U.S. Inspector General urges psychologists to set up voluntary compliance procedures

The National Psychologist September/October 2000, Vol 9, 5.

U.S. Inspector General urges psychologists to set up voluntary compliance procedures

 

By Paula E. Hartman-Stein, Ph.D.

 

The U.S. Inspector General’s office has long warned health care professionals, including psychologists, that it will continue to step up its enforcement policies against fraud, waste and abuse, claiming that American taxpayers are being cheated.

Latest in the federal agency’s strategy is to urge all healthcare providers in private practice to establish their own internal compliance procedures to prevent fraud and abuse for Medicare claims.

When the policy goes into effect this fall, it will be voluntary.

Earlier, OIG urged hospitals, home health agencies, hospices and clinical laboratories to set up internal compliance safeguards. Now, the policy is being extended to practitioners, even solo practitioners.

Commenting on the voluntary nature of the Compliance Guidelines, James Georgoulakis, Ph.D., APA’s representative to the American Medical Association’s Resource-Based Value Update Committee, noted: “Those offices without a compliance plan may not, in the eye of the government, be meeting a standard of care.”

Time and resources are the major downsides to the voluntary compliance program for psychologists, according to Georgoulakis.

“Psychologists in general know very little about compliance issues and even less about setting up a program that will meet the OIG recommended standards,” he said. Georgoulakis predicted that psychologists will view the system as an intrusion on private practice. To abide by the compliance guidelines, psychologists would have to implement written policies and standards of conduct for their practices. They would also be expected to:

  • designate a compliance officer or contact
  • develop training and education programs
  • create lines of communications to keep employees of a practice updated about compliance activities
  • perform internal audits
  • enforce standards through well-publicized disciplinary directives
  • take prompt corrective action to “detected offenses.”

According to a news release in June, the OIG says it recognizes that solo and small group practices may not have the resources to put a full-fledged compliance program in place. The agency suggests that a practice can foster a “culture that embraces compliance consistent with the size and resources available to a physician’s practice.”

Significant benefits to psychologists from implementing the voluntary program are also possible. Georgoulakis stated that “the recommendation that the office-based practices have their records audited by their own consultants will prove beneficial to psychologists, both in terms of clinical practice and minimizing errors in coding and ensuring compliance with their medical carriers’ directives. An effective compliance program will reduce the number of formal investigative audits of psychologists.”

The current draft of the OIG document includes appendices outlining risk areas such as basic information about criminal, civil and administrative statutes related to the federal health programs. The OIG provides self-disclosure protocol as well as how to request an advisory opinion and Internet resources.

There is apprehension in Congress relating to the magnitude of the Medicare program which could, without intensive watchdog activities, translate to egregious misconduct among providers. Medicare is a $225 billion annual program with 39 million elderly or eligible disabled beneficiaries.

The American Medical Association was significantly involved in the “comment” period that has now ended. The American Psychiatric Association was also listed among 60 vendors who commented. The American Psychological Association was not included on the list, according to the OIG press office.

Psychologists can find the OIG document Psychologists can find the OIG document here: http://oig.hhs.gov/authorities/docs/physician.pdf

 

Paula E. Hartman-Stein, Ph.D., is a consultant and practitioner in Kent, Ohio. She is a member of three technical expert panels for PQRS measures and provides training for psychologists and social workers regarding professional practice involving the treatment of older adults. She may be reached through her website, www.centerforhealthyaging.com