OIG releases draft compliance program for the DME industry

by MATTHEW HAY

HHBR Washington Correspondent

WASHINGTON – The Department of Health and Human Services (HHS; Washington) Office of Inspector General (OIG) released a draft voluntary compliance program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Jan. 28 that did little to ease the concerns of the DME industry. HHS said the creation compliance program guidance has become "a major initiative of the OIG in its efforts to engage the private healthcare community in addressing and fighting fraud and abuse.

The OIG has recently developed and issued voluntary compliance programs for clinical laboratories, hospitals, home health, and third party medical billing companies. More recently, it released a draft compliance program for the hospice industry. Comments are due on the draft compliance plan for DMEPOS on March 1.

"Given the diversity within the industry, there is no single best’ DMEPOS supplier compliance program," said the OIG. But the OIG said that despite the "variances and complexities" of the industry and differences between large national and regional suppliers and small independent suppliers there are elements that can be used by all suppliers regardless of their size and the type of equipment they provide.

The draft compliance program includes these seven elements that the OIG deems fundamental to an effective program: 1) Implementing written policies, procedures, and standards of conduct; 2) Designating a compliance officer and a compliance committee; 3) Conducting effective training and education; 4) Developing effective lines of communication; 5) Enforcing standards through well-publicized disciplinary guidelines; 6) Conducting internal monitoring and auditing; and 7) Responding promptly to detected offenses and developing corrective action.

"The biggest concern we have," said the Health Industry Distributors Association’s (HIDA; Alexandria, VA) Mark Hobratschk, "is the fact that the OIG included in this plan several Medicare policy issues that have not yet been resolved by HCFA."

Among these items, he said, are items relating to supply closets’ CMN cover letters, faxed CMNs, and supplier billing agents completing CMNs. "HCFA is in the process of issuing a ruling on these issues, and by putting them in this plan, the OIG really appears to be usurping HCFA’s authority to develop Medicare policy."

Hobratsck said that where some of these issues are concerned, notably CMN cover letters and supply closets’, it is likely that HCFA’s policies will differ significantly from what is contained in the plan. HIDA is currently drafting comments to the draft compliance plan which are due in two weeks.