OIG proposal may increase financial penalties for providers

Healthcare providers could be subject to steeper monetary penalties under a new proposal from the Department of Health and Human Services' Office of the Inspector General.

"As those programs have changed over the last two decades, OIG has received new fraud-fighting CMP (civil monetary penalties) authorities in response, including new authorities under ACA [Affordable Care Act]," the proposal states. The proposed rule allows HHS to financially penalize healthcare organizations if they don't grant OIG timely access to documents necessary to conduct audits and investigations. To define timely access, OIG will take into account factors such as volume of material requested, but will be able to request the documentation immediately if given reason to believe the organization is attempting to alter or destroy it.

Several other infractions could also trigger penalties under the new proposal, including failure to report and return overpayments from federal healthcare programs, ordering or prescribing medications while excluded from those programs and making false statements on program enrollment materials.

The proposal is subject to a 60-day comment period. "OIG anticipates that CMP may increase in the future in light of the new CMP authorities and other changes proposed in this rule," the proposal states. "However, it is difficult to accurately predict the extent of any increase due to a variety of factors, such as budget and staff resources, the number and quality of CMP referrals or leads, and the length of time needed to investigate and litigate a case. In calendar years 2004-2013, OIG collected between $10.2 million and $26.2 million in CMP resolutions for a total of over $165.2 million."

OIG audits last fall found that Medicare overpaid the three-hospital Southcoast Hospitals Group in Massachusetts over $1 million in 2010 and 2011 due to the system's lack of adequate safeguards against inaccurate billings. The system did not comply with billing requirements for 165 incorrect inpatient claims and 75 incorrectly billed outpatient claims, FierceHealthcare previously reported.

To learn more:
- here's the proposal (.pdf)