HHS OIG proposes exclusion authority, civil monetary penalty rules that will unjustly penalize providers

The HHS Office of the Inspector General (OIG) is proposing to update the OIG’s exclusion and civil monetary penalty authorities to protect Federal health care programs from fraud and abuse. The OIG proposes to broaden the circumstances under which it may exclude a provider from Medicare enrollment. The proposed rule also asserts that no statute of limitations applies to its ability to exercise its exclusion authority. Additionally, the HHS OIG is proposing another rule that revises the OIG’s civil monetary penalty rules which would vastly expand the OIG’s ability to impose penalties and substantially increase the penalty amount that could be imposed.

The AADA argued that the rules would implement a punitive approach on providers under a low evidentiary bar of “gross negligence” or “knew or should have known”  that would allow provider exclusions based on alleged, minor and possibly inaccurate charges from the distant past. The AADA questioned the equity of the proposed rules that — while intended to punish wrongdoers — may, in fact, ensnare and unfairly burden innocent providers, and urged HHS to reconsider rule provisions that would make ethical, competent and committed providers excessively vulnerable to civil monetary penalties and potential exclusion from a major government program through which they provide ongoing, vital care to millions of Americans. Read the AADA’s letters to the HHS OIG on the proposed rule to expand the OIG scope of authority, and the proposed rule to revise the OIG’s civil monetary penalty rules.

CMS proposes rule to modify EHR incentive deadlines

The AADA is applauding CMS for proposing to modify the meaningful use timeline for Electronic Health Records (EHR) Incentive Programs, and proposing to change the reporting requirements for clinical quality measures for 2014. However, while the proposed changes come in response to the AADA and other stakeholders’ concerns about vendor delays and implementation problems, the AADA is concerned that the changes come late in the program year, and that timing may limit the benefit of the proposed modifications. Read the AADA’s letter to CMS. Read the full text of the proposed rule.

CMS releases Medicare physician payment data

CMS has released individual physician Medicare payment data from 2012 to the public. In May 2013, a federal judge lifted an injunction that prohibited CMS from releasing any payment information that could be used to identify individual physicians. According to CMS, this data will afford researchers, policymakers and the public great transparency into health care spending and physician practice patterns. 

In August, CMS requested feedback on this policy from stakeholders. In its comment letter, the AADA strongly opposed this proposal.  

Congressional Skin Cancer Caucus

A Congressional Skin Cancer Caucus that includes Reps. Jim Cooper (D-Tenn.), Carolyn Maloney (D-N.Y.), Peter Roskam (R-Ill.), and Charlie Dent (R-Pa.) was formed in July 2013 to focus on addressing the growing rate of skin cancer among Americans.

This new bipartisan Congressional Member Organization will serve as a forum and resource for members of Congress working on this issue, and will support legislative activities and public policies that raise awareness about skin cancer, foster effective skin cancer prevention outreach and education, increase screening and early detection of skin cancer, and improve access to skin cancer care and treatment.

Read the press release issued about the Skin Cancer Caucus.

Physician workforce shortage

With a physician workforce shortage projected to reach 130,600 physicians in 2025, the AADA and other specialty societies are calling on Congress to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). Medicare’s current cap on financial support for GME prevents teaching hospitals from expanding the number of training positions and often prevents new hospitals from establishing teaching programs. In a joint letter, the organizations stressed that Medicare GME cuts will threaten access to care for millions of current and future patients. Read the AADA letter.