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[ Music ] Finally, we hear from the Chief Counsel of
the Office of Counsel to the Inspector General. Leading a full service in-house law firm is
our top lawyer, Greg Demske. And Greg leads a team of lawyers overseeing compliance and
protecting government health care programs from fraud. Welcome, Greg, and just say a
few words about your role across all of OIG. Sure, Roberta. First, we are the lawyers for
OIG, which means we're advising the investigators, auditors, evaluators on the work that they're
doing, day to day. And that's similar to what OIG's Counsel's Offices would do across government.
But in addition to that, we have some special responsibilities. For example, we have administrative
enforcement authority to exclude providers from participating in Federal health care
programs. Very important.
And also to issue civil money penalties, or CMPs, against those who commit fraud against
our programs. You also provide guidance to the entire health
care community. What are some examples of that?
That's right. That's one of our other special responsibilities: guidance. And Congress has
required us to give some guidance. For example, under the anti-kickback statute -- this is
a statute that is very broad and covers the entire health care arena -- we are required
to issue safe harbor regulations and advisory opinions that help define the contours of
that broad statute. But in addition to what we're required to do, OIG has a longstanding
commitment to providing guidance to providers who are trying to do the right thing and promote
compliance from within. So, for example, we've issued compliance program guidance, fraud
alerts, bulletins, videos; all of which is available on the website.
What are some significant changes to regulations that you're proposing in the year ahead?
Well, we have regulations that govern some of the guidance that we provide but also our
enforcement actions. And we don't issue a lot of regulations in OIG, but in 2014, we
plan to issue proposed regulations in three areas: CMPs, exclusions and safe harbors.
And these proposed regulations will really update and modernize what we already have
in place and address changes to the law, saying the Affordable Care Act or other provisions.
And we'll get public comment, which will allow us to bring our regulations up to date.
Looking ahead, what are some ways that you'll be using your administrative enforcement authorities?
Well, I see two trends that have started and will continue even more so in the future.
One, we are using data and working with the auditors and evaluators, as well as investigators
in OIG, to identify areas where we should look to do administrative enforcement, but
also, particular subjects that we should pursue. And secondly, we are concentrating, more than
ever, on bringing cases where the enforcement action supports guidance we've given. So,
for example, if we've said certain conduct is problematic and violates the law, we're
going to look to pursue cases for those people who violate that guidance. That's designed
to provide a level playing field for those providers that are playing by the rules.
You do a lot of outreach to the provider community. So, what are some new ways that you'll promote
compliance? Well, in addition to the ones that I mentioned
before, one of the areas that we provided guidance to in the past is for boards of directors
at health care entities. And we've provided free documents in the past, but we've continued
to hear from compliance officers that there's a need for more guidance for members of boards
of directors. So, we plan in 2014 to issue new guidance in that area. And, really, all
the guidance that we provide recognizes, number one, that we can't be everywhere. We can't
be the cop on the beat, looking over the shoulder of every provider. And secondly, that the
vast majority of providers are trying to comply with the law in a complex regulatory environment.
So, we're going to try to give them the tools to comply from the provider side.
Great point. Thank you, Greg Demske, for wrapping up our program with how your lawyers promote
compliance, protect the public and hold those accountable who steal from Federal health
care programs. And thank you, again, to all of OIG's leadership for their contributions
to this program. Please visit our website for an in-depth look at our oversight work
and many resources. To stay connected to OIG's work, please sign up for our email updates
and follow us on Twitter. Thanks for watching and have a healthy and happy 2014.
[ Music ]