On Tuesday, Nov. 27, the Office of Inspector General’s (OIG) Semiannual Report to Congress was posted on the OIG website. The final pages of the report summarize the OIG’s response to seven proposals and recommendations it received for new or modified “safe harbors,” which would protect health care providers and others from liability under the federal anti-kickback statute or related administrative authorities. The OIG had issued its annual solicitation for such proposals in December 2011.
Among the submissions reviewed by the OIG was an AASM recommendation for the development of a safe harbor for a Board Certified Sleep Medicine Physician (BCSMP) to order and provide durable medical equipment (DME) to Medicare patients for use in the treatment of obstructive sleep apnea (OSA). Currently this practice is prohibited under federal law, known as the Physician Self-Referral Law (‘Stark’).
The OIG determined that it would not adopt the AASM’s recommendation for the development of a new safe harbor. The AASM is following up with the OIG to gain additional information about this decision.
“The AASM maintains its position that the current practice model of care for OSA is fragmented, and that board certified sleep medicine physicians and their team are uniquely qualified to provide high quality, coordinated and cost effective diagnostic and treatment services for OSA,” said AASM President Dr. Sam Fleishman. “The Board of Directors will evaluate its options and consider future action.”
The AASM also will continue discussions with the Centers for Medicare and Medicaid Services (CMS), which has previously expressed interest in working with the AASM on the development of a new model for the treatment of sleep disorders. Earlier this month, in the display copy of the final rule for the 2013 physician fee schedule, CMS emphasized the important role of the physician in the provision of DME. A new requirement outlined in the final rule would require a physician encounter with the patient in order for Medicare to pay for DME.
“We believe physician involvement will not only assist in reducing waste, fraud and abuse but it will also help to ensure that beneficiaries receive high quality DME to meet their specific needs,” wrote CMS.
The AASM will keep members informed as we continue to promote the vital role of board-certified sleep specialists in the long-term management of patients with OSA and other sleep disorders.
All AASM members are encouraged to support this vital initiative by making a donation to the AASM Political Action Committee (PAC). It is crucial that the AASM PAC have sufficient funds to keep the interests of the sleep medicine field well represented in Washington. Your generous donation is needed today.