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New Five Point Strategy Revealed
[By Staff Reporters]
According to the Report on Medicare Compliance, October 20, 2008, the Health and Human Services [HHS] Office of Inspector General [OIG] recently unveiled a five-point strategy for fighting fraud and abuse in anticipation of a new presidential administration.
Five Pillars
The five “pillars” are:
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scrutinize who is allowed to bill before enrollment.
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establish reasonable and responsive payment methodologies.
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help industry adopt practices that promote compliance.
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vigilantly monitor claims for payment, and;
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respond quickly to detected fraud.
OIG and DOJ
Among other activities, the OIG and Department of Justice [DOJ is using data mining to identify claims problems before they get out of hand.
Assessment
For example, the Office of Evaluation and Inspections [OEIs] issued a 2006 report on aberrant physical therapy billing – physicians were billing for services performed by unlicensed people in the patients’ homes – while an OIG attorney deputized by the Department of Justice [DOJ] is now prosecuting cases based on this violation in the Southern District of Mississippi.
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Filed under: Health Law & Policy, Healthcare Finance, Risk Management | Tagged: DOJ, HHS | 7 Comments »
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