OIG Tips Series ~ OIG upcoming changes in CMP and Exclusions were highlighted by Inspector General Dan Levinson at HCCA’s Compliance Institute this past spring. In continuing his use of colorful slides from the San Diego area the owl was used as a signal to compliance office to be on the outlook for upcoming changes. Levinson pointed to three upcoming initiatives at his April keynote:New safe harbors under the Anti-Kickback Statute
- New authorities for Civil Monetary Penalties Law
- New authorities under exclusions
The representative slide was appropriately a picture of an owl, which continued the theme of color slides representative of the San Diego zoo and wild animal park attractions:
…..new safe harbors under the Anti-Kickback Statute; new authorities with respect to the Civil Monetary Penalties Law, our old 42 Part 1003; and exclusions, new authorities, updating the exclusions, including proposing early reinstatement provisions, which we haven’t had before, trying to modernize our work in all three areas. I would say that as far as the new safe harbors and the new Civil Monetary Penalties Law provisions, those are still in process and are likely to have a longer timeline than our work on the exclusions, which I’m hoping that our new regs on exclusions will be available as early as later this spring or early summer.
OIG Upcoming Changes: CMP and Exclusions
In May the OIG did release proposed rules to 1) expand the HHS Office of Inspector General’s (OIG’s) authorities under the Civil Monetary Penalty (CMP) Regulations in 42 C.F.R. Part 1003 and 2) OIG’s exclusion authority under Part 1001. Both of these Proposed Rules incorporate expanded authority under the Affordable Care Act (ACA).
The Civil Monetary Penalties Law and the Exclusions Authority are two of the “Five Faces of Fraud and Abuse” – along with the False Claims Act, Anti-Kickback Statute and Stark Laws. . There is a proposed expansion of the range of conduct wherein CMPs can be assessed by the OIG, including: failure to provide timely access to documents, making false statements on enrollment applications (such as 855i or PECOS equivalent) to participate in federal health care programs including Medicare, failing to report and return known overpayments with the allotted timeframe, and finally making or using a false statement that is material to a false or fraudulent claim.
Proposed comments on the rules are due in this month and after consideration and review the OIG will publish the final rule(s) essentially putting more power in its arsenal as given under the Affordable Care Act
Do you do exclusions checks? Did you know that you can potentially be fined $10,000 per day that an excluded individual is on your staff? Do you understand what constitutes a civil monetary penalty? Stay tuned for further details on the OIG upcoming changes.