July 25, 2014

Office of the Inspector General "OIG" Publishes New Physician Compliance Guidance

The Office of the Inspector General for the U.S. Department of Health and Human Services has published a new guidance document for physicians on compliance with healthcare fraud and abuse laws.  The document, A Roadmap for Physicians: Avoiding Medicare Fraud and Abuse, summarizes the five main federal fraud and abuse laws:  the False Claims Act; the Anti-Kickback statute; the Physician Self-Referral Law (“Stark”), the Medicare exclusion statute; and the Civil Monetary Penalties (“CMP”) law.  These materials then offer guidance on how physicians can comply with these laws in their relations with vendors, payers, and other providers.  Examples include practical advice on such issues as coding, documentation, investments in health care business ventures, physician recruitment, and medical director arrangements.   These materials may be found on the OIG website by following this link.

Daniel Levinson, HHS Inspector General, and Lew Morris, Chief Counsel to the Inspector General, both alluded to these new resources during testimony on March 2 before the U.S. Senate Committee on Finance, where they spoke on OIG’s collaboration with members of the private sector in their efforts to combat fraud.  Messrs. Levinson and Morris also described two other ongoing initiatives aimed at strengthening the integrity of the Medicare and Medicaid programs, involving the targeting of “hot spots” with Medicare Fraud Strike Teams and increased utilization of exclusion and other tools when dealing with “untrustworthy” providers. This testimony is also accessible on the OIG website.

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About the Author

David Edquist, Business, Environmental, Health, attorney, Von Briesen, law firm

David Edquist brings a risk management approach to his work with the firm’s health care and business clients that is based on over thirty years of experience in litigating commercial disputes in state and federal courts and before various administrative tribunals.

David advises our health care clients on joint ventures, affiliations, and acquisition agreements; issues facing not-for-profit institutions, including corporate governance and tax exemption; environmental compliance; and physician contracting and patient referral issues, including fraud investigations. In this...


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