria? Since when would a violation of the TCS rule - however purposeful - result in a prison sentence? William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "John Sherman" <[EMAIL PROTECTED]> To: "WEDI SNIP Transactions Workgroup List" <[EMAIL PROTECTED]> Sent: Wednesday, June 04, 2003 11:51 AM Subject: RE: Payors not compliant effective on provider After November 15, 2003, Providers still have the option of submitting claims on paper, but health plans must accept standard transactions from providers if the provider chooses to submit claims electronically. If the provider submits electronically it must be in the standard format and content. Health plans and providers may use healthcare clearinghouses to assist them if they so choose. The risk to the provider of submitting paper claims is that they may not be paid as quickly as they would if they submitted electronically. The plan not being compliant should be a red flag to the provider. The plan is facing fines, possible prison for executives who ignored the law and the providers timely payment for claims is at risk. John Sherman HIPAA Project Manager Corporate Benefit Services of America (952)593-6478 Fax (952)582-2849 [EMAIL PROTECTED] -----Original Message----- From: Brenda K. Burton [mailto:[EMAIL PROTECTED] Sent: Wednesday, June 04, 2003 10:20 AM To: WEDI SNIP Transactions Workgroup List Subject: Payors not compliant effective on provider Please, if somebody could clarify/refer me to the answer (I'm sure this has been dicussed): If a payor is unable to handle electronic transactions by October 16, may they revert to paper unilaterally? What other A/R risks are present for the healthcare provider if a particular payor is not able to be compliant by October 16? Looking for contingency planning reasons. Thanks! Brenda Brenda K. Burton MEDEXTEND 877-491-7650 Join us for discussion at: http://groups.yahoo.com/group/compliantbilling/join Available on Instant Messenger as: medextend --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
