 |
President's Message: The Big Dog BarksOIG Compliance Program Guidance for Physician PracticesA. Allen Seals, M.D., President |
| In a previous column, I summarized organized medicine's
response to the Health Care Financing Administration (HCFA) proposed revision of
evaluation and management (E&M) guidelines. As important as it is for physicians to be
knowledgeable of current E&M guidelines, it is equally imperative that physicians be
aware that the "attack dog" under the HCFA front porch goes by the name of
"Inspector General". Instead of putting real effort into a serious introspection of the inherent wastefulness of our present Medicare bureaucracy, the current administration has instead focused almost all of its energy in reducing costs by prowling the streets looking for fraudulent abusers. Indeed, the rhetoric from the current administration (and certain political candidates) has been not to place attention on the real system wide inefficiencies in the Medicare system, but instead to blame Medicare costs on physicians, and paint a picture of widespread fraud and abuse by dishonest doctors. While there is actual evidence of only a very small number of individuals who attempt to abuse Medicare payments, the HCFA has decided that the only way to reduce costs is to unleash a large canine with sharp teeth ready to bite the slightest hint of maleficence. It is entirely overlooked by HCFA administrators that most of these infractions are later proven to be only honest errors, usually committed by a clerk in the physicians billing and coding office, usually involving a relatively minor monetary amount. The recently published "Draft Compliance Program Guidelines for Individual and Small Group Practices" released by the Office of the Inspector General (OIG) on June 7, shows the "teeth" of the OIG enforcement policy. After release of this draft document, the OIG in an uncharacteristic gesture of openness invited public comment for 45 days, and then effectively closed its doors to all further debate on July 27. The Inspector General is expected to bark out the final version of the guidance later this year in the Federal Register. The OIG believes that every effective compliance program should begin with a commitment by the physician practice to address all of the applicable elements listed below, which are based on the seven elements set forth in the Federal Sentencing Guidelines: (1) establishing compliance standards through the development of a code of conduct and written policies and procedures; (2) assigning compliance monitoring efforts to a designated compliance officer or contact; (3) conducting comprehensive training and education on practice ethics and policies and procedures; (4) conducting internal monitoring and auditing focusing on high-risk billing and coding issues through performance of periodic audits; (5) developing accessible lines of communication, such as discussions at staff meetings regarding fraudulent or erroneous conduct issues and community bulletin boards, to keep practice employees updated regarding compliance activities; (6) enforcing disciplinary standards by making clear or ensuring employees are aware that compliance is treated seriously and that violations will be dealt with consistently and uniformly; and (7) responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate government entities. The top dog at the OIG, Inspector June Gibbs Brown, adopted a patronizing tone in addressing physicians on these compliance guidelines stated, "Adopting a voluntary compliance program is a lot like practicing preventative medicine, it helps identify and treat small problems before they become big problems." In lecturing doctors, the Inspector General goes on to state, "strong enforcement and strong voluntary prevention are equally important in safeguarding the government health programs from fraud and abuse. And the cornerstone of our prevention efforts is the development of voluntary compliance guidance that, in partnership with the private sector will help the health care community develop effective compliance programs." In other words, the Inspector General views all physicians as possible future criminals who must be sniffed out and hunted down. Practicing medicine can now be viewed as a potentially illegal activity and practicing medicine in noncompliance with OIG guidelines can place the physician on the verge of getting into "big problems". However, don't worry, she wants to be your "partner" and help you, the potential fraudulent physician, by providing these helpful guidelines for your voluntary internal compliance program. I strongly recommend that every physician read the complete version of this OIG document (found at the OIG website, www.hhs.gov/oig, under the heading of "What's new at HHS/OIG"), and formulate your own plans to avoid being put in the kennel and feeling the bite of Inspector Brown. August, 2000/ Jacksonville MedicineWhat's New
·
Northeast Florida Medicine Journal ·
Know Your Physician
· Legal
& Legislative
Duval County Medical Society
·
555 Bishopgate Lane
·
Jacksonville, FL 32204 |
|