Medicare Compliance & Reimbursement

Plus:  Medicare defrauder loses medical license, title.

The Centers for Medicare & Medicaid Services finally issued instructions on how to enroll in the Competitive Acquisition Program for Part B drugs, which promised to take the headache of stocking and billing for drugs out of providers' hands.

In Transmittal 932, dated April 28, the agency says providers can enroll by going to www.cms.hhs.gov/CompetitiveAcquisitionBios/02_infophys.asp and downloading the application form. You can submit the form to your carrier.

"I think CMS is just going through the formality" of setting up the CAP program, because the agency knows providers aren't interested, says Carolyn Davis Hutt, reimbursement coordinator with Oncology Hematology West in Omaha, NE. "I have never felt that this was going to work."

In other transmittals, CMS also:

· Clarified the process of applying for a provider number and having your information checked by the carrier, in April 28 Transmittal 146.

· Allowed you to report diagnosis code V06.6 instead of both V03.82 and V04.81 if your patient received both the pneumococcal pneumonia and influenza vaccines, in April 28 Transmittal 921. It also required the carriers to accept CPT code 90660 for the flu vaccine.

· Introduced two new HCPCS codes for radiopharmaceutical diagnostic agents for PET scans in Transmittal 923, dated April 28. Code A9555 replaces Q3000 and A9552 replaces C1775.

Doctor Can Never Use That Title Again, Judge Orders

A defrauder of Medicare gets stripped of her freedom, her medical license--and her title.

After U.S. District Judge David Hittner sentenced Callie Hall Herpin to ten years in prison for health care fraud, he ordered her never to call herself a doctor again. "I consider you a disgrace to every physician in this country," he told her according to the Houston Chronicle.

Herpin was convicted of running a clinic that didn't treat any patients, but instead churned out false prescriptions for Vicodin and codeine-fortified cough syrup. She also allegedly prescribed unnecessary wheelchairs in a scheme that defrauded Medicare and Medicaid of $13 million. She must repay $12.9 million.

If Herpin ever calls herself a doctor after she gets out of prison, Hittner will send her back inside for violating his order, he said. "You will, from this date forward, immediately correct any individual or entity referring to you as doctor, M.D. or physician," Hittner instructed. Hittner wanted to sentence her to 27 years instead of 10, but her plea agreement capped her sentence at the federal maximum.