New triggers proposed for civil monetary penalties

The Office of Inspector General proposed new regulations Monday to add to the list of wrongdoings punishable by civil monetary penalties. The new offenses include:

  • failure to grant OIG timely access to records;
  • ordering healthcare services or prescribing while excluded from participation in federal healthcare programs;
  • making false statements, omissions or misrepresentations in an enrollment application;
  • failure to report and return an overpayment; and
  • making or using a false record or statement that is material to a false or fraudulent claim.

"For over 22 years, OIG has exercised the authority to impose CMPs, assessments and exclusions in furtherance of its mission to protect federal healthcare programs and their beneficiaries from fraud, waste and abuse," the proposal states.

As those programs have changed, OIG received new fraud fighting CMP authorities in response, including expanded sanctioning powers under the Affordable Care Act.    

Comments on the proposal are due by July 11.

OIG expects to see a spike in CMP collections if the proposed regulations become final. But it's difficult to predict how much more the agency will recoup due to budget and staff resources, the number and quality of CMP referrals, and the time required to investigate and litigate cases, the proposal noted. From 2004 to 2013, OIG collected between $10.2 million and $26.2 million in CMP resolutions totaling more than $165.2 million.

A post from the New York Nursing Home Abuse Lawyer Blog reveals where some CMP dollars went.    

Penalties collected from aberrant nursing home providers have funded projects to improve the quality of nursing home care. Delaware, for example, used CMP money to provide a training workshop on bedsores and restraints, the post noted. Florida used funds to train staff to manage mentally ill patients more effectively. Iowa created retention programs for certified nurse assistants. And Maryland funded a pets-on-wheels program to bring joy to nursing home residents.  

But many states have had trouble determining how much CMP money they're entitled to, the post stated. Sometimes CMPs were issued by the government, but states never collected or pursued the funds. And some states deposited CMP dollars--which are supposed to be handled separately--into a general account and used them to bankroll projects unrelated to nursing home care, the post noted.

For more:
- read the proposed regulations
- here's the New York Nursing Home Abuse Lawyer Blog post