Proposed Rules Expand OIG’s Exclusion Authority and Revise Civil Monetary Penalties
July 3, 2014
July 3, 2014 admin
In May, the Department of Health and Human Services Office of Inspector General (OIG) proposed changes to the OIG’s exclusion authority and ability to impose civil monetary penalties (CMPs). The proposed rules codify the changes made by the Affordable Care Act, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and other statutory authorities.
The first rule proposes to expand the OIG’s exclusion authority in accordance with the Affordable Care Act (ACA). 79 Fed. Reg. 26810. The comment period for this proposed rule ends July 8. The OIG proposes that the following new conduct would subject a person to permissive exclusion:
The OIG’s proposed rule makes several additional changes, including the following:
The proposed rule also clarifies that there is no statute of limitation period for exclusions.
The second proposed rule expands the OIG’s ability to assess CMPs. 79 Fed. Reg. 27080. The comment period for this proposed rule ends July 11. The proposed rule adds penalties for the following conduct:
The OIG is soliciting comments about its proposed clarification of the penalty for failing to report and return a known overpayment. Under the ACA, overpayments must be reported and returned by the later of 60 days after the date the overpayment was identified or the date any corresponding cost report is due, if applicable.
The new CMP provision does not have a specific penalty amount, but uses the default penalty of up to $10,000 for each item and service. The OIG has proposed a penalty of up to $10,000 for each day a person fails to report and return a known overpayment by the deadline. Noting that Congress did not specify a per day penalty, the OIG also has requested comments on whether to interpret the $10,000 penalty for each item and service as pertaining to each claim for which the provider or supplier identified an overpayment.
Health care providers should continue to monitor the OIG’s rulemaking in the fraud and abuse area as the OIG continues to implement changes as a result of the ACA.
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