During the first week of November, the Office of Inspector General (OIG) released a guide entitled “Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse” (the Roadmap). As stated in the introduction, the Roadmap “assists physicians in understanding how to comply with [Medicare and Medicaid fraud and abuse laws] by identifying ‘red flags’ that could lead to potential liability in law enforcement and administrative actions.” The Roadmap summarizes the five main federal fraud and abuse laws (the False Claims Act, the Anti-Kickback Statute, the Stark Law, the Exclusion Statute and the Civil Monetary Penalties Law) and provides tips on how physicians can comply with these laws in their relationships with payers (such as Medicare and Medicaid), vendors (drug, biologic, etc.) and fellow providers (such as hospitals and nursing homes). The Roadmap also offers new physicians guidance regarding compliance program creation and where to go for help if they suspect that they may have a potential compliance problem.

The Roadmap was developed as a result of an OIG survey of medical school deans and designated officials at institutions that sponsor residencies and fellowships to learn the types of instruction medical students, residents, and fellows receive on Medicare and Medicaid fraud, waste, and abuse. In its October 2010 report, “Medicare and Medicaid Fraud and Abuse Training in Medical Education,” the OIG reported that nearly all respondents (92% of deans and 90% of designated institutional officials) indicated a preference for OIG generated training material. The OIG report also indicated that despite the lack of a federal requirement, 44% of medical schools and 68% of residency and fellowship programs provided instruction on Medicare and Medicaid fraud and abuse laws in 2010.

The Roadmap should be a helpful tool in all new physician training programs. A copy of the OIG report can be found by clicking here. A copy of the Roadmap can be accessed here.