The Congress has increasingly added responsibili ties and authorities to the Office of Inspector General in the Department of Health and Human Services. The Inspector General's responsibilities extend be yond oversight of the monies spent by the Medicare and Medicaid programs to the assurance of the quality of care rendered to beneficiaries. His quality assur ance mandate includes the imposition of sanctions against health care providers and practitioners who fail to meet new patient care obligations under Sec tion 1156 of the Social Security Act.
The sanction processes followed by the peer review organizations (PROs) and the Inspector General have been subject to debate and change. Over the past year instructions and procedures have been strengthened by new PRO notice procedures, clearer instructions of PRO proceedings, and permitted use of expert wit nesses to provide evidence on cases in question. The Inspector General has received only 163 sanction recommendations from PROs from July 1985 through March 1988. Sixty-four physicians and one hospital have been excluded from the Medicare pro gram, and monetary penalties have been imposed on 25 physicians and 2 hospitals. Fifty-nine cases rec ommended for sanction have been rejected by the Inspector General.
This article discusses the balancing of beneficiary and provider interests in the sanctions process and other quality assurance activities carried out by the Inspector General.
