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Publication of OIG Special Fraud Alert on Physician Liability For Federal Register / Vol. 64, No. 7 / Tuesday, January 12, 1999 / Notices 1813 IV. Key to the OPO Codes • The accuracy of our estimate of the DEPARTMENT OF HEALTH AND The key to the acronyms used in the information collection burden. HUMAN SERVICES listings to identify OPOs and their • The quality, utility, and clarity of Office of Inspector General addresses is as follows: the information to be collected. DCTC—Washington Regional • Recommendations to minimize the Publication of OIG Special Fraud Alert Transplant Consortium, 8110 Gateway information collection burden on the on Physician Liability for Certifications Road, Suite 101 W, Falls Church, VA affected public, including automated in the Provision of Medical Equipment 22042 collection techniques. and Supplies and Home Health MAOB—New England Organ Bank, One Services Gateway Center, Newton, MA 02158 Therefore, we are soliciting public MIOP—Organ Procurement Agency of comment on the information collection AGENCY: Office of Inspector General Michigan, 2203 Platt Road, Ann requirements for the issue described (OIG), HHS. Arbor, MI 48104 below. ACTION: Notice MNOP—Lifesource, Upper Midwest Designation of one OPO for each SUMMARY: This Federal Register notice Organ Procurement Organization Inc., service area: 2550 University Avenue West, Suite sets forth a recently issued OIG Special 315 South, St. Paul, MN 55114–1904 Section 486.316(e) states the Fraud Alert concerning physician MSOP—Mississippi Organ Recovery requirements for a Medicare or liability for certifications in the Agency, Inc., 12 River Bend Place, Medicaid participating hospital to provision of medical equipment and Suite B, Jackson, MS 39208 request a waiver permitting the hospital supplies and home health services. For NYAP—OPO of Albany Medical to have an agreement with a designated the most part, OIG Special Fraud Alerts College, 47 Scotland Avenue, AP8, OPO other than the OPO designated for address national trends in health care Albany, NY 12208 the service area in which the hospital is fraud, including potential violations of NYFL—Finger Lakes Donor Recovery located. However, the burden associated the Medicare anti-kickback statute. This Network, Corporate Woods of with these requirements is currently Special Fraud Alert, issued to the health Brighton, Building 120, Suite 180, approved under OMB 0938–0688, care provider community and now Rochester, NY 14623 HCFA–R–13, Conditions of Coverage for being reprinted in this issue of the NYWN—Upstate New York Transplant Organ Procurement Organizations, with Federal Register, specifically highlights Services, Inc., 165 Genesee Street, physicians’ responsibilities in making Suite 103, Buffalo, NY 14209 an expiration date of November 30, 1999. certifications for home health services OHLC—Life Connection of Ohio, 1545 and durable medical equipment, and the Holland Road, Suite C, Maumee, OH If you comment on any of these legal significance of the certifications. 43537 information collection and record FOR FURTHER INFORMATION CONTACT: Joel OHLP—Lifeline of Ohio, 770 Kinnear keeping requirements, please mail J. Schaer, Office of Counsel to the Road, Suite 200, Columbus, OH 43212 copies directly to the following: TNMS—Mid-South Transplant Inspector General, (202) 619–0089. Foundation, 956 Court Avenue, Health Care Financing Administration, SUPPLEMENTARY INFORMATION: Memphis, TN 38163 Office of Information Services, I. Background VAOP—Virginia Organ Procurement Security and Standards Groups, Agency, 1527 Huguenot Road, Division of HCFA Enterprise The Office of Inspector General (OIG) Midlothian, VA 23113 Standards, Attention: Louis Blank, issues Special Fraud Alerts based on WISE—Wisconsin Donor Network, HCFA–1062–NC, Room N2–14–26, information it obtains concerning particular fraudulent or abusive Froedtert Memorial Lutheran Hospital 7500 Security Boulevard, Baltimore, practices within the health care 9200 West Wisconsin Avenue, MD 21244–1850, and Milwaukee, WI 53226 industry. WIUW—University of Wisconsin OPO, Office of Information and Regulatory Special Fraud Alerts are intended for University of Wisconsin Hospital and Affairs, Office of Management and widespread dissemination to the health Clinics, 600 Highland Avenue, Budget, Attention: Allison Eydt, care provider community, as well as Madison, WI 53792 HCFA Desk Officer, Room 10235, those charged with administering the New Executive Office Building, Medicare and Medicaid programs. To V. Collection of Information Washington, DC 20503. date, the OIG has published in the Requirements Federal Register the texts of 9 Authority: Section 1138 of the Social 1 Under the Paperwork Reduction Act Security Act (42 U.S.C. 1320b–8). previously-issued Special Fraud Alerts. of 1995, we are