Home Health & Hospice Week

OIG considers expanding civil monetary penalties.

Just when you’ll be getting used to new civil monetary penalty sanctions for surveys, your CMP burden is likely to get worse.

Background: The second slate of alternative sanctions for home health agency surveys will take effect July 1, and it includes the serious ones — civil money penalties and payment suspensions — plus Informal Dispute Resolution (IDR). The lesser sanctions — temporary management, directed plans of correction, and directed in-service training — took effect last July.

Guidance to surveyors on how to apply sanctions is in the Centers for Medicare & Medicaid Services’ March 14 Survey & Certification Letter 14-14 at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-14-14.pdf.

Now the HHS Office of Inspector General is prepared to add to the CMP burden. A May 12 proposed rule suggests allowing civil monetary penalties for several additional infractions. The OIG proposed changes to the Civil Monetary Penalties regulations to add penalties, assessments and exclusions for the following infractions:

• Failure to grant the OIG timely access to records
• Making false statements, omissions or misrepresentations in an enrollment application
• Failure to report and return an overpayment
• Making or using a false record or statement that is material to a false or fraudulent claim.

Another addition wouldn’t affect home care providers: ordering or prescribing while excluded.

This means that you could potentially face financial penalties, or even exclusion, if the OIG requests your records and you don’t submit them in a timely manner, among other reasons listed above.

Proposal Boosts Overpayment Penalties

The OIG’s proposal also suggests increasing the amount that you’ll be fined if you fail to report an overpayment within the later of A) 60 days after the date the overpayment is identified or B) the date of any corresponding cost report due. The proposed default penalty for this in the OIG’s new document is listed as “up to $10,000 for each day a person fails to report and return an overpayment by the deadline.” 

Note: You have until July 11 to comment on the proposed rule. To read the complete proposal,visit http://oig.hhs.gov/authorities/docs/2014/fr-79-91.pdf.