RE: Solicitation of Information and Recommendations for Revising the Compliance Program Guidance for the Hospital Industry, OIG-12-CPG.

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Monday, August 19th 2002

The Honorable Janet Rehnquist
Inspector General
Department of Health and Human Services
Attention: OIG-12-CPG
Room 5527A, Cohen Building
330 Independence Avenue, SW
Washington, DC 20201

Dear Ms. Rehnquist:

On behalf of our nearly 5,000 member hospitals, health systems, networks and other providers of care, the American Hospital Association (AHA) welcomes the opportunity to provide our comments to the OIG on the need for revisions to the current Compliance Program Guidance for Hospitals (CPG).

We appreciate your review of the CPG and your desire to keep it current with the latest developments in the hospital field.  The AHA and its members were active in the development of the 1998 CPG.  We believe that formal compliance programs play a key role in minimizing billing errors as hospitals strive to comply with Medicare's very complex legal and regulatory requirements. 

Compliance has become part of the hospital culture.  Hospitals across the country have established compliance programs and are actively pursuing compliance initiatives.  In revising the CPG, the OIG should recognize the extent to which hospitals have embraced compliance.  Individual hospitals have invested significant resources in compliance plans and activities, and the AHA continues to make compliance a focus of the services it provides to members. 

Some of the current OIG guidance is oriented to the start-up of a compliance program.  In the area of training, particularly, the look of the program for new employees or those directly affected by changes in law or regulation will be different than it is for those who have been participating in training for a number of years and are less directly affected by change.  The guidance should acknowledge the variety of means through which training can be accomplished (including Web-based or other approaches that do not require face-to-face participation) and give hospitals the latitude to choose what works best within their organizations.  This includes recognizing that requiring a minimum number of hours for each employee to be trained is often cumbersome, costly and unnecessary.  Guidance should leave to the discretion of the hospital the extent of training that is needed.

Compliance programs are established voluntarily as part of hospitals’ good faith efforts to meet their legal obligations.  However, in the investigations and reporting section, the CPG uses the term “noncompliance” largely in the context of misconduct.  The CPG recognizes that overpayments occur based on mistake or error, not necessarily fraud or misconduct, but the overall tone of the CPG is oriented to fraud and misconduct.  In a revised CPG we urge that the tone be more evenhanded.  For example, the return of overpayments should be given equal prominence with the voluntary disclosure process.  And guidance on reporting "potential" misconduct should be consistent.  Under the current guidance, a hospital is encouraged to report what “may” be a problem, but the protocol seems to assume that all reported matters involve misconduct.  An emphasis on the return of unearned payments would reward an effective compliance program and give meaning to the continued recognition by the OIG that instances of fraud are the clear exception.  

Finally, as you consider changes, please keep in mind that the hospitals using this compliance guidance are diverse in size, location, and complexity.  The CPG should make clear that the details it provides are intended as guidance, not as a prescription for a single compliance program that every hospital must follow.

Again, we appreciate this early opportunity to provide comment.  The AHA also supports the comments submitted by the Association of American Medical Colleges and the Federation of American Hospitals.  We look forward to an additional opportunity to comment on any proposed changes, and to work with the OIG in developing revised guidance.  If you have any questions about these remarks, please feel free to contact Maureen D. Mudron, Washington counsel, at 202.626.2301.


Rick Pollack
Executive Vice President 


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