American Academy of Home Care Physicians
Promoting the art, science and practice of medicine in the home.

AAHCP
1999 Volume Vol 11. No. 1
Issn# 1049-0027

Government Update
By: C. Gresham Bayne, MD

OIG Issues Special Fraud Alert To Physicians
In a Special Fraud Alert issued January 7, 1999, the HHS's Office of Inspector General warned physicians of their responsibilities for certifications in the provision of medical equipment, supplies and home health services.

Citing specific examples of abusive practices discovered in the course of their investigations, the OIG Special Fraud Alert also warned physicians of the potential consequences for unlawful acts including serious criminal, civil, and administrative penalties.

The Fraud Alert reminds physicians of the importance of making proper physician certifications with special emphasis on documentation of medical necessity for home health services and durable medical equipment. It warns against inappropriate certifications such as the following:

a) home health agency certification that falsely represents that skilled nursing services are medically necessary; b) falsely representing that a patient is confined to the home when the patient is ambulatory; c) signing blank CMN's or falsely representing the necessity of respiratory equipment, wheelchairs and hospital beds; or d) accepting payment from a DME supplier for signing prescriptions for medical equipment.

The Alert emphasized that "physicians are not personally liable for erroneous claims due to mistakes, inadvertence, or simple negligence." In contrast, "knowingly signing a false or misleading certification or signing with reckless disregard for the truth" can lead to penalties including criminal prosecution, fines, and administrative sanction such as exclusion from participation in Federal health care programs. The Alert warns against signing certification as a "courtesy" to a patient, agency or supplier when they have not made a determination of medical necessity; knowingly or recklessly signing a false or misleading certification that causes a false claim to be submitted to the Federal government; or receiving any financial benefit for signing the certification. It also includes telephone numbers for reporting fraudulent or abusive activities by physicians, home health agencies or medical equipment and supply companies.

The full text of the Alert can be obtained from the OIG's Web page (http://www.dhhs.gov/progorg/oig/frdalrt/index.htm) or by going to the AAHCP's web page and clicking on the OIG link to get to the same site.

Said George Taler, MD, President of the Academy,"The AAHCP was asked to comment on an early draft of this alert, and will continue to work to help OIG representatives understand the home care physician perspective on this matter. We are concerned that physicians will react to this Alert by curtailing even appropriate referrals to home care agencies and DME suppliers. We want to be sure that physicians understand that PROPERLY made certifications and referrals are not only in the best interests of patients, but should not be challenged." A quick source of information about the requirements is the AAHCP "Blue Booklet" "Making Home Care Work in Your Practice." Ordering information is on our web site, or you can call 410-676-7966.