February 2005 Newsletter

OIG Compliance: Hospitals

By Catherine Sicker, Compliance Officer, Partner

In the summer of 2004, the Office of Inspector General (OIG) published a draft Supplemental Compliance Program Guidance (CPG) for Hospitals. The final copy was released on January 31, 2005. This document augments rather than replaces the original CPG which addressed the fundamentals of establishing an effective compliance program. It does not create any new law or legal obligations. CPGs are meant to encourage the development and use of internal controls to monitor adherence to applicable statutes, regulations, and program requirements.

This document is the first guidance supplement published since the OIG began releasing CPGs in 1998. Ten CPGs have been issued for a variety of health care entities. This supplement may be informative to entities other than hospitals as a resource for benchmarking their own practices. It also highlights the OIG's current enforcement focus and foreshadows the release of other supplements.

A significant component of this supplement is the OIG's discussion of fraud and abuse risk areas and new compliance recommendations. One portion of the document identifies areas of operation that present potential risk of liability and addresses previous inquiries from hospitals.

• Submission of Accurate Claims Information
• Outpatient Procedural Coding
• Admissions and Discharges
• Supplemental Payment Considerations
• Use of Information Technology
• Referral Statutes
• Stark (Physician Self-Referral) Law
• Anti-Kickback Statute
• Joint Ventures
• Compensation Arrangements with Physicians
• Relationships with Other Health Care Entities
• Recruitment Arrangements
• Discounts
• Medical Staff Credentialing
• Malpractice Insurance Subsidies
• Payments to Reduce or Limit Services: Gainsharing Arrangements
• Emergency Medical Treatment and Labor Act (EMTALA)
• Substandard Care
• Relationships with Federal Health Care Beneficiaries
• Gifts and Gratuities
• Cost-Sharing Waivers
• Free Transportation
• HIPAA Privacy and Security Rules
• Billing Medicare and Medicaid Substantially in Excess of Usual Charges" Areas of General Interest
• Discounts to Uninsured Patients
• Preventative Care Services
• Professional Courtesy