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Personal Care Agency Fraud – Business Structure Can Impact Compliance Risk

Tuesday, June 27th, 2017

Personal Care Agency Structure Can Increase Risk and Government Scrutiny

Personal Care Agency FraudThe OIG recently released a review of Medicaid Fraud Control Unit activities which identified personal care agencies as accounting for nearly one-third of fraud prosecutions.  Previous blogs identified a number of compliance risks that often ensnare agencies.  Risk can also be impacted by the structure and nature of the business that is conducted by the agency.  The business might be perfectly legal, but can still create additional risk.

An good example involves personal care agencies that focus on recruiting patients with extended families who already reside with the patient.  A personal care business plan that focuses on training extended family might be technically legal, but can certainly present risk that a reviewer will more closely scrutinize record-keeping, PCW training, and other requirements.  Closer scrutiny may result in overpayment requests and/or investigation.

The normal business plan for a personal care agency involves the hiring and training of personal care worker who are assigned to clients who retain the agency’s services.  Normally, a PCW and a client do not know each other and certainly are not sharing a residence with the client.  Some agencies might focus their business on recruitment of patients who live with extended family.  Simply by providing training to the existing family member, the agency is able to generate reimbursement.  The extended family member is able to earn a wage for the service that it performed.

Immediate family will normally not qualify to generate reimbursement as a personal care work.  More distant family might be able to generate reimbursement.  There may be nothing specific in the laws of the applicable state that prohibits this type of arrangement.  At the same time, there is nothing prohibiting a regulator from more closely scrutinizing regulatory requirements when presented with agencies that may be technically legal but could be viewed as being abusive at their core.

The main point here is that business structure and other factors might present additional levels of risk to an agency.  Business structure should be considered as a factor when conducting risk analysis.  Businesses that are operated in technical compliance could present higher degrees of risk than more traditional business structures.

OIG 2017 Annual Work Plan

Monday, January 23rd, 2017

OIG Annual Work Plan for 2017 – Topics Covered

The Health and Human services Office of Inspector General (OIG) recently released its 2017 Annual Work Plan.  Work planning is an ongoing project within the OIG.  Every year, the OIG publishes a work plan that consolidates the OIG audits and evaluations that are being conducted or planned within the organization.  The annual work plan has become a source that compliance officers look to as a tool for the identification of potential risk areas or areas of emphasis within their organization.  It is obviously not the only source for identifying compliance risk areas, but is certainly one reliable source that providers can draw on when setting their annual compliance priorities.

The 2017 OIG Work Plan can be download through the OIG site.

Ruder Ware’s health care group will continue to put out blogs and articles on various issues identified in the 2017 Annual Work Plan.  We will focus primarily on issues that were introduced for the first time in this year’s plan.

A listing of some of the issues addressed in the 2017 annual work plan include:

Hyperbolic Oxygen Therapy Services – Provider Reimbursement in Compliance with Federal Regulations

Incorrect Medical Assistance Days Claimed by Hospital

Inpatient Psychiatric Facility Outlier Payments

Case Review of Inpatient Rehabilitation Hospital Patients Not Suites for Intensive Therapy

Intensity-Modulated Radiation Therapy

Outpatient Outlier Payments for Short-Stay Claims

Comparison of Provider-Based and Freestanding Clinics

Reconciliation of Outlier Payments

Hospital Use of Outpatient Stays Under Medicare’s Two Midnight Rule

Case Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy

Medicare Costs Associated with Defective Medical Device

Payment Credits for Replaced Medical Device That Were Implanted

Medicare Payment for Overlapping Part A Inpatient Claims and Part B Outpatient Claims

Selected Inpatient and Outpatient Billing Requirements

Duplicate Graduate Medical Education Payments

Indirect Medical Education Payments

Outpatient Dental Claims

Nationwide Review of Cardiac Catheterization and Endomyocardial Biopsies

Payments for Patients Diagnosed with Kwahiorkor

Use if Hospital Wage Data Used to Calculate Medicare Payments

CMS Validation of Hospital-Submitted Quality Reporting Data

Long Term Care Hospitals – Adverse Events in Post-acute-Care for Medicare Beneficiaries

Hospital Preparedness and Response to Emerging Infectious Diseases

Nursing Home Complaint Investigation Data Brief

Skilled Nursing Facilities – Unreported Incidents of Potential Abuse and Neglect

Skilled Nursing Facility Reimbursement

Skilled Nursing Facility Adverse Even Screening Tool

National Background Checks for Long Term Care Employees – Mandatory Review

Skilled Nursing Facility Prospective Payment System Requirements

Potentially Avoidable Hospitalizations of Medicare and Medicaid Eligible Nursing Facility Residents

