OIG doubles staff to track integrity agreements in 2000
OIG doubles staff to track integrity agreements in 2000
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) currently has 405 corporate integrity agreements (CIA), Michael Shaw, associate counsel in the OIG’s Civil Recoveries Branch told a Healthcare Financial Management Association Conference Aug. 27. And nine months into FY ’99, his office has already completed 92 CIAs, he added.
"I was a bit surprised by those numbers," remarks health care attorney Sandy Teplitzky, of Ober Kaler in Baltimore. "I can imagine that is a tremendous strain on the OIG’s resources to keep up with them because each of these agreements has to be monitored and requires an annual report."
According to Shaw, his office is now hiring additional staff for just that reason. A total of 39 CIAs were completed between FY ’94 to FY ’96. In FY ’97, that number jumped to 83 and hit 233 in FY ’98.
"A lot of times we have not been able because of resources to monitor a certain case," Shaw conceded.
"Our compliance unit of the civil recoveries branch come October is doubling, so we are able to do not only more on-site reviews but getting up to date on reviewing our annual reports that come in."
A full 264 of the 405 active CIAs are with hospitals, according to the OIG’s latest count. But 216 of those agreements were executed under the Hospital Outpatient Laboratory Project alone (which also explains the spike in FY ’98).
Practitioners placed second with 43 agreements, followed by outpatient services (15), durable medical equipment suppliers (14), and skilled nursing facilities (10). Registering single digits were laboratories (9), ambulances (9), billing contractors (4), carriers/intermediaries (3), and home health agencies (3).
Shaw also offered his advice to hospitals and other providers about how avoid becoming part of these statistics. "The only way you get credit for your compliance program is if it is effective," he said. "But there are a whole assortment of factors that get you there."
Look beyond the risk areas included in OIG compliance program guidelines, he advises. Those areas will vary not only by industry but by company. "That should be based on your track record with your surveyors and the way your audits have been turning out results."
Make sure your policies are written so they can be understood and applied by employees, he added.
"I cannot tell you how many policies I’ve received in my review of CIAs where there is just a whole lot of legal mumbo-jumbo,’" Shaw asserted. Don’t expect employees to know their Starks’ from their anti-kickbacks’, he explained. But do expect them to know not to accept a gift from a doctor.
That might mean developing two or three levels of policies depending on the audience, he added. And in some cases, it might mean providing it in Spanish or other languages.
Shaw said his office also looks at whether the company’s compliance officer function has been added to other duties that might conflict.
"In certain circumstances, we don’t believe that a compliance officer should also have to role of general counsel or CFO," he said. "We’re not saying you can’t do it, but we want you to understand the risks that are associated with doing that."
Shaw also urged companies to reevaluate the results of past audits, pre-established baselines, or prior deficiencies. "That is very important," he warns. "If you keep having the same problem year after year, then you have not done anything to correct it." The same applies to conditional deficiencies, he added.
He also warned against taking the wrong signal from a dormant hotline. "Nobody has all the answers, and that’s what hotlines are for. People should be asking questions."
That means employees must be protected from retaliation, added Shaw. "If they don’t feel comfortable because their manager is the one telling them to carry out a potentially unlawful practice, they should be allowed to go outside that chain of command."
Shaw also urged companies to report billing errors under the OIG’s voluntary disclosure program when appropriate. He reported the OIG has so far had 41 voluntary disclosures, but only two resolutions.
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