OIG issues final rules revising safe harbors, civil monetary rules

The Department of Health and Human Services’ Office of Inspector General today issued a final rule amending the safe harbors to the anti-kickback statute and civil monetary penalty rules, as authorized by the Affordable Care Act and other laws. As urged by the AHA, the new safe harbor that protects certain arrangements to provide free or discounted local transportation to patients provides greater flexibility than initially proposed. In addition, the agency finalized exceptions to the beneficiary inducement CMPs to protect certain arrangements that offer beneficiaries incentives to engage in their wellness or treatment regimens or improve or increase beneficiary access to care, including better care coordination. The agency also issued a final rule expanding its civil monetary penalty authorities as authorized by the ACA and other laws. Like the proposed rule, the final rule allows civil monetary penalties, assessments and exclusion for failing to grant timely access to records; ordering or prescribing while excluded; making false statements, omissions or misrepresentations in an enrollment application; failing to report and return an overpayment; and making or using a false record or statement that is material to a false or fraudulent claim. The rule also finalizes five “primary factors” for determining the degree of CMP sanctions. Both rules are effective 30 days after publication in the Dec. 7 Federal Register.