required to provide 60­ It is the OIG’s intention to publish (Catalog of Federal Domestic Assistance day notice in the Federal Register and future Special Fraud Alerts in this same Program No. 93.773, Medicare—Hospital solicit public comment before a manner as a regular part of our Insurance; Program No. 93.774 Medicare— collection of information requirement is dissemination of such information.2 Supplementary Medical Insurance, and submitted to the Office of Management In an effort to promote voluntary Program No. 93.778, Medical Assistance compliance in the health care industry and Budget (OMB) for review and Program) approval. In order to fairly evaluate and assist providers in their compliance whether an information collection Dated: January 5, 1999. efforts, the OIG has developed a Special requirement should be approved by Robert A. Berenson, Fraud Alert, set forth below, that OMB, section 3506(c)(2)(A) of the Director, Center for Health Plans and addresses potential problem areas with Paperwork Reduction Act of 1995 Providers, Health Care Financing requires that we solicit comment on the Administration. 1 See December 19, 1994 (59 FR 65372); August following issues: [FR Doc. 99–630 Filed 1–11–99; 8:45 am] 10, 1995 (60 FR 40847); June 17, 1996 (61 FR • 30623); and April 24, 1998 (63 FR 20415). The need for the information BILLING CODE 4120±01±P 2 All OIG Special Fraud Alerts are also available collection and its usefulness in carrying on the internet at the OIG web site at http:// out the proper functions of our agency. www.dhhs.gov/progorg/oig/frdalrt/index.htm. 1814 Federal Register / Vol. 64, No. 7 / Tuesday, January 12, 1999 / Notices regard to physician certification in the disregard as to the truth of the discharge their responsibility to assess provision of medical equipment and information being submitted. While a their patients’ conditions and need for supplies and home health services. physician’s signature on a false or home health care. Similarly, the OIG has Among other things, this newly-issued misleading certification made through found numerous examples of physicians Special Fraud Alert addresses: (1) the mistake, simple negligence, or who have ordered DME or signed CMNs importance of physician certification for inadvertence will not result in personal for DME without reviewing the medical Medicare; (2) how improper physician liability, the physician may unwittingly necessity for the item or even knowing certifications foster fraud; and (3) be facilitating the perpetration of fraud the patient. potential consequences for knowingly on Medicare by suppliers or providers. signing a false or misleading Accordingly, we urge all physicians to Physician Certification for Home Health certification, or signing with reckless review and familiarize themselves with Services disregard for the truth. A reprint of this the information in this Fraud Alert. If a Medicare will pay a Medicare­ Special Fraud Alert follows. physician has any questions as to the certified home health agency for home application of these requirements to health care provided under a II. Special Fraud Alert: Physician specific facts, the physician should physician’s plan of care to a patient Liability for Certifications in the contact the appropriate Medicare Fiscal confined to the home. Covered services Provision of Medical Equipment and Intermediary or Carrier. may include skilled nursing services, Supplies and Home Health Services home health aide services, physical and (January 1999) The Importance of Physician occupational therapy and speech Certification for Medicare The Office of Inspector General (OIG) language pathology, medical social was established at the Department of The Medicare program only pays for services, medical supplies (other than Health and Human Services by Congress health care services that are medically drugs and biologicals), and DME. in 1976 to identify and eliminate fraud, necessary. In determining what services As a condition for payment, Medicare waste, and abuse in the Department’s are medically necessary, Medicare requires a patient’s treating physician to programs and to promote efficiency and primarily relies on the professional certify initially and recertify at least economy in departmental operations. judgment of the beneficiary’s treating every 62 days (2 months) that: The OIG carries out this mission physician, since he or she knows the • The patient is confined to the home; through a nationwide program of audits, patient’s history and makes critical • The individual needs or needed (i) inspections, and investigations. decisions, such as admitting the patient intermittent skilled nursing care; (ii) To reduce fraud and abuse in the to the hospital; ordering tests, drugs, speech or physical therapy or speech­ Federal health
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