BNA’s Health Care Fraud Report™ is the go-to source for health care fraud reporting, with in-depth information on government and private enforcement actions and strategies designed to...
By James Swann
March 31 -- The Department of Health and Human Services Office of Inspector General is working on new regulations covering the anti-kickback statute's safe harbors, civil monetary penalties and the OIG's exclusion authority, Inspector General Daniel R. Levinson said at a conference March 31.
Speaking at the Health Care Compliance Association's Compliance Institute in San Diego, Levinson said the new regulations for excluding individuals and entities from participating in federal health-care programs might be released by early spring or summer. He didn't elaborate on what they would include beyond new early reinstatement provisions.
Levinson said work on AKS safe harbors and civil monetary penalties will take longer.
In addition to addressing upcoming work by the OIG, Levinson also discussed current developments, such as ongoing reviews of the health insurance exchanges.
Levinson said the OIG is reviewing the rollout of the health insurance exchanges to identify where problems occurred. He also said reviews are looking at payment accuracy, cost sharing, tax credits and eligibility.
The OIG is also reviewing all contractors that were associated with the development and rollout of the exchanges.
Other areas of interest for the OIG include ongoing hospital compliance reviews, which Levinson said continue to look at billing and payment issues, both in terms of policies and procedures, as well as quality and patient safety issues.
He also said the OIG is looking at the level of adverse events in inpatient rehabilitation facilities.
Levinson stressed the importance of compliance officers listening to employees and being aware of any potential problems.
As an example, he mentioned a recent False Claims Act case, which he said resulted from not enough listening. As a result, Florida's Halifax Hospital Medical Center faces a potential $85 million settlement, Levinson said.
The Department of Justice March 10 announced that it had reached an $85 million settlement with Halifax in a lawsuit alleging Stark self-referral law violations and improper physician compensation arrangements (18 HFRA 233, 3/19/14).
Levinson also talked about the importance of compliance staff, especially regarding judgment. “We get tons of data, but do we get the information we need?” he asked.
He said determining what's important relies on human judgment. “We need to separate the wheat from the chaff,” Levinson said.
Levinson said the OIG is committed to building a team approach to its oversight duties, working hard to bring together the agency's various components.
Such efforts are “trying to make us a coordinated team,” he said. “We need to speak as one OIG.”
Looking ahead, Levinson said the stakes are high for the health-care compliance community, adding that, to borrow a phrase from Facebook Chief Operating Officer Sheryl Sandberg, “Everybody should be leaning in.”
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