New compliance guides bring new worries
September 1, 1999 3 minutes read
New compliance guides bring new worries
Developing compliance plan ever more important
In mid-August, a Seattle physician appeared in court to answer charges that he tried to defraud the government of Medicare funds. His was the latest in a string of practices targeted by the Depart ment of Health and Human Services’ Office of the Inspector General (OIG). The charges were brought shortly after the department issued its latest batch of voluntary compliance guidelines for Medicare managed care plans.
The guidelines include information on policies, procedures, and standards of conduct; on designating a compliance officer and committee; on developing training and education programs; on creating complaint hotlines; and on performing internal audits to monitor compliance. The guidelines are available in their entirety at the Federal Register’s Web site at www.nara.gov, pp. 33869-33887, June 24, 1999. It also is available at the OIG’s Web site, www.dhs.gov/progorg.oig under the "What’s new" section.
Although this latest group of guidelines initially will have more impact on managed care organizations that run the Medicare managed care programs, they eventually will filter down to physician practices. Practices may be required by their managed care organizations to implement compliance plans the MCOs create.
Physicians a new target
Physician practices heretofore have not been perceived as targets of the OIG, but there is some feeling that a change is coming. According to Karen E. Davidson, Esq., a lawyer at the West Conshohocken, PA, law firm of Mackarey & Davidson, government investigators have indicated they are just learning about Medicare Part B billing. They are beginning to understand both the potential for fraud and abuse and the amount of money that could be recouped from practices found to be violating the law.
"I think you will see more [emphasis on med ical practices] in the future," she says. "And I think practices would be well-served to start implementing a compliance plan."
Creating a compliance plan almost always requires hiring outside consultants and lawyers. Davidson says practices that have an administrator who is extremely savvy, up on the guidelines, has gone to seminars, and has the time to put together a plan could develop one internally; legal counsel could review the plan when it is complete. Most practices, however, will have to shell out some serious money to put together a good plan, she says.
"Having a compliance program will probably help you sleep better at night," says Davidson. "Spending $15,000 or $20,000 to do this may seem like a lot. But if you have a substantial amount of Medicare billing per physician, it doesn’t seem like so much." And the initial outlay of money could seem like peanuts next to fines and penalties levied on practices found to be in violation of regulations. Even if you do commit an error, says Davidson, having an effective plan in place may help keep your fines down. "If you don’t have a plan implemented, the presumption that you did this inadvertently is gone. You are looked at as if it was more intentional."
While the guidelines aren’t compulsory, Davidson says there are sound reasons to create a compliance plan based on the guidelines anyway. "It’s like buying insurance. It’s an expense, but you do it just in case."
(Editor’s note: In future issues of the newsletter, Practice Marketing & Management will run a series of articles on the hows and whys of creating a sound compliance plan.)
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