PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 10338799

New exclusions and penalties complicate compliance programs.

F P Fedor·C J Fuhrman
View original source ↗Export metadata ↓

Abstract

A new final rule and a proposed rule published September 2, 1998, by the HHS Office of Inspector General (OIG) outline regulations that implement enforcement provisions of the Health Insurance Portability and Accountability Act of 1996 and the Balanced Budget Act of 1997, respectively. The rules give the OIG discretionary authority to exclude organizations from participation in state or Federal healthcare programs or exact civil monetary penalties for certain types of infractions. Healthcare organizations, therefore, need to understand these rules and incorporate corresponding changes and processes into their compliance programs to avoid violations that could lead to penalties or exclusions.

Explore related subjects

FraudGuideline AdherenceHealth Insurance Portability and Accountability ActInsurance Claim ReportingLiability, LegalMedicareUnited StatesUnited States Dept. of Health and Human ServicesJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

F P Fedor, C J Fuhrman. 1998. New exclusions and penalties complicate compliance programs.. https://pubmed.ncbi.nlm.nih.gov/10338799/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2006

Representative payment policies and administrative procedure for imposing penalties for false or misleading statements or withholding of information. Final rules.

We are amending our regulations on representative payment and on the administrative procedure for imposing penalties for false or misleading statements or withholding of information to reflect and implement certain provisions of the Social Security Protection Act of 2004 (SSPA). The SSPA amends representative payment policies by providing additional safeguards for Social Security, Special Veterans and Supplemental Security Income beneficiaries served by representative payees. These changes include additional disqualifying factors for representative payee applicants, additional requirements for non-governmental fee-for-service payees, authority to redirect delivery of benefit payments when a representative payee fails to provide required accountings, and authority to treat misused benefits as an overpayment to the representative payee. In addition, we are amending our rules to explain financial requirements for representative payees, and we have made minor clarifying plain language changes. The SSPA also allows us to impose a penalty on any person who knowingly withholds information that is material for use in determining any right to, or the amount of, monthly benefits under titles II or XVI. The penalty is nonpayment for a specified number of months of benefits under title II that would otherwise be payable and ineligibility for the same period of time for payments under title XVI (including State supplementary payments).

Fraud↗