Medicare Hospice Vulnerabilities and Recommendations for Improvement

Review of Hospices Compliance with Medicare Requirements

Hospice Home Care – Frequency of Nurse On-Site Visits to Assess Quality of Care and Services

Comparing HHS Survey Documents to Medicare Claims Data

Home Health Compliance with Medicare Requirements

Part B Services During Non Part-A Nursing Home Stays; Durable Medical Equipment

Medicare Market Share of Mail-Order Diabetics Testing Strips

Positive Airway Pressure Device Supplier – Supplier Compliance Documentation Requirements for Frequency and Medical Necessity

Orthotic Braces – Reasonableness of Medicare payments Compared to Amount Paid by Other Payors

Osteogenesis Simulators – Lump Sum Purchase Versus Rental

Power Mobility Devices – Lump Sum Purchase Versus Rental

Competitive Machines and Related Drugs – Supplier Compliance with Payment Requirements

Access to Durable Medical Equipment in Competitive Bidding Areas

Orthotic Braces – Supplier Compliance with Payment Requirements

Nebulizer Machines and Related Drugs – Supplier Compliance with Payment Requirements

Access to Durable Medical Equipment in Competitive Bidding Areas

Monitoring Medicare Payments for Clinical Diagnostic Laboratory Tests – Mandatory Review

Medicare Payments for Transitional Care Management

Medicare Payments for Chronic Care Management

Data Brief on Financial Interests Reported Under the Open Payments Program

Personal Care Service Providers and Wisconsin Medicaid

Thursday, February 6th, 2014

Personal Care Service Providers – Wisconsin Medical Assistance

Wisconsin Statute § 49.45(42)(d)3 describes the types of organizations that qualify to receive Medicaid reimbursement for “personal care services.”  Qualified entities include licensed home health agencies and other entities that are certified under section (2)(a)(11) to provide personal care services under section 49.46(2)(b)6j.  The DHS does not appear to have implemented regulations that specifically describe the criteria that “other entities” must meet in order to become qualified to receive reimbursement from Medicaid for the provision of personal care services.

The applicable provisions of section 49.45(2)(a)(11) do not contain specific criteria that “other entities” must meet but simply refers to the requirement that DHS promulgate rules establishing qualifications of providers.  The referenced statutory provision does not refer specifically to the requirements that “other entities” must meet in order to qualify to receive reimbursement for personal care services.

The requirements that must be met in order to become a licensed home health are more extensive than the personal care services entity.  However, becoming licensed as a home health agency will qualify you to provide and bill for personal care services directly.  It would also permit you to bill private pay patients for skilled nursing and other home health services and would provide the foundation for you to receive CMS certification as a home health agency.

Fraud Risks In Nursing Home/Hospice Relationships

Wednesday, October 30th, 2013

Fraud Risks Between Nursing Homes and Hospice Providers

Hospice Nursing Home Fraud and AbuseRelationships between hospices and nursing homes are a particular area of concern.  OIG is inherently suspicious of benefits that hospices may provide to nursing homes in order to gain hospice referrals of nursing home patients.  For example, if a hospice provides services to nursing home patients that are normally provided by the nursing home, the benefit could be deemed to be a “kickback” for referrals.  Hospices should have clear policies and procedures regarding the scope of services to be provided to nursing home patients.  Any formal agreement with a nursing home should be carefully scrutinized to assure compliance and provision should be added agreeing to the appropriate scope of care that is to be provided to nursing home patients.

Government focus on hospice providers should heighten awareness to these issues.  Hospices must make certain that they have formal compliance programs in place and that the compliance program is actively operated to identify and address risk.  Certainly, the risks identified above should be addressed by all hospice providers.  There are a broad range of additional items that should be actively addressed.  Additionally, all elements of the compliance program should be fully operationalized.  Even the most robust compliance program will not necessarily detect all compliance problems.  It is important that hospice providers are able to demonstrate that they are continually monitoring risk and operating their program.  When undetected programs come to light, the hospice provider will be able to show that reasonable steps are routinely taken to identify and correct problems.  This will go a long ways toward reducing potential exposure, even in cases where risk is not detected through the program.

