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New exclusions and penalties complicate compliance programs.

F P Fedor1, C J Fuhrman

  • 1Diepenbrock, Wulff, Plant & Hannegan, LLP, Sacramento, CA, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|May 29, 1999
PubMed
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New Health Insurance Portability and Accountability Act (HIPAA) and Balanced Budget Act rules grant the Office of Inspector General (OIG) authority to penalize healthcare organizations. Compliance programs must adapt to avoid exclusions and civil monetary penalties.

Area of Science:

  • Healthcare Law and Regulation
  • Compliance Management
  • Public Health Policy

Background:

  • The Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Balanced Budget Act of 1997 introduced significant regulatory changes.
  • The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is responsible for enforcing these regulations.
  • New rules published on September 2, 1998, detail enforcement mechanisms for these acts.

Purpose of the Study:

  • To inform healthcare organizations about new enforcement regulations from the OIG.
  • To highlight the discretionary authority granted to the OIG for penalties and exclusions.
  • To emphasize the need for updated compliance programs within healthcare organizations.

Main Methods:

  • Analysis of a final rule and a proposed rule published by the HHS OIG.

Related Experiment Videos

  • Interpretation of enforcement provisions under HIPAA and the Balanced Budget Act.
  • Review of the OIG's authority regarding civil monetary penalties and program exclusions.

    • Main Results:

    • The OIG has been granted discretionary authority to exclude organizations from federal healthcare programs.
    • The OIG can impose civil monetary penalties for specific violations of healthcare regulations.
    • These rules necessitate proactive compliance measures by healthcare entities.

    Conclusions:

    • Healthcare organizations must understand and integrate new OIG regulations into their compliance frameworks.
    • Failure to comply with these rules can result in severe penalties, including exclusion from federal programs.
    • Proactive adaptation of compliance processes is crucial for avoiding legal and financial repercussions.