The Facts
On April 29, 2009, the Senate Finance Committee released the first of three anticipated health reform option papers. The proposals under consideration would make significant fraud and abuse changes encourage transparency and program integrity. Comments must be submitted to the Committee by May 15, 2009.
Transparency
The proposal would impose new transparency obligations on physicians, hospitals, nursing homes and pharmaceutical manufacturers. Transparency proposals include the following:
- Amend the Stark Law in-office ancillary services exception to require physicians to disclose financial interests in certain imaging services
- Eliminate the Stark Law “whole hospital” and rural provider exceptions with limited grandfather provisions to preclude physicians from self-referring to hospitals
- Require pharmaceutical and medical device manufacturers to disclose financial relationships with physicians
- Require nursing homes to disclose ownership information, implement compliance programs for their employees and report staffing data
Program Integrity
The Committee proposes to strengthen compliance requirements and enforcement activity by taking the following action:
- Increasing funding to federal enforcement programs
- Strengthening the screening process for Medicare program provider applications, which may include criminal background and licensure checks and unannounced site visits
- Requiring providers to implement compliance programs as a condition of participation in Medicare and Medicaid
- Amending the Civil Monetary Penalties (CMPs) Law to increase penalties and extend the use of CMPs for certain violations
What’s at Stake
The federal government may increase enforcement activities bolstered by easier access to publicly available information on existing arrangements and relationships. Providers could face increased penalties or suspension of payment for compliance failures.
What You Should Do
- Consider submission of comments to the Committee. Comments can be submitted through May 15, 2009.
- Assess and audit current approaches to management of financial relationships, and closely evaluate the implications of publicly disclosing the details of these relationships.
- Evaluate the additional investment of time and resources to meet the proposed transparency requirements.
- Review and update compliance plans.
- Continually evaluate ongoing business decisions in light of the direction and quick pace health reform is taking..
