The Office of Inspector General (OIG) is part of the U.S. Department of Health and Human Services (HHS) and serves as the internal watchdog for HHS programs like Medicare and Medicaid. The OIG’s job is to monitor compliance with Medicare/Medicaid billing rules.
The OIG offers a lot of compliance resources to physicians, including special fraud alerts, advisory bulletins, podcasts, videos, brochures, and “white papers.” You can download the complete compliance guide here. A great overview is A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse. You can even ask the OIG to review an existing or proposed business arrangement, after which the OIG will issue an “advisory opinion” which covers the application of the Federal anti-kickback statute and other policies. Those Advisory Opinions (both favorable and unfavorable) are publicly available.
This is a great resource for any wound care practitioner starting a new practice!
Remember that the OIG handles the “administrative enforcement” of compliance issues. For example, the OIG can impose civil monetary penalties on practitioners, and it can exclude practitioners from participating in the Medicare/Medicaid programs. However, if the OIG finds evidence of criminal conduct, it refers those cases to the Department of Justice (DOJ), the federal government’s main law enforcement agency.
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