Compliance corner: What regulators are up to
June 1, 1999
Compliance corner: What regulators are up to
The health care compliance field obviously is a growth industry. Here is a summary of recent events and actions:
• The whistle-blower express. The Health Care Financing Administration has issued a program memorandum (transmittal AB-98-77) instructing that any fraud and compliance issues brought to a Medicare fiscal intermediary by the employee of a provider be immediately referred to the Office of the Inspector General (OIG). "We’re anticipating this will put a little more fire under providers to strengthen their compliance efforts," notes a HCFA spokesperson.
• Docs and DME. The OIG has released a report, titled Ordering Medicare Equipment and Supplies: Physician Patient Relationship, that agrees with HCFA’s rule that a physician ordering durable medical equipment also must have treated the patient. The OIG also recommended that the treatment occur just prior to the durable medical equipment order and that the physician’s name and specialty and the patient’s related diagnostic information be required on all claims forms.
• Defining reasonable and necessary. HCFA officials say the agency plans to publish a proposed rule this summer explaining the general criteria it uses to evaluate whether items and services covered under Medicare are medically "reasonable and necessary."
• New anti-kickback safe harbors on the horizon. In a speech before a group of health care lawyers, D. McCarty Thornton, OIG chief counsel, said the OIG hoped to publish eight new safe harbor exceptions to federal anti-kickback law sometime this summer.
Thornton said the new safe harbors probably would cover:
— physician investments in group practices;
— investments in ambulatory surgical centers by physicians;
— specialty service referral agreements;
— cooperative hospital service agreements.
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