OIG Issues Supplemental Compliance Program Guidance for Nursing Facilities
On September 20, 2008, the Department of Health and Human Services, Office of Inspector (the "OIG") published in the Federal Register a supplemental compliance guidance for Nursing Facilities ( the "Guidance"). The purpose of the Guidance is to supplement its prior compliance program guidance for nursing facilities issued in 2000. According to the OIG:
"The new CPG emphasizes the importance of submitting accurate claims and discusses issues related to reporting resident case-mix data, therapy services, screening for excluded individuals and entities, and restorative and personal care services. The guidance also urges nursing facilities to consider the risks of improper kickback payments associated with their business arrangements including those involving free goods and services, as well as those with physicians and suppliers."
The OIG's expanded discussion in the Guidance of fraud and abuse risks present in a nursing facility environment illustrates its increased enforcement focus on relationships between nursing homes and their referral sources, such as hospices. The Guidance includes, for example, a list of questions for a nursing home to ask itself when identifying potential kickback risks. The Guidance also contains a list of "potentially aggravating considerations" for a nursing home to look for when trying to determine arrangements at greatest risk of prosecution, such as whether the arrangement has a "potential to interfere with, or skew, clinical decision-making."
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