OIG explains process for advisory opinions
The federal Office of Inspector General issued rules effective Feb. 21, 1997, on giving advisory opinions to providers. The rules were published Feb. 19 in the Federal Register and are available from the OIG’s public affairs office. The rules tell providers what’s legal regarding both the Medicare Anti-Kickback Statute (a section of the Social Security Act) and "Safe Harbor" and "Fraud Alert" regulations (under the Medicare and Medicaid Patient and Program Protection Act of 1987).
The OIG will issue opinions in cooperation with the U.S. Department of Justice. Opinions will cost a non-refundable $250, though the office may charge more if extra work or outside consulting services are required.
The OIG won’t issue opinions on hypothetical cases. The OIG will only issue opinions to people (or providers) involved in an arrangement, not to third parties. The OIG reserves the right to revoke decisions, and says it will notify requesting parties if it takes such action.
In other action on the anti-fraud and -abuse front, Sen. John McCain (R-AZ) has introduced two new bills.
The "Medicare Whistleblower Act of 1997" (S264) aims to provide incentives to whistle-blowing beneficiaries. McCain also introduced the "Medicare Overpayment Reduction Act" (S267), which includes a variety of measures. For a copy of the OIG’s "advisory opinion" regulation, call the OIG Public Affairs Office at (202) 619-1142. t
OIG report examines low-cost, high-cost agencies
The average number of visits per Medicare beneficiary at high-cost home health agencies is growing at a rate twice that of low-cost agencies, according to a new Operation Restore Trust analysis of 1993-1994 data by the Office of Inspector General of the U.S. Department of Health and Human Services. But the OIG can’t explain the difference. "Determining when it is appropriate and medically necessary to provide Medicare home health services is often ambiguous and largely discretionary," the OIG says.
In Operating Practices of High-Cost and Low-Cost Home Health Agencies (Report OEI-04-93-00261), the OIG says if the Health Care Financing Administration (HCFA) can’t control home care through more effective management oversight, "then statutory or regulatory changes may be needed to protect the Medicare program . . ."
The average number of visits per low-cost agency rose from 30 in 1993 to 33 in 1994, an annual increase of 10%. But high-cost agencies averaged 85 visits per beneficiary in 1993 and increased 20% to hit 102 in 1994. For every visit a low-cost agency made in 1993, a high-cost agency made 2.8 visits. By 1994 that ratio had increased to 1:3.1. t
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