Practice Management Alert

Here’s where you can read the final rule for yourself.

Attention physician practices: If you’re slow to respond to federal audit requests, you could find yourself excluded from Medicare and Medicaid.

So says the HHS Office of Inspector General in a final rule published in the Jan. 12, 2017 Federal Register and scheduled to take effect Feb. 13, 2017. The proposed rule was published May 9, 2014.

The final rule expands the OIG’s authority to exclude “individuals and entities … convicted for the interference with or obstruction of both investigations and audits” related to federal health care funds.

The final rule also says that providers who illegally prescribe or distribute a controlled substance could face exclusion. Ditto for providers who have direct or indirect ownership interests with individuals who have been convicted of criminal offenses.

A note about all the brouhaha in Washington: The new regulation implements provisions in the Affordable Care Act. At press time, Congress had taken the first steps to repeal and replace the ACA.

Repeal — if it happens — would take a long time, and unraveling and replacing regs related to the ACA would be even slower. So for now, this regulation and other ACA-related regs stand until further notice.

To read the final rule, go here: https://www.federalregister.gov/documents/2017/01/12/2016-31390/health-care-programs-fraud-and-abuse-revisions-to-the-office-of-inspector-generals-exclusion. In next month’s Practice Management Alert, we’ll go into more detail about the rule. We’ll also have advice from attorneys and other experts to help your practice comply should federal auditors ever come knocking.