Last year, the responsibility for investigating certain types of employee misconduct — including workers’ compensation fraud — was transferred from the Postal Inspection Service to the Office of Inspector General (OIG).

OIG workers’-comp investigations routinely involve an OIG agent visiting an injured employee’s treating physician. The agent’s tactics can be intimidating — intrusive to physicians and harassing to employees. This is especially startling when you consider that less than one-half of one percent of all Office of Workers’ Compensation (OWCP) claimants have ever been found guilty of fraud.

Claimants and their doctors should be well prepared when confronted with an OIG investigation. In addition to the valuable information Industrial Relations Director Greg Bell provided in a recent article [ The American Postal Worker, Nov./Dec. 2005 - PDF , (password protected) the following may be useful.

PR Note: Links added..also see APWU Questions and USPS Answers Regarding Office of Inspector General (OIG) Investigations

The HIPAA Privacy Rule

Under standards established by the Health Insurance Portability and Accountability Act (HIPAA), healthcare providers are restricted in how much information they can release to an investigating agency. During injury compensation investigations, HIPAA permits physicians to disclose some protected information without getting the permission of the patient.

Also known as the HIPAA Privacy Rule, the federal act does not, however, require a healthcare provider to disclose information that is “protected.” Healthcare providers have no legal obligation to disclose protected health information to an OIG agent unless a disclosure request has been made through a lawful process such as an order from a court or administrative tribunal.

HIPAA standards also establish that even without a patient release, healthcare providers may disclose restricted information to people involved in processing or adjudicating claims, or who are coordinating care. Disclosures of this sort are a routine and expected part of the injury-compensation process. It is noteworthy that HIPAA limits these routine disclosures to the medical information required by federal injury compensation law.

Even in the above circumstances, physicians could still be in violation of HIPAA if they voluntarily disclose information (such as prescribed medication) which is more than the minimum necessary to meet OWCP claims-processing needs.

It is the physicians who are controlled by the HIPAA language; the physicians’ behavior is what ultimately must face legal scrutiny.

Doctor’s Appointments

Doctor-patient confidentiality is a well-established legal privilege, and both the patient and the doctor have a strong legal basis to bar an OIG agent — or anyone else — from participating in a doctor-patient discussion or appointment. But there do not seem to be any rules that could reasonably bar an OIG agent from just showing up at a doctor’s office.

Regardless of what an investigator says or under what circumstances an OIG agent first appears, neither the claimant nor the doctor should be intimidated — nor should they be lulled into a false sense of security. (The agent has not arrived for milk and cookies.) Both the doctor and patient should make it clear they are willing to cooperate with the investigation at a time that is mutually agreeable to all parties, and at a time when legal and/or union representatives can be present. They should advise investigators that they will not be permitted to observe or participate in the actual visit: That’s a clear violation of doctor-patient confidentiality. Physicians should further advise that they will not disclose any information that would cause them to be in violation of the HIPAA Privacy Rule.

Some physicians are refusing to treat workers’ compensation patients because of OIG encounters or because of their concern over potential investigations.

There is no way to compel physicians to treat OWCP claimants if they choose not to. There aren’t many options for the person who faces such a dilemma other than to ask for a referral, or to seek another physician — one whose knees won’t buckle and who is willing to serve as the patient’s advocate. Although there may not be any way to stop frivolous OIG investigations, patients who know their rights should at least be able to slow them down

source: The American Postal Worker magazine, March/April 2006 issue, pg. 45