Wednesday, June 4, 2014

OIG Proposes Rule to Expand CMP Authorities

Dianne De La Mare

In May, the US Department of Health and Human Resources, Office of Inspector General (OIG) published a proposed rule, Fraud and Abuse: Revisions to the Office of Inspector General’s Civil Monetary Penalty Rules that would amend the health care program civil monetary penalty (CMP) regulations. The proposed rule would codify the OIG’s expanded statutory authority under the Affordable Care Act (ACA) to impose CMPs on providers and suppliers and would allow for significant penalties.

For example, the proposed rule would permit the OIG to impose $10,000 per day penalties on providers and suppliers who fail to timely report and return an identified overpayment. This proposal could increase the OIG’s ability to leverage substantial penalties beyond that which is permitted under current regulations. Further, OIG proposes permitting CMPs for conduct including: failure to grant OIG timely access to records; ordering or prescribing while excluded when the excluded person knows that the item or service may be paid for by a federal health care program; making false statements, omissions or misrepresentations in enrollment to a federal health care program; or making or using a false record that is material to a false or fraudulent claim.

AHCA/NCAL will submit formal comments by the July 11th deadline in response to OIG’s proposed rule, and ask that you submit any feedback or comment by Monday, July 2nd directly to Lyn Bentley at lbentley@ahca.org or Dianne De La Mare at ddmare@ahca.org.

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