MEDICARE FRAUD: Government Releases Compliance Standards

      The federal government Wednesday released "new guidelines to help prevent Medicare fraud" in the billing practices of the nation's hospitals, the Nashville Banner reports. The Department of Health and Human Services guidelines, "which hospital officials have awaited for months," are voluntary. "At the heart" of these rules, the Banner reports, "are recommendations that hospitals monitor their compliance with federal law and report any evidence of fraud within 60 days" (Scribner, 2/12). Written by the HHS' Office of the Inspector General, the guidelines state: "Fundamentally, compliance efforts are designed to establish a culture within a hospital that promotes prevention, detection and resolution of instances of conduct that do not conform to federal and state law" (OIG Compliance Program Guidance For Hospitals, February 1998).

Compliant And Willing
      "Hospitals across the country have been scrambling to put formal compliance systems in place for months," said American Hospital Association spokesperson Rick Wade (Banner, 2/12). "The guidelines come as government agencies scrutinize Medicare spending and mount a massive investigation of billing and other practices at hospitals across the country," the Memphis Commercial Appeal reports. And while the guidelines are voluntary, there are "incentives for hospitals to develop formal programs to prevent and find fraud before investigators discover it independently." For instance, "the government will consider whether a hospital has an effective compliance program before it levies fines or issues sanctions in cases of overbilling." Inspector General June Gibbs Brown said, "It will cost some money to have a first-rate (compliance) program, but there will probably be savings in the long run" (Campbell, 2/13).