Hospice – Nursing Home Relationships – Compliance Reviews

Friday, October 18th, 2013

Hospice Compliance Reviews – OIG Focus On Hospice Admissions

Hospice Admission Criteria ComplianceThe OIG has repeatedly expressed suspicion about hospice relationships with nursing homes and admission of “marginal” hospice patients who reside in nursing homes.  Hospices should routinely monitor their percentage of patients who reside in nursing homes and audit admission decisions relative to those patients.  This is an area of frequent review and hospices should assure that each nursing home/hospice patient meets admission criteria.

OIG also expressed concern over hospice marketing materials that could lead to inappropriate admissions.  Marketing materials should accurately describe the nature of hospice care and the criteria that must be met to receive hospice benefits.  Of particular importance is assuring that marketing materials clearly describe the requirement that the patient forgo any curative treatment in order to maintain eligibility for hospice benefits.

Misuse of hospice inpatient care is also prominent on the OIG’s radar.  Medical records of inpatients are vulnerable to review by the government to confirm the appropriateness of inpatient hospice benefits.  Hospices should add review of inpatient care admissions to their list of audit and review items if they have not already done so.

Hospice and Home Health Areas of Review Risk

Wednesday, September 18th, 2013

Home Health and Hospice Review Areas

home health hospice fraud reviewsThere are several areas applicable to home health and hospice that are susceptible to review.  Hospice reviews have tended to focus on whether patients actual meet criteria to be eligible to receive hospice benefits.  The focus on hospice arises, at least in part, due to the expansion of this segment of health care industry and the relatively rapid increase in spending for hospice care.  The government’s audit and enforcement trends indicate a deep suspicion that hospice are admitting patients who are not terminal or do not otherwise meet eligibility criteria.  The government points to the relatively large number of hospice patients who are discharged from hospice care alive.

In order to qualify for hospice benefits, a Medicare patient must have an illness that is terminal.  A physician must certify that the patient is terminal and is unlikely to live longer than six months if the illness runs its expected course.  The patient must also waive their right to receive curative treatment for the terminal condition in order to qualify for benefits.  Physician certification must be provided at two 90-day intervals following hospice admission.  After the first 180 days of hospice care, the patient must be seen “face-to-face” by a nurse practitioner who determines continued eligibility for coverage.  This process of certification and admission qualification creates several obvious pouts of risk for providers.  The government seems to be keying in on a few of these points of risk as evidenced by recent enforcement actions.

Payments to physicians for administrative duties should be carefully scrutinized to assure that the compensation arrangement does not create a referral inducement.  Medical director agreements must be analyzed under the Anti-Kickback Statute and applicable Stark Law exceptions.  Compensation should be at fair market value, cannot take into account he volume or value of referrals, and must meet other regulatory requirements.

CMS Improvement Standard Case Settlement

Tuesday, October 23rd, 2012

CMS Settles Class Action Reversing Nursing Home Improvement Standard

It is being reported that the Center for Medicare Advocacy, Inc. has settled its class action suit with the Center for Medicare and Medicaid Services regarding the “improvement standard” that CMS has historically required in order to continue Medicare reimbursement for patients in nursing homes. The “improvement standard” resulted in Medicare coverage being denied in cases where a patient’s condition was found to be stable, chronic, not improving, or for “maintenance only.”

The proposed settlement agreement will require CMS to revise relevant portions of its Medicare Benefit Policy Manual to clarify coverage standards for skilled nursing facilities, home health, and outpatient therapy benefits when a patient has not restoration or improvement potential but still needs the services that are provided by those types of providers. CMS is also required to clarify similar coverage standards that are applicable to inpatient rehabilitation facilities.

The settlement agreement provides for input by counsel representing the class into the process of developing new manual provisions that conform with the settlement.

The class action suit has alleged that Medicare routinely denied coverage based on the improvement standard. The settlement will require CMS to clarify that the improvement standard will no longer be applied to deny coverage. The people most affected by this barrier include people living with a range of conditions including multiple sclerosis, Alzheimer’s disease, ALS (Lou Gehrig’s disease), spinal cord injuries, diabetes, Parkinson’s disease, hypertension, arthritis, heart disease, and stroke. Many of these individuals who were not showing progress but still required care, and the institutions that serve them, will not be able to obtain reimbursement for services that they require.

