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OIG issues its Semi-annual Report to Congress...
...enforcement is up
On November 27, 2012, the Department of Health and Human Services Office of Inspector General (OIG), the authority for enforcing compliance in the health care field, issued its Semi-annual Report to Congress for April 1, 2012 - September 30, 2012. This report summarizes the OIG's activity for the past 6 months, and indicates that enforcement is up.
The entire report may be found here:
https://oig.hhs.gov/reports-and-publications/archives/semiannual/index.asp
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OIG recoveries increased
The following table shows that, overall, OIG enforcement efforts increased from 2011 to 2012:
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OIG enforcement activity
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2011 Result
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2012
Result
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Recoveries from audits and investigations
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$5.2 Billion
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$6.9 Billion
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Individuals/entities excluded from Federal health care programs
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2662
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3131
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Criminal actions brought against individuals/ entities
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723
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778
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Civil actions brought (false claims lawsuits, civil monetary penalty settlements, provider self-disclosures)
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382
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367
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Providers can expect this enforcement trend to continue: the Patient Protection and Affordable Care Act (PPACA) increased funding for healthcare enforcement activities by $250 million over the next few years. The OIG's enforcement activities during this 6 month period included: - A 20 year incarceration sentence and $6.7 Million restitution levied against a nursing home operator who submitted claims to Medicare and Medicaid for services that were so deficient they were "worthless."
- A $351,255 settlement with a rehabilitation and skilled care center that employed an assistant director of nursing who was excluded from participating in the Medicare and Medicaid programs.
- A $6.1 Million settlement with a hospice company that allegedly violated the false claims act when it submitted claims to Medicare for services provided to beneficiaries who did not meet hospice eligibility requirements.
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What you can do
Many providers have already begun implementing compliance programs in order to meet the PPACA's deadline (all nursing homes must have compliance programs in place by March 23, 2012). If you do not have an effective compliance program in place--or if your program has not been evaluated in a while--now is the time to address compliance. By implementing and continuing an effective compliance program, providers can both satisfy the PPACA's mandatory compliance program requirements, and avoid OIG enforcement.
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MPA can help
Management Performance Associates can help you implement compliance policies and procedures. To learn more about how your compliance program can help you avoid penalties, please visit our website: http://www.healthcareperformance.com, or give us a call at 314-434-4227 ext. 16.
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 Margaret Scavotto
General Counsel & Compliance Manager
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