Honest mistakes’ won’t be criminalized with OPPS
The federal Office of the Inspector General (OIG) said it won’t take civil or criminal action for billing errors due to what it calls "honest mistakes" or negligence during the implementation of the new outpatient prospective payment system (OPPS). "The hospital will be asked to return the funds erroneously claimed, but without penalties," wrote Inspector General June Gibbs Brown in a letter to American Hospital Association (AHA) president Dick Davidson. OIG will consider:
• the rule’s clarity;
• the complexity and novelty of the OPPS billing system;
• the quality of guidance issued by the Health Care Financing Administration and/or fiscal intermediaries;
• the extent to which the provider has tried to understand the rule;
• whether the provider has an effective compliance program.
The letter can be viewed at http://www.hhs. gov/oig/new.html.
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