Category: Health News
Created: 9/17/2008 2:00:00 AM
Last Editorial Review: 9/17/2008
In early 2006, the Department of Justice (DoJ) instituted a change in how it dealt with Medicare, Medicaid and tricare fraud. In prior years, these issues were typically dealt with as civil issues with civil penalties and restitution. Most offenders plead "guilty" or "no contest" to the charges, paid a fine and went home. Beginning in early 2006, DoJ began using the "guilty" plea from the civil cases as evidence to prosecute these individuals criminally. The type of insurance fraud spanned the gambit from billing for nonexistent patients to billing more than the documentation would support. It is this latter prosecution that is the cause of concern.
It is this last fact that opens the door for DoJ to involve itself in hospital preparedness. Through their actions in 2006, DoJ has shown the willingness to criminally prosecute healthcare providers for overt insurance fraud. Signing the CMS attestation when not in compliance with NRP/NIMS is the same as signing the attestation that chart documentation is in compliance with CMS documentation standards. In short, the failure to be all hazards prepared may have just been raised to the level of a federal felony.
The Unprepared Beware.
This is the first step in a progression that if followed by CMS, DHHS, DHS and DoJ will put the full weight and power of the federal government behind an unfunded mandate for hospital preparedness. An appreciation how CMS and DoJ have handled dealt with healthcare providers who have run afoul of these agencies in the past 18 months may portend the future.
The Unprepared Beware
NRP and NIMS regulations are promulgated upon all signatories to NRP/NIMS, including DHHS. As signatories, all government agencies agree to promulgate the requirements of NRP/NIMS upon all their agencies/departments. Since DHHS is a signatory,this would include CMS (Medicare, Medicaid tricare). Since a all healthcare providers who bill CMS directly or indirectly are regulated by CMS and have independent contractor status with CMS, the requirements and regulations promulgated upon CMS by NRP/NIMS through DHHS are passed down to those contractors. This is affirmed by every healthcare provider every time they bill CMS on a UB92, CMS1500 or electronic equivalent because these forms include the attestation that the healthcare provider is in compliance with all regulations and requirements of CMS and the program billed.
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