Schaum Kathleen D
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:
Adv Skin Wound Care. 2015 Feb;28(2):55-8. doi: 10.1097/01.ASW.0000459891.21303.0f.
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.
（1）美国卫生保健财务管理局（OIG）2014年提交给国会的半年报；（2）2015年OIG工作计划。你可以通过本文前面提供的互联网链接阅读这两份文件的详细内容。进行这些自我审核并采取措施纠正问题，远比可能面临的其他选择要好得多，例如：被排除在医疗保险、医疗补助及其他联邦医疗保健计划之外；因提交或致使提交关于个人明知或应知为虚假或欺诈性的项目或服务的索赔而受到民事罚款；因以下行为受到刑事处罚：（1）明知且故意索取、收受、提供或支付报酬（现金或实物）以诱导或（2）作为（1）将个人转介给提供或安排提供联邦医疗保健计划下应付的任何项目或服务的个人或实体的回报，或（2）购买、租赁或订购，或安排或推荐购买、租赁或订购联邦医疗保健计划下应付的任何商品、设施、服务或项目。如果伤口护理专业人员在审核过程中发现问题领域，他们应始终联系其合规官员。他们应共同决定是否应向OIG进行自我披露。自1998年以来，OIG提供了全面的指南，描述了提供者自愿向OIG自我披露欺诈、浪费或滥用行为的流程。提供者自我披露流程为提供者提供了一个机会，以尽量减少如果发现欺诈行为，OIG进行全面审计或调查可能带来的潜在成本和干扰。自我披露还允许提供者协商达成公平的货币和解，并有可能避免被排除在参与联邦医疗保健计划之外。自我披露流程指导提供者和供应商完成向OIG构建关于构成潜在违反联邦法律事项的披露的过程。在进行初步披露后，提供者或供应商应彻底调查所发现事项的性质和原因，并对其经济影响做出可靠评估。OIG评估每次内部调查的报告结果，以确定适当的行动方针。自我披露指南可在OIG网站上获取，网址为http://oig.hhs.gov/compliance/self-disclosure-info 。
