Complaince

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Friday, May 31, 2002

Remember, ignorance is not an excuse
With Erica Rochelle
Q. Can I be held responsible for something I did wrong but didn't know was a violation when I can show I acted in good faith?

A. According to Black's Law Dictionary, "Ignorance of the law excuses no one." Routinely, suppliers face the challenge of proving to the DMERC, Fair Hearing Officer or Administrative Law Judge, that they had no idea what they were doing violated Medicare rules and regulations and that they acted in good faith by providing a service they thought was reasonable and necessary.

Good faith means the absence of malice and the absence of design to defraud. However, good faith is an intangible remedy that must be substantiated by more than the supplier's word of honor. Thus comes the ability to show appropriate measures are taken in daily activities that coincide with the intent or interpretation of the Medicare rules.

Drafting functional procedures and gathering all necessary and appropriate documentation to substantiate your claims is the only way to prove beyond a shadow of a doubt that you followed what you perceived to be the rule and acted in good faith when providing your service. Documentation is the key to success.

Medicare policy dictates that all suppliers have in their possession at the time of delivery enough documentation to substantiate the claim, thus including supporting documentation from the ordering physician. Failure to obtain the required documentation constitutes a violation of the policy and could result in a denial of the claim or a demand for overpayment.

The only way to cure this and to successfully argue good faith would be to document your attempts to collect the information from the physician, implement policies that require gathering corroborating documentation prior to delivery and conduct internal audits to ensure compliance. You will then be able to make that additional documentation available to the governing body and argue from a much stronger position that you provided the service in good faith, even though your documentation may not be perfect.

Erica Rochelle is a v.p. for compliance with the KMT Group. Reach her at (803) 254-3995.

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