OIG Issues Final Compliance Program Guidance for Individual and Small Group Physician Practices

Health Law Alert


OIG Issues Final Compliance Program Guidance For Individual And Small Group Physician Practices

The Department of Health and Human Services Office of Inspector General ("OIG") has issued final compliance program guidance for individual and small group physician practices. The final physician guidance can be viewed at the OIG's web site, WWW.HHS.GOV/OIG/NEW.HTML, or through our firm's web site at WWW.SSKRPLAW.COM under our Health Care Issues\Health Law link.

The final guidance emphasizes a step by step approach. It provides greater flexibility than the draft guidance and guidance previously issued by the OIG for other health care industry providers. The final guidance is not in and of itself a compliance program. It lists seven components which can form the basis of a compliance program for a physician practice. These components are (1) auditing and monitoring; (2) written standards and procedures; (3) designating a compliance officer/contact ; (4) training and education; (5) responding to detected violations; (6) open lines of communication, and (7) enforcing disciplinary standards. In order to assist physician practices in assessing risk vulnerabilities, the final guidance also lists four major compliance risk areas: (1) coding and billing; (2) reasonable and necessary services; (3) documentation, and (4) improper inducements, kickbacks and self-referrals. Larger practices are advised to use both the physician guidance and previously issued guidance such as Third-Party Medical Billing Company Compliance Program Guidance. The OIG does not indicate what number of physicians constitutes a large practice.

As we anticipated, the draft guidance is premised on the seven elements set forth in the Federal Sentencing Guidelines and include: (1) establishing compliance standards through the development of a code of conduct and written policies and procedures; (2) assigning compliance monitoring efforts to a designated compliance officer or contact; (3) developing training and education programs; (4) conducting internal monitoring and auditing focusing on high risk billing and coding issues through performance of periodic audits; (5) developing accessible lines of communication to keep practice employees updated regarding compliance activities; (6) establishing disciplinary standards that ensure employees are aware that compliance is treated seriously and violations will be dealt with consistently and uniformly; and (7) responding appropriately to detected violations including prompt corrective action.

To use the OIG's analogy, just as immunizations given to patients prevent them from becoming ill, the implementation of a compliance program is an important way for practices to prevent erroneous, improper or fraudulent conduct and avoid the serious ramifications of such conduct. All our physician practice clients should take steps to develop a compliance program that fits their circumstances and incorporates, to the extent appropriate, the guidance provided by the OIG. This is especially so in light of the final guidance's flexibility. We have already developed compliance programs for many of our physician practice clients. Contact us so we can assist you in this very important matter.

Thomas J. Tamburelli
Health Care Department

Health Law Alert is provided by Sherman, Silverstein, Kohl, Rose & Podolsky, P.A. as a courtesy. It is not intended as legal advice.