By Jerri Lynn Ward, JD, Of Counsel, Garlo Ward P.C.
www.garloward.com
Posted February 22, 2005
It was a time when reimbursements were cut to the bone, and when
Providers were set upon by Regulators and Plaintiff’s
Personal Injury Lawyers. It was an age undreamed of�
when out of Austin Texas a New Threat appeared!
Let me tell you of the days when there appeared…
Barbarians at your Door!!!
The new Medicaid rules became final in January, 2005. The rules are voluminous and draconian. It is my plan to do a series of articles on important parts of the rules. This first installment deals with confiscation of original documents.
Confiscating Your Original Documents:
The new Rules allow the OIG of Health and Human Services to confiscate original documents. If you do not give them immediate access to your documents and allow them to secure and take custody of your originals when they so demand, the Rule states that they may sanction you:
RULE �371.1643
(f) Failure to Grant Immediate Access.
(1) The Inspector General may sanction any provider or person, including managed care organizations and their subcontractors, as defined in �371.1601 of this subchapter, that:
…
C) fails to provide to the Inspector General or any other federal or state agency, division, agent or consultant as described in subparagraph (A) of this paragraph, upon request and as requested, for the purpose of reviewing, examining, and securing custody of records, access to, disclosure of, and custody of copies or originals of any records, documents, or other requested items, as determined necessary by the Inspector General or those specified in subparagraph (A) of this paragraph to perform statutory functions, any records the provider or person is required to maintain; any records necessary to verify items or services furnished and delivered under Medicaid, any other HHS program, or any state health care program to determine whether payment for those items or services is due or was properly made. This includes, without limitation: clinical medical patient records, other records pertaining to the patient, any other records of services provided to Medicaid or other HHS program recipients and payments made for those services, documents related to diagnosis, treatment, service, lab results, charting, billing records, invoices, documentation of delivery of items, equipment, or supplies, and radiographs and all requirements of �371.1617(a) (2) of this subchapter. It also includes the business and accounting records with backup support documentation, statistical documentation, computer records and data, patient sign in sheets, and schedules. Accessible information must include information that is necessary for the agencies specified in this paragraph to perform statutory functions. It includes those elements described in �371.1601 of this subchapter (definition of “failure to provide immediate access”).
Should you not grant “immediate access”, you may be excluded from the program from the date such access was not granted until access is denied. You may be excluded for an additional year under certain circumstances contained in the Rule.
The Rule states that the OIG will work with the provider “within the limitations necessitated by the circumstances of the investigative case, to provide the provider or person, within a reasonable time, as determined by the Inspector General, and at the provider or person’s expense, with copies of the records necessary for the provider to continue their immediate business. Nothing herein shall be interpreted to impede the Inspector General’s or other requestor’s ability to obtain all records and documents as required and to which the requestor is entitled under this section.”
If voluminous original documents are confiscated from you, expect great expense and long delays in getting them returned. Should it become apparent that you are the target of a fraud investigation, you may want to make additional copies of documents that are necessary for patient care or running your business.
All information in this article is informational only and is not legal advice. Should you have any questions or a situation requiring advice, please contact an attorney.
Copyright 2005 by Garlo Ward, P.C., all rights reserved.
Lakeway, Texas 78734 USA
Telephone: 512-302-1103
Facsimilie: 512-302-3256
Email: Info@Garloward.com
