Moving the HME Industry Forward

Legislative/Advocacy

OIG Self-Disclosure Protocol – Part 2

April 27, 2015

AMARILLO, TX – Today’s DME supplier is highly regulated. It must abide by a plethora of federal anti-fraud laws, including (but not limited to) the Medicare anti-kickback statute and the federal False Claims Act. Because the day-to-day operations of a DME supplier are complicated, because the documentation requirements the DME supplier must meet are complex, and because federal anti-fraud laws are broadly written, it is not uncommon for the supplier to unwittingly cross into fraud territory.

If a DME supplier discovers that it is engaging in activities that violate one or more federal anti-fraud laws, the question becomes:  What should the supplier do?  One course of action is for the supplier to utilize the OIG’s Self-Disclosure Protocol (“SDP”).

Part 1 gave an overview of the SDP. This Part 2 discusses the information that should be contained in the narrative that is submitted to the OIG. Part 3 will discuss the SDP requirements for conduct involving false billings.

Information to Be Included in Narrative Submission
1) The name, address, type of provider, provider identification number(s), tax identification numbers(s) of the disclosing party and the government payors (including Medicare contractors) to which the disclosing party submits claims;
2) If the disclosing party is an entity that is owned or controlled by or is otherwise part of a system or network, an organizational chart, a description or diagram describing the pertinent relationships; the names and addresses of any related entities; and any affected corporate divisions, departments or branches.
3) The name, street address, phone number, and email address of the disclosing party’s designated representative for purposes of the voluntary disclosure.
4) A concise statement of all details relevant to the conduct disclosed, including, at a minimum, the types of claims, transactions, or other conduct giving rise to the matter; the period during which the conduct occurred; and the names of entities and individuals believed to be implicated, including an explanation of their roles in the matter.
5) A statement of the federal criminal, civil, or administrative laws that are potentially violated by the disclosed conduct.
6) The federal health care programs affected by the disclosed conduct.
7) An estimate of the damages, as described below, to each federal health care program relevant to the disclosed conduct, or a certification that the estimate will be completed and submitted to OIG within 90 days of the date of submission.  When a disclosing party can determine the amount of actual damages to federal health care programs, the actual damages must be provided instead of an estimate.
8) A description of the disclosing party’s corrective action upon discovery of the conduct.
9) A statement of whether the disclosing party has knowledge that the matter is under current inquiry by a government agency or contractor.  If the disclosing party has knowledge of a pending inquiry, it must identify the involved government entity and its individual representatives.  The disclosing party must also disclose whether it is under investigation or other inquiry for any other matters relating to a federal health care program and provide similar information relating to those other matters.
10) The name of an individual authorized to enter into a settlement agreement on behalf of the disclosing party.
11) A certification by the disclosing party, or in the case of an entity, an authorized representative on behalf of the disclosing party, stating that to the best of the individual’s knowledge, the submission contains truthful information and is based on a good faith effort to bring the matter to the government’s attention for the purpose of resolving potential liability to the government and to assist OIG in its resolution of the disclosed matter.

Jeff Baird will be presenting the following webinar in the month of May:
AAHomecare’s Educational Webinar
Value-Added Services vs. Prohibited Beneficiary Inducement: When is the Line Crossed?
Presented by:  Jeffrey S. Baird, Esq., Brown & Fortunato, P.C.
Tuesday, May 5, 2015, from 2:30-4:00 p.m. EASTERN TIME
It is perfectly acceptable for the HME supplier to provide services to its patients that the supplier’s competitors do not provide. This is good business. These are classified as “value-added services.” On the other hand, when a supplier offers “something of value” to induce a prospective customer (a Medicare beneficiary) to buy something from the supplier (as opposed to buying something from the supplier’s competitor), then this may result in a prohibited inducement in violation of the beneficiary inducement statute and the Medicare anti-kickback statute. The line between a value-added service and a prohibited inducement can be unclear. This program will discuss the difference between “value-added services” and “prohibited inducements” and how the supplier can be aggressive in providing great services without “crossing the line.”
Contact Ika Sukh to register at ikas@aahomecare.org.
FEES: Member: $99.00    
Non-Member: $129.00

AAHomecare’s Educational Webinar
How the Losing Bidder Can Enter the Competitive Bid Arena
Presented by:  Jeffrey S. Baird, Esq., Brown & Fortunato, P.C.
Thursday, May 28, 2015
2:30-4:00 p.m. EASTERN TIME
Sadly, there are way too many quality DME suppliers that have not been awarded contracts.  There are ways, however, for the non-contract supplier to enter the competitive bidding arena “after the fact.”  This program will discuss those ways.  Examples include purchasing 100% of a contract supplier’s assets; engaging in a partial asset purchase in which the non-contract supplier purchases only those assets associated with the contract supplier’s competitive bid contract; 100% stock acquisition; and establishing a 5% or more common ownership that will entitle the non-contract supplier to be added to the contract supplier’s competitive bid contract.  In addition, the webinar will discuss whether, as a result of one of these transactions, any liability of one company will be imposed on the other company.
Contact Ika Sukh to register at ikas@aahomecare.org.
FEES
Member: $99.00    
Non-Member: $129.00

Jeffrey S. Baird, JD, is chairman of the Health Care Group at Brown & Fortunato PC, a law firm based in Amarillo, Tex. Jill S. Vogel, JD, is an attorney with the Health Care Group at Brown & Fortunato PC. They represent pharmacies, HME companies, and other health care providers throughout the United States. Baird and Vogel are Board Certified in Health Law by the Texas Board of Legal Specialization. Baird can be reached at (806) 345-6320 or jbaird@bf-law.com. Vogel can be reached at (806) 345-6343 or jvogel@bf-law.com.