Washington A draft voluntary compliance program guide to assist home medical equipment providers in the fight against fraud and abuse was published by the Health and Human Services Office of Inspector General in the January 28 Federal Register.

The plan consists of seven elements that OIG determined are fundamental to an effective compliance program. They are:

* Implementing written policies, procedures and standards of conduct. This provision promotes the provider's commitment to compliance by including adherence to the program as an element in evaluating managers and employees. It also would address specific areas of potential fraud, such as claims development and submission processes; completing certificates of medical necessity; and financial relationships with physicians and others authorized to order durable medical equipment, prosthetics and orthotics supplies (DMEPOS).

* Designating a compliance officer and compliance committee. This element assigns responsibility for operating and monitoring the program, as well as defines who reports where.

* Conducting effective training and education.

* Developing effective lines of communication. This could involve the creation of a hotline or reporting system to receive complaints and the adoption of procedures to protect the anonymity of complainants and to protect callers from retaliation.

* Enforcing standards through well-publicized disciplinary guidelines. This calls for development of a system to respond to allegations of improper or illegal activities and the enforcement of appropriate disciplinary action against employees who violate internal compliance policies or legal requirements.

* Conducting internal monitoring and auditing. Providers would use audits or other risk-evaluation techniques to monitor compliance, identify problem areas and assist in the reduction of problem areas.

* Responding promptly to detected offenses and developing corrective action. This provision mandates investigation and remediation of systemic problems and development of policies that address the non-employment or retention of sanctioned individuals.

OIG said the guidelines are pertinent to all HME providers interested in implementing a compliance program that promotes prevention, detection and resolution of unethical or illegal business practices. The guide focuses especially on reimbursement and payment, areas where claims and billing operations are often the source of fraud and abuse.

OIG also cautioned that "superficial or hastily constructed and implemented [programs] could expose the DMEPOS supplier to greater liability than no program at all," and insisted that the long-term benefits of implementing a program "significantly outweigh the costs."

Among the issues explained in detail in the Federal Register are procedures for completing and submitting certificates of medical necessity and cover letters, marketing and record-keeping.

OIG said it hopes the voluntary compliance program will enable HME providers to improve the quality of service to patients while reducing fraud, waste, abuse and cost of health care to federal, state and private health insurers.-K.G.