Miller Health Law Group on Reducing the Risk of not Being Paid HMOs and IPAs

On September 25, 2000, the Office of Inspector General (“OIG”) of the Department of Health and Human Services issued its final guidelines (“Final Guidelines”) to aid individual physicians and small group practices to design voluntary compliance programs. The Final Guidelines set forth seven components of an effective compliance program. The OIG recognizes that individual and small group practices because of their limited financial and staffing resources, may not be able to implement all seven components.
• conduct internal monitoring and auditing
• implement compliance and practice standards
• designate a compliance officer or contact
• conduct appropriate training and education
• respond appropriately to detected offense and develop corrective action
• develop open lines of communication
• enforce disciplinary standards through well-publicized guidelines

The Final Guidelines also identify four principal potential areas of risk for physicians:
• coding and billing
• the reasonableness and necessity of services
• adequate documentation
• improper inducements, kickbacks and self referrals.

Some physicians have the mistaken belief that all that is required in order to have a compliance program is to prepare a written policy and procedures manual. The OIG makes clear that “compliance programs are not just written standards and
procedures that sit on a shelf in the main office of the practice, but are an every day part of the practice operations.” If your practice would like a copy of the Final Guidelines or assistance in developing a compliance program, please feel free to contact us.

Does Your Buy-Sell Agreement Need a Tune-Up?
Every practice with two or more physician owners should have a wellthought out, up-to-date, “buy-sell”agreement. “Buy-Sell” Agreements govern the disposition of a physician’s ownership interest in a medical group if the physician departs, either voluntarily or involuntarily. The enclosed article, “Does Your Buy-Sell Agreement Need a Tune Up,” which appears in the October 1, 2000 issue of the Medical Group Management Update, discusses the key issues that should be covered in a “buy-sell” agreement.

Please feel free to contact us if you have any questions concerning your group’s “buy-sell” agreement.