Primary Care Optometry News, July 2016
Charles B. Brownlow, OD
The Office of the Inspector General acts as the “enforcer” for the Centers for Medicare and Medicaid Services. This office establishes requirements for Medicare providers and creates a plan each year to guide compliance efforts throughout the system. Contractors are kept busy, conducting reviews and audits of provider billing practices as well as reviews of patient records where appropriate.
As is true with most requirements, Medicare would prefer that all providers were always compliant with its rules; if they were, audits, fines and penalties would not be necessary. Based on Medicare’s long history, however, it is pretty clear that voluntary compliance has not been enough. In spite of Medicare’s best efforts, including the Office of Inspector General’s (OIG’s) annual warnings, many providers seem to be ignorant or unaware of the requirements of their Medicare contract and/or unaware of methods for ensuring that their practices are compliant with those requirements.