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Transcript for audio podcast: OIG Outlook 2014: Chief Counsel to the IG, Gregory E. Demske

From the Office of Inspector General of Department of Health and Human Services

[Roberta Baskin] 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.

[Greg Demske] 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.

[Roberta Baskin] Very important.

[Greg Demske] And also to issue civil money penalties, or CMPs, against those who commit fraud against our programs.

[Roberta Baskin] You also provide guidance to the entire health care community. What are some examples of that?

[Greg Demske] 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.

[Roberta Baskin] What are some significant changes to regulations that you're proposing in the year ahead?

[Greg Demske] 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.

[Roberta Baskin] Looking ahead, what are some ways that you'll be using your administrative enforcement authorities?

[Greg Demske] 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.

[Roberta Baskin] You do a lot of outreach to the provider community. So, what are some new ways that you'll promote compliance?

[Greg Demske] 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.

[Roberta Baskin] 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.


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