As evidenced by the latest enforcement actions by the OIG, people break the rules. Fraud, waste and abuse happen all too often in the healthcare industry. This is why physician practices and third party medical billing companies are required to provide a means for their employees to report suspicious behavior, non-compliant practices and incidents. In addition, there must be a way for employees to report anonymously, if they so choose.
The Office of Inspector General (OIG) and the Office of the Medicaid Inspector General (OMIG) are at the forefront of the efforts to fight fraud, waste and abuse in Medicare, Medicaid and more than 100 other programs. OIG and OMIG explicitly state that a means of anonymous reporting is a required element of a compliance program. In addition, employers must have a policy of non-intimidation and non-retaliation for good faith participation in the compliance program, including reporting potential issues such as:
Billing for medically unnecessary services
Intentionally billing for a more expensive treatment than was provided
Billing for services that were not provided
Routinely waiving copays
Accepting kickbacks for patient referrals
Physician offices and third party medical billing companies should provide a written method of confidential disclosure. An example for single site offices is a locked device placed in an inconspicuous location that is regularly checked for submissions. Another example is a toll-free anonymous phone number to report fraud or abuse through a company business associate, such as an attorney.
In addition, the toll-free hotline phone numbers (OIG 1-800-447-8477 and OMIG 1-877-873-7283) are to be posted in employee break rooms or other common and easily accessible areas. The OIG has posters and flyers available for download on its Website that include these numbers and other important information.
If an employee chooses to report anonymously, it is important that he or she include as much information as possible including:
Who is involved
When it occurred
Whether there are witnesses to the misconduct
When people break the rules in the healthcare industry, we all pay for it. For a compliance program to work, employees must be able to ask questions and report problems. By encouraging constructive communication, even if suspicious behavior is reported anonymously, organizations create a culture of critical thinking without fear of retribution.
Thomas Maher, CPA, CPC
President and CEO
Practicefirst Medical Management Solutions, LLC