Daniel Levinson, DHHS Inspector General, issued another “Open Letter” to health care providers today, addressing “my perspectives on compliance, the resolution of health care fraud cases, corporate integrty agreements (CIAs), and the OIG’s Provider Self-Disclosure Protocol (SDP). I am also announcing an initiative that promotes the use of the SDP to resolve civil monetar penalty (CMP) liability under the physician self-referral and anti-kickback statutes for financial arrangements between hospitals and physicians.” My read is that the letter is pushing physicians and other providers who come to realize that they may be in violation of the physician self-referral or anti-kickback rules to use the volutary “self-disclosure program (SDP) to fully disclose all wrong-doing to the OIG’s offce and to settle the matter. In today’s letter, the OIG reminds people that an SDP settlement does not include the US Department of Justice (and state law enforcement for that matter), so theoretically, one could in charged again. Thanks.
Here’s my management (and specifically not legal) advice on this:
One of the benefits of a working compliance plan is that you are monitoring your services for necessity, and you are monitoring your billing for appropriateness. If you come across actions or events that you are concerned about and may be in violation of the laws and regulations, call you health care attorney. First, your attorney has privilage (meaning your conversations cannot be disclosed) and secondly, they can represent you before the OIG, the Department of Justice and other law enforcement agencies and best work out a settlement.
I’m a believer in compliance plans as a management tool. One tactic is to routinely spot check billing before it goes