[Federal Register: September 8, 1999 (Volume 64, Number 173)]
[Notices]               
[Page 48846-48847]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr08se99-79]                         

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Inspector General

 
Solicitation of Information and Recommendations for Developing 
OIG Compliance Program Guidance for Individual Physicians and Small 
Group Practices

AGENCY: Office of Inspector General (OIG), HHS.

ACTION: Notice.

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SUMMARY: This Federal Register notice seeks the input and 
recommendations of interested parties as the OIG considers developing a 
compliance program guidance for individual and small group physician 
practices, especially those serving Medicare and other Federal health 
care program beneficiaries. Many physicians have expressed an interest 
in better protecting their practices from the potential for fraud and 
abuse. While the OIG believes that the great majority of physicians are 
honest and share our goal of protecting the integrity of Medicare and 
other Federal health care programs, all health care providers have a 
duty to reasonably ensure that the claims submitted to Medicare and 
other Federal health care programs are true and accurate. The 
development of a comprehensive, effective compliance program by 
individual physicians and small group practices will go a long way 
toward achieving this goal. Over the past two years, the OIG has 
developed guidances for hospitals, clinical laboratories, home health 
agencies, third-party medical billing companies and durable medical 
equipment companies. While the OIG has previously referred physicians 
and physician groups to the OIG's compliance guidance for third-party 
medical billing companies for guidance regarding the risk areas that 
are most directly relevant to physicians, we have received continued 
interest from physicians for a specific guidance directed at their 
individual practices. In order to provide such meaningful guidance to 
individual and small group physician practices, the OIG is soliciting 
comments, recommendations and other suggestions from concerned parties 
and organizations on how best to develop a compliance program guidance 
to reduce the potential for fraud and abuse in the individual or small 
group physician practice, as well as feedback as to whether such a 
guidance would be beneficial to physician practices.

DATES: To assure consideration, comments must be delivered to the 
address provided below by no later than 5 p.m. on November 8, 1999.

ADDRESSES: Please mail or deliver your written comments, 
recommendations and suggestions to the following address: Department of 
Health and Human Services, Office of Inspector General, Attention: OIG-
7-CPG, Room 5246, Cohen Building, 330 Independence Avenue, S.W., 
Washington, D.C. 20201.
    We do not accept comments by facsimile (FAX) transmission. In 
commenting, please refer to the file code OIG-7-CPG. Comments received 
timely will be available for public inspection as they are received, 
generally beginning approximately 3 weeks after publication of a 
document, in Room 5541 of the Office of Inspector General at 330 
Independence Avenue, S.W., Washington, D.C. 20201 on Monday

[[Page 48847]]

through Friday of each week from 8:00 a.m. to 4:30 p.m.

FOR FURTHER INFORMATION CONTACT: Kimberly Brandt, Office of Counsel to 
the Inspector General, (202) 619-2078.

SUPPLEMENTARY INFORMATION: The development of compliance program 
guidances has become a major initiative of the OIG in its effort to 
engage the private health care community in addressing and combating 
fraud and abuse. Recently, the OIG has developed and issued compliance 
program guidance directed at various segments of the health care 
industry.<SUP>1</SUP> New OIG guidance under consideration will be 
designed to provide clear direction and assistance to physicians 
providing services to Medicare and other Federal health care program 
beneficiaries who are interested in reducing and eliminating the 
potential for fraud and abuse within their practice.
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    \1\ See 62 FR 9435 (March 3, 1997) for clinical laboratories, as 
amended in 63 FR 45076 (August 24, 1998); 63 FR 8987 (February 23, 
1998) for hospitals; 63 FR 42410 (August 7, 1998) for home health 
agencies, and 63 FR 70138 (December 18, 1998) for third party 
medical billing companies. The guidances can also be found on the 
OIG web site at http://www.hhs.gov/oig.
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    The guidances represent the culmination of the OIG's suggestions on 
how providers can most effectively establish internal controls and 
implement monitoring procedures to identify, correct and prevent 
fraudulent and wasteful activities. As stated in previous guidances, 
these guidelines are not mandatory for providers, nor do they represent 
an exclusive document of advisable elements of a compliance program.
    In an effort to formalize the process by which the OIG receives 
public comments in connection with compliance program guidances, the 
OIG is seeking, through this Federal Register notice, formal input from 
interested parties as the OIG considers developing a compliance program 
guidance directed at individual and small group physician practices. 
The OIG will give consideration to all comments, recommendations and 
suggestions submitted and received by the time frame indicated above.
    We anticipate that the physician guidance will contain seven 
elements that the OIG considers necessary for a comprehensive 
compliance program. These seven elements have been discussed in our 
previous guidances and include:
    <bullet> The development of written policies and procedures.
    <bullet> The designation of a compliance officer and other 
appropriate bodies.
    <bullet> The development and implementation of effective training 
and education programs.
    <bullet> The development and maintenance of effective lines of 
communication.
    <bullet> The enforcement of standards through well-publicized 
disciplinary guidelines.
    <bullet> The use of audits and other evaluation techniques to 
monitor compliance.
    <bullet> The development of procedures to respond to detected 
offenses and to initiate corrective action.
    The OIG would appreciate specific comments, recommendations and 
suggestions on (1) risk areas for the individual or small group 
physician practice, and (2) aspects of the seven elements contained in 
previous guidances that may need to be modified to reflect the unique 
characteristics of the individual or small group physician practice. 
Detailed justifications and empirical data supporting suggestions would 
be appreciated.
    We also request that any comments, recommendations and input be 
submitted in a format that addresses the above topics in a concise 
manner, rather than in the form of a comprehensive draft guidance that 
mirrors previous guidances.

    Dated: August 31, 1999.
June Gibbs Brown,
Inspector General.
[FR Doc. 99-23294 Filed 9-7-99; 8:45 am]
BILLING CODE 4150-04-P