Center for Medicare Advocacy Link

OIG Issues 2013 Annual Work Plan, Outlines Areas of Focus for Fiscal Year Ahead

Wednesday, October 10th, 2012

OIG 2013 Annual Work Plan Summary 

            Medical Practice Compliance Programs  The Office of Inspector General of the Department of Health of Health and Human Services (“OIG”) has published their annual work plan for the 2013 fiscal year (“2013 Work Plan”).  The Work Plan focuses on areas where OIG plans to focus significant resources during the 2013 fiscal year.  The 2013 Work Plan creates opportunities for providers to get a glimpse of what the OIG feels is important and to integrate these areas into their ongoing compliance activities.

              This update will briefly summarize some of the new issues that were added this year.  It is not a comprehensive description of all items that are on the OIG’s radar.  Providers are advised to review the entire 2013 Work Plan plus the work plans from the past several years to get a more complete picture of issues that the OIG feels are important.

Hospital-Related Issues

1.           Expansion of DRG Payment Window.  OIG states its intent is to analyze claims data to determine whether any savings could be achieved by bundling outpatient services that are delivered up to 14 days before a hospital inpatient admission.  Current Medicare policy bundles outpatient services that are delivered three days prior to inpatient admission into the “DRG window.”

2.           Provider-Based Status of Hospital on Physician Practices.  There is currently an incentive for a physician group to bill as a provider-based physician practice where there are ties to a hospital.  The OIG will be reviewing the appropriateness of physician practices who are billing as “provider-based” groups without meeting all of the necessary criteria.

3.           Medicare Transfer Policy.  The OIG will review Medicare payments made to hospitals for beneficiary discharges that should more appropriately have been coded as transfers.  Hospitals that transfer beneficiaries to another facility are not entitled to the full DRG payment that is due when a patient is properly discharged.  This creates an incentive for hospitals to code for a discharge when the patient is actually being transferred to another facility.  The OIG will be reviewing hospital billings to look for inappropriate “discharge” classifications.  Hospitals should audit their discharge and transfer practices to be certain that they are properly coding transfers where applicable.

4.           Payment for Discharges to Swing Beds and Other Hospitals.  Currently, Medicare does not reduce the DRG amount that is paid when a patient transfer is made into a “swing bed,” even when the “swing bed” is located in a separate facility.  The OIG will be reviewing this practice to determine whether any savings can come from reducing DRG payments when the swing bed transfer is made to another facility.

5.           Hospital Payments for Canceled Surgical Procedures.  The OIG will be reviewing payments that are made for canceled surgical procedures which are then followed by a second payment for a rescheduled procedure.  Current Medicare policy does not preclude payments for claims when there is an inpatient stay followed by canceled surgical procedure.  CMS will be reviewing this policy to determine whether savings can be made in this area.

6.           Payments from the Mechanical Ventilation.  CMS will be reviewing Medicare payments for mechanical ventilation.  Patients are required to receive 96 hours of mechanical ventilation in order to be eligible for payments under the DRG system.

7.           Improve An Organization Work With Hospital.  OIG will be reviewing the extent that Quality Improvement Organizations have worked with hospitals to conduct quality improvement projects and to provide technical assistance.

8.           Hospital Acquisition of Ambulatory Surgery Centers.  OIG will be reviewing hospital acquisitions of ambulatory surgery centers to determine whether these centers are being acquired as a method to increase reimbursement.  ASC services that are provided as in an outpatient department of the hospital are reimbursed at higher rates than independently owned an ambulatory surgery centers.

9.           Critical Access Hospital Payments for Swing Bed Services.  Critical access hospitals are able to designate a portion of the 25 bed allotment for use as acute care or swing bed services with CMS’s approval.  There is no limitation on the length of stay that is permitted for swing bed utilization.  The OIG will be reviewing this policy to determine whether reimbursement changes are required in this area.

Long Term Care Issues

1.           Long-Term Care Hospital Interrupted State Payments.  The OIG will be reviewing Medicare payments for interrupted stays in long-term care hospitals for the year 2011.  They will be identifying readmission patterns to determine whether the long-term care hospital’s re-admittance policies are in compliance with rules.

2.           Nursing Home Verification of State Agency Deficiency Corrections.  The OIG will be determining whether state survey agencies properly followed up and verified fulfillment of corrective action plans for deficiencies and identified during nursing home recertification surveys.  The OIG is concerned that state survey agencies may not always be verifying that identified deficiencies were properly corrected.

3.           Nursing Home Use of Atypical Antipsychotic Drugs.  The OIG will be reviewing administration of atypical antipsychotic drugs to nursing home residents.  The OIG will describe characteristics associated with nursing homes that frequently administer atypical antipsychotic drugs.

