More than half of U.S. medical schools don't provide any instruction on federal fraud and abuse laws, according to a report from the Office of Inspector General.
That should change, the report said, because Medicare and Medicaid fraud and abuse cost billions each year "and put the programs' beneficiaries' health and welfare at risk," the OIG says.
Finding from 131 medical school deans:
- 44% (or 57 deans), say they provide instruction dealing with fraud and abuse laws
- Of those 57, 53 deans say the instruction takes place in the classroom
- 38% say they provide the training annually
- 38 deans said they covered the False Claims Act while 35 teach nuances dealing with the anti-kickback statute.
Medical schools have opportunities to address these topics, even though there is no federal requirement that they do so, the OIG report states.
Of the 387 institutions offering residency and fellowship programs in medicine that responded to the OIG request, 263 or 68% provide instruction on fraud and abuse and of those, 81% did it using conferences and lectures.
The OIG highlighted five areas of fraud and abuse law that the office thinks medical students need to learn. They are:
1 The civil False Claims Act, which charges anyone who knowingly submits a fraudulent claim for services to the federal government. Violations generally are punishable by a civil penalty of up to $10,000 an three times the amount of damages suffered by the government.
2. Anti-kickback statute, which imposes felony charges and fines up to $25,000 to anyone "who knowingly and willfully receives or pays anything of value to influence the referral of federal healthcare program business.
Violators also are potentially subject to civil penalties up to $50,000 and prohibited from participating further in federal healthcare programs.
3. Physician self-referral statute, which prohibits the practice of physicians' referring patients to facilities in which they have ownership or other financial interests, can be punished with civil penalties of $15,000 per improper claim, denial of payment and refunds for certain past claims.
4. The Civil Monetary Penalties Law may result in penalties between $10,000 and $50000 and up to three times the amount unlawfully claimed.
5. The Exclusion Statute excludes entities or individuals from being reimbursed or participating in Medicare or Medicaid programs for a minimum of three years, depending on the offense, to lifetime exclusion.
The OIG says it "has dedicated significant resources to promoting the adoption of compliance programs and encouraging health care providers to incorporate integrity safeguards into their organizations as an essential component of a comprehensive antifraud strategy," steps that it will continue and beef up.
It regularly, for example, posts advisory opinions on whether specific business arrangements constitute fraud or abuse and periodically issues fraud alerts and advisory bulletins to alert and inform the industry about areas of special interest.
The OIG says that it plans to take steps to improve awareness among medical schools about the law by preparing and distributing educational materials for medical schools, and residency and fellowship programs. It also plans to seek feedback on compliance challenges that physicians, hospitals and other providers face.