Compliance News Roundup: Diving Into A CIA Part 3: Risk Assessments

1. Kelly Loter, 48, the owner of Dallas’ Level Two advertising firm, has admitted his role in what he describes as a massive healthcare fraud scheme. The U.S. Department of Justice says Forest Park Medical Center paid more than $40 million in bribes and kickbacks in exchange for patient referrals. Read more here: http://www.dallasobserver.com/news/dallas-ad-exec-admits-role-in-forest-park-medical-center-healthcare-fraud-9071066

2. Indicted in $6.6 million health care fraud case - A former union official and an insurance broker have been charged for their alleged roles in conspiring to defraud Horizon Blue Cross Blue Shield and a union healthcare plan.-U.S. Attorney Paul J. Fishman announced Monday that Sergio Acosta, 66, of Passaic and Lawrence Ackerman, 53, of Old Tappan were indicted by a federal grand jury on one count of conspiring to defraud Horizon Blue Cross Blue Shield and one count of conspiring to defraud the union's self-insured healthcare plan. Read more here: http://www.northjersey.com/story/news/crime/2017/01/09/2-indicted-66-million-health-care-fraud-case-horizon-blue-cross-blue-shield/96362620/

3. DTH - Diving Into A CIA Part 3: Risk Assessment - Compliance risk assessments in healthcare are somewhat analogous to home inspections that most of us pay for before closing on the purchase of a new home. And if you’ve purchased more than one home and have had home inspections performed for different homes, you will know that different deficiencies or issues can be identified with different homes being inspected. In other words, even though the list of items that are examined or inspected from home to home may be the same, the deficiencies identified can vary from home to home. In one home is may be plumbing or electrical wiring while in other homes it could be the foundation and heating system. 

This is like risk assessments performed for compliance programs. If you work for a physician practice specializing in radiology, the compliance risks identified will probably be different than a risk assessment performed for an acute care hospital or skilled nursing facility, for example. Read more here: Deeper Than the Headlines: Diving Into A CIA Part 3: Risk Assessments

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