Office of Inspector General
330 Independence Ave., SW
Washington, DC 20201
This is an invitation to the nation's health care providers to join me in a national campaign to eliminate fraud and abuse from Medicare, Medicaid and the more than 200 other Federal health and human development programs that serve some of our most vulnerable citizens.
As most of you are aware, the Congress greatly increased the resources and authorities of my office to combat health care fraud, and an intensified crackdown is being pursued with the full support of the Administration. We are bolstering our investigative and audit staffs, formulating new anti-fraud strategies, and strengthening our collaboration with the Health Care Financing Administration, the Department of Justice, and other Federal, State, and local law enforcement offices. As Inspector General, I am committed to vigorously pursue civil and criminal action against those who defraud this nation's health care programs.
These additional resources and broadened alliances will unquestionably enhance our effectiveness in fighting fraud and abuse, but the Federal Government alone cannot solve this problem. We need the involvement of you and your fellow health care providers. Through cooperative efforts we can best ensure the success of initiatives to identify and penalize the relatively few dishonest providers whose fraudulent activities are eroding the solvency of the Federal health programs and undermining public confidence in the health care industry.
As an example of how we can work together, the staff of my Office of Enforcement and Compliance has been meeting with representatives of several provider groups preparatory to drafting model compliance programs for health care providers. To date, we have established general guidelines that describe seven elements fundamental to an effective program of provider compliance with the rules governing participation in the Government's health care programs. Using these building blocks, we are eager to continue this collaboration to expeditiously produce sector-specific compliance programs for each of the health care provider components doing business with the Government. Work is now nearing completion on the compliance model for clinical laboratories. It will be released this month and other model programs are expected to be issued soon thereafter. Copies of the programs will be made available through your professional association, published in the Federal Register, and posted on the Internet as they are completed. For those of you who have access to the Internet, visit our web site.
While compliance programs are not a novel idea, they are becoming increasingly popular as affirmative steps toward promoting a high level of ethical and lawful corporate conduct. Numerous providers have expressed interest in better protecting their operations from fraud through the adoption of compliance programs. Many companies already have a program or are in the process of developing one either in-house or with the assistance of outside consultants. When fraud is discovered, both the Department of Justice and my office look at the entity to see if reasonable efforts have been made by management to avoid and detect any misbehavior that occurs within their operations. We use this analysis to determine the level of sanctions, penalties and exclusions that will be imposed upon the provider. To my knowledge, this is the first time the Government is revealing the elements upon which we base those judgments.
In closing, I want to emphasize that my staff and I are committed to creating an atmosphere that encourages voluntary compliance and self-disclosure by health care providers. We are providing information which will help you protect yourselves against unscrupulous people. We have the opportunity to work together to rid the health care system of this insidious threat.
June Gibbs Brown