[Federal Register Volume 64, Number 173 (Wednesday, September 8, 1999)]
[Notices]
[Pages 48846-48847]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-23294]
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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 Individual Physicians and Small
Group Practices
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 as the OIG considers developing a
compliance program guidance for individual and small group physician
practices, especially those serving Medicare and other Federal health
care program beneficiaries. Many physicians have expressed an interest
in better protecting their practices from the potential for fraud and
abuse. While the OIG believes that the great majority of physicians are
honest and share our goal of protecting the integrity of Medicare and
other Federal health care programs, all health care providers have a
duty to reasonably ensure that the claims submitted to Medicare and
other Federal health care programs are true and accurate. The
development of a comprehensive, effective compliance program by
individual physicians and small group practices will go a long way
toward achieving this goal. Over the past two years, the OIG has
developed guidances for hospitals, clinical laboratories, home health
agencies, third-party medical billing companies and durable medical
equipment companies. While the OIG has previously referred physicians
and physician groups to the OIG's compliance guidance for third-party
medical billing companies for guidance regarding the risk areas that
are most directly relevant to physicians, we have received continued
interest from physicians for a specific guidance directed at their
individual practices. In order to provide such meaningful guidance to
individual and small group physician practices, the OIG is soliciting
comments, recommendations and other suggestions from concerned parties
and organizations on how best to develop a compliance program guidance
to reduce the potential for fraud and abuse in the individual or small
group physician practice, as well as feedback as to whether such a
guidance would be beneficial to physician practices.
DATES: To assure consideration, comments must be delivered to the
address provided below by no later than 5 p.m. on November 8, 1999.
ADDRESSES: Please mail or deliver your written comments,
recommendations and suggestions to the following address: Department of
Health and Human Services, Office of Inspector General, Attention: OIG-
7-CPG, Room 5246, Cohen Building, 330 Independence Avenue, S.W.,
Washington, D.C. 20201.
We do not accept comments by facsimile (FAX) transmission. In
commenting, please refer to the file code OIG-7-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, S.W., Washington, D.C. 20201 on Monday
[[Page 48847]]
through Friday of each week from 8:00 a.m. to 4:30 p.m.
FOR FURTHER INFORMATION CONTACT: Kimberly Brandt, Office of Counsel to
the Inspector General, (202) 619-2078.
SUPPLEMENTARY INFORMATION: The development of compliance program
guidances has become a major initiative of the OIG in its effort to
engage the private health care community in addressing and combating
fraud and abuse. Recently, the OIG has developed and issued compliance
program guidance directed at various segments of the health care
industry.1 New OIG guidance under consideration will be
designed to provide clear direction and assistance to physicians
providing services to Medicare and other Federal health care program
beneficiaries who are interested in reducing and eliminating the
potential for fraud and abuse within their practice.
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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 63 FR 70138 (December 18, 1998) for third party
medical billing companies. The guidances can also be found on the
OIG web site at http://www.hhs.gov/oig.
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The guidances represent the culmination of the OIG's suggestions 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 considers developing a compliance program
guidance directed at individual and small group physician practices.
The OIG will give consideration to all comments, recommendations and
suggestions submitted and received by the time frame indicated above.
We anticipate that the physician 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.
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.
The development of procedures to respond to detected
offenses and to initiate corrective action.
The OIG would appreciate specific comments, recommendations and
suggestions on (1) risk areas for the individual or small group
physician practice, and (2) aspects of the seven elements contained in
previous guidances that may need to be modified to reflect the unique
characteristics of the individual or small group physician practice.
Detailed justifications and empirical data supporting suggestions would
be appreciated.
We also request 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 a comprehensive draft guidance that
mirrors previous guidances.
Dated: August 31, 1999.
June Gibbs Brown,
Inspector General.
[FR Doc. 99-23294 Filed 9-7-99; 8:45 am]
BILLING CODE 4150-04-P