4.           Nursing Home Minimum Data Set Submissions.  OIG will determine whether CMS and state agencies oversee the accuracy and completion of minimum data sets that are submitted for nursing facilities.

Home Health Care

1.           Home Health Agency Face-To-Face Requirements.  OIG will be reviewing Medicare eligible home health services to be certain that face-to-face encounters are taking place as required under the Patient Protection and Affordable Care Act.  Previous studies indicated that only 30% of beneficiaries had at least one face-to-face visit with the physician who ordered the home health.

2.           Criminal Background Checks By Home Health Agencies.  The OIG will be reviewing home health agencies to determine whether they are complying with state requirements that require criminal background checks to be conducted on home health applicants and employees.  Federal law requires compliance with state and local laws regarding criminal background checks.  In previous OIG reviews, 92% of nursing homes employed at least one individual with criminal convictions.

Medical Equipment Suppliers

1.           Accreditation of Medical Equipment Suppliers.  OIG will be reviewing CMS procedures for conducting validation surveys of medical equipment suppliers.  CMS is required to conduct validation surveys regarding beneficiary safety and quality of care that may place Medicare beneficiaries at risk.

2.           Payments for Power Mobility Devices.  A series of reviews will be conducted relative to power mobility devices.  Reviews will focus on whether Medicare payments made to suppliers were made in accordance with federal regulations and were “reasonable and necessary.”  OIG will also be reviewing payment methods to determine whether savings can be achieved by eliminating the option of a lump sum purchase and requiring leasing of some power mobility devices.

3.           Continuous Positive Airway Pressure Supplies.  CMS will be reviewing whether scheduling of replacement supplies is appropriate and whether changing the scheduling could avoid possible wasteful spending.  There is currently no national requirement for CPAP replacement schedules.

4.           Diabetes Testing Supplies.  There are a number of new areas identified for examination relating to diabetes testing supplies.  Providers involved in these areas should carefully review the new items that relate to diabetes management and testing.

Program Integrity

1.           Onsite Visits for Medical Providers in Supplier Enrollment and Reenrollment.  CMS has the right as it deems necessary to perform onsite inspections of providers who are enrolling in the Medicare program.  CMS is authorized to expand the role of unannounced pre-enrollment visits.  Reviews found that some 33% of medical equipment suppliers in South Florida do not maintain physical facilities.  OIG will be examining these requirements to determine whether additional site visits are appropriate.

2.           Improper Use of Commercial Mailboxes.  Medicare providers are required to establish a physical business location with a permanent visible sign and a specific street addresses.  Mailboxes alone or not permitted.  Recent evidence suggests that individuals attempting to defraud Medicare may be using commercial mailbox addresses for this purpose.  OIG will be reviewing providers and suppliers to determine whether their listed addresses match commercial mailbox addresses.

3.           Provider Subject To Debt Collection.  CMS will be determining whether payment should be rechanneled relative to providers who have been reported to the Department of Treasury for collection of overpayment refunds.

Physician Billing

1.           Payment for Personally Performed Anesthesia Services.  OIG will be reviewing anesthesia claims to determine whether they are supported in accordance with Medicare requirements.  In order for a provider to be reimbursed as a personally performed anesthesia service, proper information must be included on the claim and in the medical chart to verify the claim.  Service modifier “AA” is used in connection with anesthesia services that are personally perform.  QK modifiers are used for medical direction of two, three, four concurrent anesthesia services.  Providers using “AA” modifiers must be able to support the requirement for receiving 100% of the personally performed services.

2.           Questionable Ophthalmological Service Billings for 2011.  OIG will be reviewing claims data to identify questionable billings for ophthalmologic services during 2011.  They will review geographic locations and provider patterns where questionable billings are located.  The types of billing that will be examined were not identified.

3.           Electrodiagnostic Testing.  OIG will be reviewing questionable billing for electrodiagnostic testing and will be attempting to identify Medicare utilization rates and get different rates by provider specialty, diagnosis, and geographic areas.  OIG identifies electrodiagnostic testing as an area of potential inappropriate financial gain posing significant vulnerabilities to the Medicare program.

Miscellaneous

1.           Location Requirements for Rural Health Clinics.  Rural health clinics are required to meet basic location requirements.  CMS has not promulgated final regulations allowing removal of rural health clinics that did not meet location requirements.  OIG will be reviewing this procedure.

