title: Don't let your revenue be part of the $4.9 billion returned to taxpayers!
abstract: Wound care professionals should carefully inspect and audit their coding and billing practices in light of (1) the OIG's 2014 Semiannual Report to Congress and (2) the 2015 OIG Work Plan.You can read the details of both documents by following the Internet links provided earlier in this article. Conducting those self-audits and taking steps to correct issues are far better than the possible alternatives, for example: exclusion from participating in Medicare, Medicaid, and other federal healthcare program civil monetary penalties for submitting or causing to be submitted a claim for items or services that the person knows or should know is false or fraudulent criminals penalties for the following:) knowingly and willfully soliciting, receiving, offering, or paying remuneration (in cash or in kind) to induce, or) in return for (1) referring an individual to a person or an entity for the furnishing, or arranging for the furnishing, of any item or service payable under the federal healthcare programs or (2) purchasing, leasing, or ordering, or arranging for or recommending the purchasing, leasing, or ordering, of any good,facility, service, or item payable under the federal healthcare programs.If wound care professionals identify problem areas during an audit, they should always contact their compliance officer.Together, they should decide if they should self-disclose to the OIG. Since 1998, the OIG has made available comprehensive guidelines describing the protocol for providers to voluntarily submit to OIG self-disclosures of fraud, waste, or abuse. The provider self-disclosure protocol gives providers an opportunity to minimize the potential costs and disruption that a full scale OIG audit or investigation might entail if fraud were uncovered. The self-disclosure also allows the provider to negotiate a fair monetary settlement and potentially avoid being excluded from participation in federal healthcare programs.The self-disclosure protocol guides providers and suppliers through the process of structuring a disclosure to OIG about matters that constitute potential violations of federal laws. After making an initial disclosure, the provider or supplier is expected to thoroughly investigate the nature and cause of the matters uncovered and make a reliable assessment of their economic impact. The OIG evaluates the reported results of each internal investigation to determine the appropriate course of action. The self-disclosure guidelines are available on the OIG website at http://oig.hhs.gov/compliance/self-disclosure-info.
authors.affiliation: Kathleen D. Schaum, MS, is President and Founder of Kathleen D. Schaum & Associates, Inc, Lake Worth, Florida. Ms Schaum can be reached for questions and consultations by calling 561-964-2470 or through her e-mail address: kathleendschaum@bellsouth.net.
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Schaum
mesh_terms: D059019:Clinical Coding / Q000191:economics* / Q000331:legislation & jurisprudence; D005607:Fraud / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D019983:Guideline Adherence / Q000191:economics / Q000331:legislation & jurisprudence; D017408:Guidelines as Topic; D006801:Humans; D008484:Medicaid / Q000191:economics* / Q000331:legislation & jurisprudence; D006278:Medicare / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States; D014483:United States Dept. of Health and Human Services / Q000191:economics*; D014947:Wounds and Injuries / Q000628:therapy