Compliance

OIG Makes Available Federal Anti-kickback Statute Video and Podcast

The Anti-kickback Statute prohibits individuals or entities from knowingly and willfully offering, paying, soliciting, or receiving anything of value to induce or reward the referral of Federal health care program business. This audio and video podcast highlights what the statute prohibits, the law’s criminal penalties, the programs the law covers, and the safe harbors to the law.

Read more: OIG Makes Available Federal Anti-kickback Statute Video and Podcast

Cover Your Attestation & Exclusion Lists

In addition to Meaningful Use Attestation requirements, many insurance companies are asking for Annual Compliance Attestation for organizations to validate compliance with applicable requirements. The attestation process consists of completing 8 sections: 7 of the sections ensure compliance with Medicare requirements; the 8th section is for your electronic attestation and signature.
 
Why are insurance companies asking for Annual Compliance Attestation? What are the Medicare requirements? Are you required to complete the attestation? How can we help you with the attestation process?
 
We will discuss why insurance companies are asking for Annual Compliance Attestation. We will also discuss annual Corporate Compliance training requirements and how Zetter HealthCare helps your organization meet the applicable requirements.
 
Why attestation?
CMS requires oversight of FDRs (first-tier, downstream, and related entities) for all Medicare Advantage plan sponsors. Insurance companies have developed annual attestation compliance attestation to validate that each contracted FDR has met CMS requirements.
 
The electronic attestation must be completed by an individual in your organization who has signatory authority to make the representations in the attestation. You should enter and submit each additional NPI (National Provider Identifier) you have signatory authority for during the attestation process.
 
Fraud, Waste, Abuse and Compliance Training
Medicare plan sponsors are required to communicate their general compliance expectations to their FDRs through distribution of the plan sponsor’s Standards of Conduct and/or compliance policies and procedures to FDRs' employees.  FDRs' employees who have involvement in the administration or delivery of Parts C and D benefits, must, at a minimum, receive Fraud, Waste and Abuse (FWA) training within 90 days of initial hiring/contracting, and annually thereafter. Plan sponsors must be able to verify that their FDRs have fulfilled these training requirements.
 
How does Zetter HealthCare help meet Annual Compliance Attestation Requirements?
Zetter HealthCare helps you cover your attestation requirements in a variety of ways. Instead of needing to take each insurance company's compliance training on each of their websites, you can simply complete our Corporate Compliance module which fulfills CMS training requirements. In addition to training, the Corporate Compliance module includes policies and procedures, information needed for reporting compliance or FWA concerns, and more. We also have a Corporate Compliance Reference Guide and a variety of posters and documents that are available to you in our Forms section.
In addition to Meaningful Use Attestation requirements, many insurance companies are asking for Annual Compliance Attestation for organizations to validate compliance with applicable requirements.
 
In the first part of our Cover Your Attestation article series, we discussed why insurance companies are asking for Annual Compliance Attestation. We also discussed annual Corporate Compliance training requirements and how Zetter HealthCare’s Compliance Program helps your organization meet the applicable requirements.
 
Now, let’s discuss FDRs (first-tier, downstream, and related entities) requirement for checking exclusion lists.
 
Exclusion Lists
Medicare Advantage plan sponsors are required to ensure that all FDRs are screening all employees/vendors/subcontractors against the DHHS OIG List of Excluded Individuals and Entities (LEIE) prior to hiring or contracting and then re-check monthly thereafter.
 
Yes, you read that right - the exclusion list is required to be checked on a monthly basis.
 
This means that your organization is responsible for not employing or contracting with excluded individuals or entities, whether in a physician practice, a clinic, or in any capacity or setting in which Federal healthcare programs may reimburse for the items or services furnished by those employees or contractors. This responsibility requires screening (prior to hiring or contracting and monthly thereafter) all current and prospective employees and contractors against OIG’s LEIE.
 
The OIG Exclusion list may be accessed by going here: http://exclusions.oig.hhs.gov/. Alternatively, you may consider reading further to see how we can help you with this process.
 
Why check for excluded individuals and entities?
According to the OIG, an excluded person violates the exclusion if the person furnishes to Federal health care program beneficiaries items or services for which Federal health care program payment is sought. In other words, an excluded person that submits a payment to a Federal health care program, or causes such a claim to be submitted, may be subject to a civil monetary penalty (CMP) of $10,000 for each claimed item or service furnished during the period that the person was excluded.  In addition, you may be subject to an assessment of up to three times the amount claimed for each item or service, and denial of reinstatement by OIG to Federal health care programs because of an exclusion violation.
 
How we can help
Because we recognize the burden of checking the online database can be a challenging and potentially costly process for your organization, Zetter HealthCare has decided to launch an affordable OIG Exclusion List service. This service is on schedule to be launched the beginning of March 2015. Our OIG Exclusion List service will ensure that your organization is screening all employees, vendors, and subcontractors against the DHHS OIG List of Excluded Individuals and Entities (LEIE) prior to hiring or contracting and monthly thereafter.
 

Compliance Culture and Officer Should be Protected

There are new tools being provided by the Health and Human Services Office of Inspector General on compliance.  The office has been posting educational resources to its Compliance 101 Web page.  Some of the educational materials recently posted included A Toolkit for Health Care Boards.  This toolkit includes among other things, a list of six objectives for promoting quality of care and six for evaluating your compliance program.

Read more: Compliance Culture and Officer Should be Protected

Another Argument for Getting the Signatures Right

Reprinted from DecisionHealth Daily.

An OIG report on claim payment denials shows a big, fat opportunity to reduce your own.

OIG's report on the "pilot prject to obtain missing documentation identified in the Fiscal Year 2010 CERT program" is mainly meant to save CMS time and money by reducing their claims error rates due to missing documentation -- the cost of all such transactions, including appeals and reversals, comes out of their pockets.

Read more: Another Argument for Getting the Signatures Right

High Level E/M Codes are Coming Under Increased Scrutiny by the OIG

The May 8, 2012, Office of Inspector General's report, Coding Trends of Medicare Evaluation and Management Services, says payments for E/M services increased 5% more than the rate of increase for all Part B payments from 2001 to 2010 (48% vs. 43%). Through claims data analysis, the OIG has identified those physicians who consistently billed the higher-level E/M codes in 2010.
The report says:

Read more: High Level E/M Codes are Coming Under Increased Scrutiny by the OIG

Medical Groups & Billing Company Settle to Resolve Overbilling Scheme

Baltimore, Maryland B Medical billing company Engage Medical, Inc., its owner Sanjay Puri and three medical practices that were its clients have agreed to pay a total of $3,340,979 to resolve claims that Engage Medical overbilled for nuclear stress tests. Engage Medical and Sanjay Puri have agreed to pay $544,500; Advanced Cardiology Center and its owners Pankaj Lal, M.D., Mubashar Choudry, M.D. and Moshin Ijaz, M.D. agreed to pay $1,894,549.50; Reva Gill, M.D. and Kenilworth Internists, P.A. agreed to pay $242,204; and Sureshkumar Muttath, M.D. agreed to pay $659,726.

Read more: Medical Groups & Billing Company Settle to Resolve Overbilling Scheme

OIG Posts 2012 Work Plan

The Office of Inspector General's ( OlG ) Work Plan sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General. The Work Plan includes projects planned in each of the Department's major entities: the Centers for Medicare & Medicaid Services; the public health agencies; the Administrations for Children & Families; and Administration on Aging.

Read more: OIG Posts 2012 Work Plan

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