Providers could be slapped with monetary penalties for slow response to document requests under OIG proposal

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Promised RAC improvements could mean more targeted doc requests.
Promised RAC improvements could mean more targeted doc requests.

Long-term care providers are facing an expanded list of infractions that could trigger civil monetary penalties, including slow response to document requests. The proposed regulation from the Department of Health and Human Services Office of Inspector General was published Monday in the Federal Register. 

Making false statements on federal healthcare program enrollment materials, failing to report and return overpayments from these programs, and ordering or prescribing medication while excluded from these programs also would be grounds for a penalty under the proposed rule.

Civil monetary penalty collections are likely to increase if the rule takes effect, the OIG noted in the proposal. Since 1981, the agency has been authorized to levy CMPs against those who defraud Medicare and Medicaid, and collections have totaled more than $165 million in the last decade. The OIG has been a prominent nursing home watchdog during this time period, but it recently announced that it might scale back oversight this year due to budget cuts.

Parties who warn nursing homes when a survey will take place also would be subject to a monetary penalty under the proposed regulation.

The civil monetary penalty regulatory language will be revised because it has become “cumbersome” through multiple additions and revisions, the OIG explained in the rule. The new regulation would present more streamlined information, including boiling down the primary factors for determining CMP amounts. These factors would be: nature of the violation; degree of guilt; prior offenses; additional bad conduct; other considerations “as justice may require.”

The CMP rule came on the heels of a proposal that would expand the Inspector General's authority to exclude providers from Medicare and Medicaid for wrongdoing.