While this is reassuring news for physician practices, returning Medicare or Medi-Cal overpayments can still result in significant problems for physician groups. Typically, carriers that discover overpayments to physicians insist upon repayment within six months or less. If the amount of the overpayment is significant, physician practices may have a difficult time making the repayment in the time allotted by the carrier. The OIG's guidance specifically recognized that small physician practices may not be able to implement the elements described above in the same fashion as larger providers. Small practices can create their own standards of conduct by reviewing the compliance standards already developed by professional associations or larger physician practices , then tailoring these standards of conduct to the compliance needs of their own practices.
Small practices can also refer to the draft guidance itself to develop their standards of conduct.
Instead of drafting their own policies and procedures, small practices can create a resource manual about specific risk areas from publicly available information , such as HCFA directives, carrier bulletins and manuals, OIG fraud alerts and advisory opinions, and private payor reimbursement guidelines. For example, one employee could be responsible for developing written policies and procedures and employee training, and another employee could oversee periodic audits and investigations. Alternatively, small groups can outsource all or part of the compliance officer function to a third party , such as an IPA, MSO, or a consultant. Small practices can attend training programs provided by outside sources, such as professional associations or hospitals, to fulfill the training component of the practice's corporate compliance plan. Readers should consult with their own legal counsel for the most current information and to obtain professional advice before acting on any of the information presented.