SZD Health Law Scan : Health Care Lawyers & Attorneys : Schottenstein Zox & Dunn Law Firm : Strategic Planning, Managed Care, Insurance : Columbus, Cleveland, Cincinnati, Central Ohio

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On June 25, 2009, Daniel Levinson, Inspector General of the U.S. Department of Health and Human Services, testified before the House Energy and Commerce Committee's Subcommittee on Health. During his testimony, he addressed the OIG's ongoing efforts in combating fraud, waste and abuse in Medicare and Medicaid. Additionally, he reiterated the OIG's "Five Principles," which the OIG believes should guide the development of a national health care integrity strategy. The Inspector General had recently announced these same principles before the Senate's Special Committee on Aging.

The Inspector General summarized the Five Principles as follows:

1.      Enrollment - Scrutinize individuals and entities that want to participate as providers and suppliers prior to their enrollment in health care programs.

2.      Payment - Establish payment methodologies that are reasonable and responsive to changes in the marketplace.

3.      Compliance - Assist health care providers and suppliers in adopting practices that promote compliance with program requirements, including quality and safety standards.

4.      Oversight - Vigilantly monitor programs for evidence of fraud, waste, and abuse.

5.      Response - Respond swiftly to detected fraud, impose sufficient punishment to deter others, and promptly remedy program vulnerabilities.

The Inspector General concluded his testimony by tying the OIG's strategy to the broader efforts to reform the U.S. health care system: "In the context of health care reform, it is an especially important time to consider how to best safeguard health care programs from fraud, waste, and abuse to protect beneficiaries and taxpayer dollars." According to the Inspector General, the Five Principles provide the necessary framework to accomplish these goals.