What Every Chiropractic Physician Should Know About OIG Compliance
The Office of the Inspector General (OIG) plays a crucial role in preventing fraud, waste, and abuse in Medicare, Medicaid, and other HHS programs, overseeing approximately $2 trillion in government spending. Chiropractors can enhance compliance and minimize risk by following the OIG’s updated guidance, including implementing a comprehensive compliance plan and adhering to key regulatory standards.
Civil Monetary Penalties, OIG, and the Chiropractic Practice
The Office of Inspector General (OIG) has the authority to impose civil monetary penalties (CMP) for various forms of healthcare fraud and abuse, including submitting claims for medically unnecessary services or engaging in kickback schemes. CMPs can range from $10,000 to $100,000 per violation, and chiropractors are not exempt.
Exclusion Authority Requirements for Chiropractic Practices
The Office of Inspector General (OIG) has the authority to exclude individuals and entities from participating in Federal healthcare programs under Section 1128 of the Social Security Act, with exclusions often resulting from fraud, abuse, or other violations. Healthcare providers must regularly check the List of Excluded Individuals/Entities (LEIE) to avoid penalties, as employing or contracting with excluded individuals can lead to significant fines and repayment obligations.
Self-Referral Law for Chiropractic Physicians
The Physician Self-Referral Law (Stark Law) prohibits physicians from referring Medicare and Medicaid patients for designated health services to entities in which they or their immediate family members have a financial interest, covering services like radiology, physical therapy, and home health care. Violations can lead to severe penalties, including repayment of funds, monetary fines, and exclusion from federal health care program
Anti-Kickback Statute for Chiropractic Physicians
The Anti-Kickback Statute prohibits any form of remuneration for referrals related to Federal health care programs, with violations leading to severe penalties, including fines and exclusion from Medicare and Medicaid. Providers must carefully navigate these regulations and consider legal counsel to ensure compliance and avoid costly repercussions.
The False Claims Act for Chiropractic Physicians
Health care fraud, waste, and abuse cost taxpayers between $30 to $100 billion annually, exposing patients to unnecessary services and reducing funds for legitimate care. The False Claims Act enforces strict penalties for false claims, requiring health care providers to implement thorough compliance measures to avoid substantial fines and legal repercussions.