Federal Register: August 17, 2000 (Volume 65, Number 160)
DOCID: FR Doc 00-20856
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Inspector General Office, Health and Human Services Department
NOTICE: NOTICES
ACTION: Reports and guidance documents; availability, etc.:
DOCUMENT ACTION: Notice.
SUBJECT CATEGORY:
Solicitation of Information and Recommendations for Developing a Compliance Risk Guidance for the Ambulance Industry
DATES: To assure consideration, comments must be delivered to the address provided below by no later than 5 p.m. on October 16, 2000.
DOCUMENT SUMMARY:
This Federal Register notice seeks the input and
recommendations of interested parties as the OIG develops a Compliance
Risk Guidance (CRG) for ambulance service providers, especially those
serving Medicare, Medicaid and other Federal health care program
beneficiaries. The ambulance industry has experienced a number of
instances of ambulance provider and supplier fraud and abuse and has
expressed interest in increasing the awareness of the industry to
assist in protecting against such conduct. In response to the
industry's concerns, the OIG has, to date, written seven Advisory
Opinions on a variety of ambulancerelated issues \1\ and has published
a proposed rule concerning a safe harbor for ambulance restocking.\2\
\1\ See Advisory Opinions Nos. 976, 983, 987, 9813, 991,
992 and 995. The Advisory Opinions can be found on the OIG web site at
http://www.hhs.gov/oig. \2\ See 65 FR 32060; May 22, 2000.
In an effort to provide further guidance, the OIG is soliciting comments, recommendations and other suggestions from concerned parties and organizations on how best to develop an ambulance CRG to reduce the potential for fraud and abuse. The OIG expects that the CRG will outline the most common and prevalent fraud and abuse risk areas for the ambulance industry. In addition, the CRG will provide guidance on how to: (1) Address these risk areas; (2) prevent the occurrence of instances of fraud and abuse; and (3) develop corrective actions when those risks or instances of fraud and abuse are identified.
The OIG expects that the risk areas identified in the CRG will not be allinclusive. Ambulance providers and suppliers will remain responsible for identifying those risk areas particular to their specific operations.
SUMMARY:
Ambulance industry; compliance risk guidance development,
SUPPLEMENTAL INFORMATION
The contents of this CRG will differ from
the previous OIG compliance program guidances.\3\ Although the CRG will
refer to the seven elements of establishing an effective compliance program, set forth in the previous compliance program
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guidances,\4\ the CRG will concentrate on specific identified risk areas and related compliance program best practices.
\3\ The OIG has issued compliance program guidance for the
following eight industry sectors: hospitals, clinical laboratories,
home health agencies, durable medical equipment suppliers, third
party medical billing companies, hospices, Medicare+Choice organizations offering coordinated care plans and nursing
facilities. Additionally, the Individual and Small Group Physician
Practice Compliance Program Guidance has been issued in draft form
(June 12, 2000; 65 FR 36818). The Compliance Program Guidances can
be found on the OIG web site at http://www.hhs.gov/oig in the
Electronic Reading Room, or by calling the OIG Public Affairs office at (202) 6191343.
\4\ The seven elements of an effective compliance program
include: (1) The development of written policies and procedures; (2)
the designation of a compliance officer and other appropriate
bodies; (3) the development and implementation of effective training
and education programs; (4) the development and maintenance of
effective lines of communication; (5) the enforcement of standards
through wellpublicized disciplinary guidelines; (6) the use of
audits and other evaluation techniques to monitor compliance; and
(7) the development of procedures to respond to detected offenses and to initiate corrective action.
The CRG will include an additional section relating to risk areas associated with the Medical Assistance or Medicaid program requirements. The OIG intends to broadly address the Medicaid risks in light of the fact that the coverage and reimbursement rules differ among the various Medicaid programs. In order for the OIG to adequately incorporate the most prevalent Medicaid risk areas, we are requesting comments and suggestions from the various State agencies providing Medicaid services and from those ambulance providers and suppliers that furnish a significant level of services to Medicaid beneficiaries.
The OIG would also appreciate specific comments related to
compliance regarding the proposed Medicare ambulance fee schedule.\5\
As appropriate, we ask that commenters please provide detailed
justifications and empirical data supporting such comments.
\5\ The Health Care Financing Administration's proposed Medicare
ambulance fee schedule is expected to be published in the Federal Register shortly.
Dated: August 11, 2000.
Michael F. Mangano,
Principal Deputy Inspector General.
[FR Doc. 0020856 Filed 81600; 8:45 am]
BILLING CODE 415201P
FOR FURTHER INFORMATION CONTACT
Sonya Castro, Office of Counsel to the Inspector General, (202) 6192078.