Nursing home industry; compliance program guidance; comment request,

[Federal Register: December 18, 1998 (Volume 63, Number 243)]

[Notices]

[Page 70137-70138]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr18de98-103]

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Inspector General

Solicitation of Information and Recommendations for Developing OIG Compliance Program Guidance for the Nursing Home Industry

AGENCY: Office of Inspector General (OIG), HHS.

ACTION: Notice.

SUMMARY: This Federal Register notice seeks the input and recommendations of interested parties into the OIG's development of a compliance program guidance for the nursing home industry and its providers and suppliers, especially those serving Medicare and Medicaid beneficiaries. Many providers and provider organizations have expressed an interest in better protecting their operations from fraud and abuse. The OIG has developed guidances for hospitals, clinical laboratories, home health agencies and third-party medical billing companies. Currently, the OIG has under development compliance program guidance for the durable medical equipment, prosthetic and orthotic supply industry and Medicare+Choice organizations with coordinated care plans. In order to provide a clear and meaningful guidance to those segments of the health care industry involved in the ownership and operation of nursing care facilities, the OIG is soliciting comments, recommendations and suggestions from concerned parties and organizations on how best to develop a compliance program guidance and reduce fraud and abuse within the nursing home industry.

DATES: To assure consideration, comments must be delivered to the address provided below by no later than 5 p.m. on February 16, 1999.

ADDRESSES: Please mail or deliver your written comments, recommendations and suggestions to following address: Office of Inspector General, Department of Health and Human Services, Attention: OIG-5-CPG, Room 5246, Cohen Building, 330 Independence Avenue, SW, Washington, DC 20201.

We do not accept comments by facsimile (FAX) transmission. In commenting, please refer to the file code OIG-5-CPG. Comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, in Room 5541 of the Office of Inspector General at 330 Independence Avenue, SW, Washington, DC 20201 on Monday through Friday of each week from 8 a.m. to 4:30 p.m.

FOR FURTHER INFORMATION CONTACT: Stephen Davis, Office of Counsel to the Inspector General, (202) 619-2078.

SUPPLEMENTARY INFORMATION: The development of compliance program guidances continues as a major OIG initiative as a vehicle for engaging the private health care community in an effort to reduce fraud and abuse. This nursing home guidance represents another step in the OIG's plan to encourage the implementation of compliance programs in specific segments of the health care industry.‹SUP›1‹/SUP› As in the past, this guidance is designed to provide clear direction and assistance to Medicare and Medicaid nursing home providers, their owners and suppliers, who are interested in reducing and eliminating fraud and abuse within their organizations.

\1\ See 62 FR 9435 (March 3, 1997) for clinical laboratories, as amended in 63 FR 45076 (August 24, 1998); 63 FR 8987 (February 23, 1998) for hospitals; 63 FR 42410 (August 7, 1998) for home health agencies, and for third party medical billing companies appearing elsewhere in this Federal Register. The guidance can also be found on the OIG web site at http://www.dhhs.gov/progorg/oig.

The guidance represents the culmination of the best suggestions and recommendations from the OIG and from representatives of the private health care community on how providers can most effectively establish internal controls and implement monitoring procedures to identify, correct and prevent fraudulent and wasteful activities. As stated in previous guidances, these guidelines are not mandatory for providers, nor do they represent an exclusive document of advisable elements of a compliance program.

In an effort to formalize the process by which the OIG receives public comments in connection with compliance program guidances, the OIG is seeking, through this Federal Register notice, formal input from interested parties as the OIG begins developing the compliance program guidance for Medicare and Medicaid covered nursing home facilities, their providers and suppliers. The OIG considers all comments, recommendations and suggestions submitted and received by the time frame indicated above.

The OIG anticipates that the nursing home guidance will contain seven elements that the OIG considers necessary for a comprehensive compliance program. These seven elements have been discussed in our previous guidances and include:

‹bullet› The development of written policies and procedures;

[[Page 70138]]

‹bullet› The designation of a compliance officer and other appropriate bodies;

‹bullet› The development and implementation of effective training and education programs;

‹bullet› The development and maintenance of effective lines of communication;

‹bullet› The enforcement of standards through well-publicized disciplinary guidelines;

‹bullet› The use of audits and other evaluation techniques to monitor compliance; and

‹bullet› The development of procedures to respond to detected offenses and to initiate corrective action.

The OIG would appreciate specific comments, recommendation and suggestions on (1) risk areas for the nursing home industry, and (2) aspects of the seven elements contained in previous guidances that may need to be modified to reflect the unique characteristics of the nursing home industry. Detailed justifications and empirical data supporting suggestions would be appreciated. The OIG is also hopeful that any comments, recommendations and input be submitted in a format that addresses the above topics in a concise manner, rather than in the form of comprehensive draft guidance that mirrors previous guidances.

Dated: December 14, 1998. June Gibbs Brown, Inspector General.

[FR Doc. 98-33566Filed12-17-98; 8:45 am]

BILLING CODE 4150-04-P