OIG tightens up provider wiggle room’

Maximum penalties are boosted

The Department of Health and Human Services’ Office of the Inspector General has issued a final rule eliminating much of the "wiggle room" providers had when defending themselves against unknowingly submitting inappropriate claims. For starters, the rule increases the maximum civil monetary penalties (CMPs) against providers from $2,000 to $10,000 per false claim.

Under the rule, providers and individuals can be held liable under CMP even if there is no proof they intended to defraud the government. In other words, ignorance is no defense. In fact, the rule says providers and other individuals can be held liable if they act in deliberate ignorance of the truth or falsity of the information or in reckless disregard of the truth.

The final rule also:

— extends current CMP provisions to include all federal health programs;

— allows CMPs to be assessed for incorrect coding, medically unnecessary services, and offering remuneration to beneficiaries to influence their choice of a particular provider or supplier;

— establishes a new CMP for physicians’ false certification of eligibility for Medicare- covered home health services;

— authorizes a fine up to $10,000 a day when an individual who is excluded from participating in a federal health program is retained in a prohibited relationship with a participating health care entity.

The full text of the rule is available at http://www.hhs.gov/oig/new.html.