[Federal Register Volume 63, Number 243 (Friday, December 18, 1998)]
[Notices]
[Pages 70137-70138]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-33566]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Inspector General


Solicitation of Information and Recommendations for Developing 
OIG Compliance Program Guidance for the Nursing Home Industry

AGENCY: Office of Inspector General (OIG), HHS.

ACTION: Notice.

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SUMMARY: This Federal Register notice seeks the input and 
recommendations of interested parties into the OIG's development of a 
compliance program guidance for the nursing home industry and its 
providers and suppliers, especially those serving Medicare and Medicaid 
beneficiaries. Many providers and provider organizations have expressed 
an interest in better protecting their operations from fraud and abuse. 
The OIG has developed guidances for hospitals, clinical laboratories, 
home health agencies and third-party medical billing companies. 
Currently, the OIG has under development compliance program guidance 
for the durable medical equipment, prosthetic and orthotic supply 
industry and Medicare+Choice organizations with coordinated care plans. 
In order to provide a clear and meaningful guidance to those segments 
of the health care industry involved in the ownership and operation of 
nursing care facilities, the OIG is soliciting comments, 
recommendations and suggestions from concerned parties and 
organizations on how best to develop a compliance program guidance and 
reduce fraud and abuse within the nursing home industry.

DATES: To assure consideration, comments must be delivered to the 
address provided below by no later than 5 p.m. on February 16, 1999.

ADDRESSES: Please mail or deliver your written comments, 
recommendations and suggestions to following address: Office of 
Inspector General, Department of Health and Human Services, Attention: 
OIG-5-CPG, Room 5246, Cohen Building, 330 Independence Avenue, SW, 
Washington, DC 20201.
    We do not accept comments by facsimile (FAX) transmission. In 
commenting, please refer to the file code OIG-5-CPG. Comments received 
timely will be available for public inspection as they are received, 
generally beginning approximately 3 weeks after publication of a 
document, in Room 5541 of the Office of Inspector General at 330 
Independence Avenue, SW, Washington, DC 20201 on Monday through Friday 
of each week from 8 a.m. to 4:30 p.m.

FOR FURTHER INFORMATION CONTACT: Stephen Davis, Office of Counsel to 
the Inspector General, (202) 619-2078.

SUPPLEMENTARY INFORMATION: The development of compliance program 
guidances continues as a major OIG initiative as a vehicle for engaging 
the private health care community in an effort to reduce fraud and 
abuse. This nursing home guidance represents another step in the OIG's 
plan to encourage the implementation of compliance programs in specific 
segments of the health care industry.1 As in the past, this 
guidance is designed to provide clear direction and assistance to 
Medicare and Medicaid nursing home providers, their owners and 
suppliers, who are interested in reducing and eliminating fraud and 
abuse within their organizations.
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    \1\ See 62 FR 9435 (March 3, 1997) for clinical laboratories, as 
amended in 63 FR 45076 (August 24, 1998); 63 FR 8987 (February 23, 
1998) for hospitals; 63 FR 42410 (August 7, 1998) for home health 
agencies, and for third party medical billing companies appearing 
elsewhere in this Federal Register. The guidance can also be found 
on the OIG web site at http://www.dhhs.gov/progorg/oig.
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    The guidance represents the culmination of the best suggestions and 
recommendations from the OIG and from representatives of the private 
health care community on how providers can most effectively establish 
internal controls and implement monitoring procedures to identify, 
correct and prevent fraudulent and wasteful activities. As stated in 
previous guidances, these guidelines are not mandatory for providers, 
nor do they represent an exclusive document of advisable elements of a 
compliance program.
    In an effort to formalize the process by which the OIG receives 
public comments in connection with compliance program guidances, the 
OIG is seeking, through this Federal Register notice, formal input from 
interested parties as the OIG begins developing the compliance program 
guidance for Medicare and Medicaid covered nursing home facilities, 
their providers and suppliers. The OIG considers all comments, 
recommendations and suggestions submitted and received by the time 
frame indicated above.
    The OIG anticipates that the nursing home guidance will contain 
seven elements that the OIG considers necessary for a comprehensive 
compliance program. These seven elements have been discussed in our 
previous guidances and include:
     The development of written policies and procedures;

[[Page 70138]]

     The designation of a compliance officer and other 
appropriate bodies;
     The development and implementation of effective training 
and education programs;
     The development and maintenance of effective lines of 
communication;
     The enforcement of standards through well-publicized 
disciplinary guidelines;
     The use of audits and other evaluation techniques to 
monitor compliance; and
     The development of procedures to respond to detected 
offenses and to initiate corrective action.
    The OIG would appreciate specific comments, recommendation and 
suggestions on (1) risk areas for the nursing home industry, and (2) 
aspects of the seven elements contained in previous guidances that may 
need to be modified to reflect the unique characteristics of the 
nursing home industry. Detailed justifications and empirical data 
supporting suggestions would be appreciated. The OIG is also hopeful 
that any comments, recommendations and input be submitted in a format 
that addresses the above topics in a concise manner, rather than in the 
form of comprehensive draft guidance that mirrors previous guidances.

    Dated: December 14, 1998.
June Gibbs Brown,
Inspector General.
[FR Doc. 98-33566 Filed 12-17-98; 8:45 am]
BILLING CODE 4150-04-P