Fwd: Mandatory(?) Fraud, Waste and Abuse Training for Delegated and Downstream Providers

[Guest guest]

Here is what my local hospital medical attorney forwarded me...

There has been a requirement since the October

2000 that Physician Practices develop and maintain a compliance program in

their practices to help detect and prevent instances of fraud/abuse.  See OIG

Compliance Program Guidance for Individual and Small Group Physician Practices (http://oig.hhs.gov/authorities/docs/physician.pdf)

With the attempt at healthcare reform,

sources of funding for this piece of legislation has to come from somewhere. 

The federal government has renewed its energy on investigations and prosecution

for fraud/abuse in healthcare billing.  The rate of return the OIG quotes if

$15.00 for every $1.00 they expend in investigations.  You can google and find

that physician, and other healthcare providers are increasingly paying

fines/penalties and getting prison time for fraud/abuse.  Millions of dollars

are being poured into this.

The FWA training is another attempt by the

federal government to insure providers (including physicians and their staff)

have received education and training related to fraud/abuse.  The increased

emphasis on whistleblower actions is transparent as well. 

What the below refers to is those organizations

that contract with CMS to provide Medicare Part D or Medicare Advantage

Prescription Drug Plan coverage are mandated to complete this training (namely

managed care organizations).  However, CMS included the downstream tier of

providers (meaning physicians).  That is why you see the Blues providing

education to physician providers.  You will probably receive many more links

from other managed care organizations for the same thing.

My suggestion is that if you don’t already

have a compliance program in place in your office, you read the Guidance

(attached above) and implement one that makes sense for the size of practice

you have.

Locke, MD