2.           Claims Processing Areas “G” Modifiers.  The OIG will determine the extent to which Medicare improperly paid claims from 2002 to 2011 where certain “G” modifiers were used.  “G” modifiers are used to indicate that Medicare denial is expected by the provider.  It has been identified that some payments were made to providers in spite of the use of these modifier codes.

3.           Analysis of Drug Shortage in Patient Safety Concerns.  The OIG will be examining the recent trend of drug shortages to determine whether there has been an effect on pricing of pharmaceuticals.  Suspicion of industry price manipulation appears to be the motivation behind this system.

Summary

              This is a brief summary of some of the areas that were described in the recent 2013 Work Plan.  For a more comprehensive discussion of these items, visit the website for the Office of Inspector General and download the complete fiscal year 2013 annual work plan.  It is highly advisable for compliance officers to examine the document in its entirety to determine what impact, if any, it will have on their compliance efforts for fiscal year 2013.  It is also good practice to review annual work plans for several previous years as part of the risk identification process.

              If there are any questions regarding these requirements or how they impact compliance programs and detailed requirements that are generally described in this document, please do not hesitate to contact John H. Fisher, II, Esq., CCEP, CHC.

OIG 2013 Work Plan Nursing Home Hospice Home Health Provisions

Friday, October 5th, 2012

 

OIG Work Plan 2013 – Provisions Affecting Nursing Homes, Home Health and Hospices

 Nursing Homes—State Agency Verification of Deficiency Corrections (New)

Nursing Homes—Use of Atypical Antipsychotic Drugs (New)

Nursing Homes—Oversight of the Minimum Data Set Submitted by Long-Term-Care Facilities (New)

Nursing Homes— Adverse Events in Post-Acute Care for Medicare Beneficiaries

Nursing Homes—Medicare Requirements for Quality of Care in Skilled Nursing Facilities

Nursing Homes—Oversight of Poorly Performing Facilities

Nursing Homes—Hospitalizations of Nursing Home Residents

Nursing Homes—Questionable Billing Patterns for Part B Services During Nursing Home Stays

 

Hospices

Hospices—Marketing Practices and Financial Relationships with Nursing Facilities

Hospices—General Inpatient Care

 Home Health Services

  HHAs—Home Health Face-to-Face Requirement (New)

 HHAs—Employment of Home Health Aides With Criminal Convictions (New)

 HHAs—States’ Survey and Certification: Timeliness, Outcomes, Followup, and Medicare Oversight

 HHAs—Missing or Incorrect Patient Outcome and Assessment Data

 HHAs—Medicare Administrative Contractors’ Oversight of Claims

 HHAs—Home Health Prospective Payment System Requirements

 HHAs—Trends in Revenues and Expenses

Excluded Party Screening – Compliance Program Key Element

Tuesday, February 14th, 2012

Screening For Excluded Providers
Key Elements Of Your Compliance Program

Most hospitals and larger healthcare organizations have gone through the process of developing compliance programs and are aware of the prohibitions against entering relationships with parties who have been excluded from a federal health care program.  Smaller organizations may not be aware of their responsibilities to screen all employees, vendors and contracting parties for exclusion.

Providers, such hospitals, medical groups, ambulatory surgery centers and home health agencies are subject to civil monetary penalties for submitting claims for healthcare items or services that are provided by excluded individuals or companies.  Fines can reach as high as $10,000 per item or service.  The fines can be astronomical if goods or services are regularly provided by the excluded party.

For this reason, compliance programs will generally include policies and procedures that require screening prior to contracting or employment.  Regular periodic screening is also highly recommended.  Smaller organizations and physician practices are at the most risk of violating these provisions.  These organizations have generally not yet faced the creation of formal compliance programs; although compliance programs will be mandatory in upcoming years.

 All health care providers must establish policies and procedures to be certain that they do not contract with excluded parties.

John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

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The Health Care Law Blog is made available by Ruder Ware for educational purposes and to provide a general understanding of some of the legal issues relating to the health care industry. This site does not provide specific legal advice and you should not use the information contained on this site to address your specific situation without consulting with legal counsel that is well versed in health care law and regulation. By using the Health Care Law Blog site you understand that there is no attorney client relationship between you and Ruder Ware or any individual attorney. Postings on this site do not represent the views of our clients. This site links to other information resources on the Internet; these sites are not endorsed or supported by Ruder Ware, and Ruder Ware does not vouch for the accuracy or reliability of any information provided therein. For further information regarding the articles on this blog, contact Ruder Ware through our primary website.