OIG Releases First Guide for Hospital Boards Regarding Detecting and Avoiding Overbilling, Healthcare Privacy and Illegal Kickbacks
21st April 2015
The Office of Inspector General at the U.S. Department of Health and Human Services has just released the first guide for hospital governing boards on how to detect and avoid overbilling, kickbacks and privacy breaches that can cause civil and criminal penalties. The guide is unique because it represents a collaboration between the OIG, the American Health Lawyers Association, the Association of Healthcare Internal Auditors and the Health Care Compliance Association.
The guide discusses specific areas of concern like upcoding, billing for medically unnecessary or nonexistent care, and disclosure of protected health information and warned about the potential for new delivery models to create fraud liability, urging boards to examine referral and compensation arrangements with physicians for possible violations of the Stark Law and the Anti-Kickback Statute.
The guide suggests creating “objective scorecards” that could rate performance in different areas and would require reports on information gathered from internal audits, whistleblower hotlines and expense accounts.
Finally, the guide suggests that boards may want to consult federal sentencing guidelines which discuss self-policing of compliance concerns as well as previous compliance commentaries from the OIG and corporate integrity agreements that providers suspected of fraud have previously entered into.