OIG Says “No Bonus Points” for Having a Compliance Plan

AAOS Now – July 2016
by Cheryl Toth, MBA

New announcements and guidance push providers toward an active program

If your practice is targeted for a Medicare audit, the Office of the Inspector General (OIG) will no longer give you points for having a compliance plan on the shelf. Unless you’ve operationalized that plan into an active program, it’s not going to garner any leniency with the auditors, according to Inspector General Daniel Levinson, who announced new compliance guidance at the 2016 Health Care Compliance Association conference.

“This announcement is a sea change for physicians,” cautioned attorney Michael Sacopulos, JD, founder and president of the Medical Risk Institute in Terre Haute, Ind. “OIG’s perspective is that physicians have had more than enough time to develop active programs and implement self-monitoring through regular internal reviews, training, and self-reporting. But most haven’t done it. So the OIG is taking a new approach and will be looking for evidence that providers have active programs in place, not just written plans.”
Therefore, if your compliance plan is collecting dust, or if your practice does not have an up-to-date plan, it’s time to get serious. “Given the government’s recent interest and latest guidance, physicians should assume that increased enforcement is not far away,” predicted Mr. Sacopulos.

From carrot to stick

The new guidance is the latest by the OIG, which also has an array of program development tools and educational materials on its website. Unfortunately, the documentation has not prompted many medical practices to integrate compliance and self-monitoring into billing and practice operations, as the following examples show.

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