Compliance and Guidance

Death Certificates

Effective Jan. 1, 2011, the physician last in attendance upon the deceased must submit a death record using the online Indiana Death Registration System (IDRS). The death record must be completed within five (5) days of initiating the document process or receiving notification from the person in charge of interment. Fines of up to $1,000 can result from a failure to comply with this law beginning Jan. 1, 2012.

In order to use the IDRS, physicians must first be registered. To register, complete a Confidentiality and User Agreement found on the IDRS website. Registration can take several days to process, so it is prudent to register before you need to use the system, or you may not be able to comply with the five-day death certificate filing timeline.

For more information, including training tutorials on how to use IDRS, visit the IDRS website. A Tip Sheet is available on the ISMA website.

Breast Density Notification and Consultation

Effective July 1, 2013, a facility that performs a mammography examination must identify patients who have “dense breasts” (defined as a patient with a greater amount of breast and connective tissue in comparison to fat in the breast) and notify the patient as such in the written mammography report. Effective Oct. 22, 2016, the Medical Licensing Board of Indiana (MLB) adopted rules to educate women with high breast density and to establish standards for providing follow-up care or testing for a woman who is at least 40 years old and who has high breast density. A key component of the new rules require a physician who interprets the mammography report for a patient with high breast density to consult with the ordering physician and the patient to determine what follow-up care or testing is appropriate. The MLB rules do not dictate the type of follow-up care or testing but instead allow for a number of possibilities. For example, a physician may recommend a breast cancer risk assessment or follow the recommendations of a recognized entity, such as the American College of Radiology or the Society of Breast Imaging.

Click here to view SEA 414. 
Click here to view the MLB rule.

Gifts from Industry

The Physician Payment Sunshine Act was included as Section 6002 of the Affordable Care Act of 2010. This Act requires applicable manufacturers to report certain industry gifts to the Department of Health and Human Services. Applicable manufacturers must also disclose any investment or ownership interests that a physician or physician's family member has in their company.

Once disclosed, this information will be made available on a public website and will be searchable by physician name, specialty, and address. Consumers will also be able to see what items were provided to physicians, as well as their value.

On Dec. 19, 2011, CMS published a proposed rule for the Physician Payment Sunshine Act. The proposed rule is available here.  CMS is expected to publish the final rule by the end of 2012 and will not require data collection by applicable manufacturers before Jan. 1, 2013. For more information on the Physician Payment Sunshine Act, visit The CMS Blog or see the following ISMA e-Reports articles:

Indiana law does not specifically address industry gifts to physicians, but the AMA has developed ethical policies on the topic. These policies are available on the AMA's website.

Indiana Unclaimed Property Act

The Indiana Unclaimed Property Act requires almost every business organization and governmental body to report and return property to the Indiana Attorney General's Unclaimed Property Division when the owner of that property cannot be found and the property has been unclaimed for a certain period of time (e.g., patient credit balances – three years; wages/payroll checks – one year).  “Property” can include patient credit balances, as well as employee wages.  If a current patient has a credit balance, the law does not apply.

IC 32-34-1-26 requires that due diligence be performed on all unclaimed property valued at $50 or more. Due diligence entails the following:

    • Examine records to find all unclaimed property.
    • Determine the owner of the property.
    • Use other internal resources to locate owners.
    • Verify that the owner has made no verbal or written contact with you concerning the property.
    • Attempt to contact the owners by first class mail at their last known address. This must be completed in no less than sixty (60) days, but no more than one hundred twenty (120) days, before filing a report.  A sample due diligence letter is available here.
    • Return money to owners you locate.
    • Register for online reporting here.
    • Report all unclaimed property to the state. The annual reporting deadline in Indiana is November 1.

If a business fails to comply with the Indiana Unclaimed Property Act, the business can be assessed interest and face other penalties.  Indiana's Unclaimed Property Act is available here.  For more information, visit and see the following ISMA e-Reports articles:

Discounts to Patients

This issue is not addressed by Indiana law. The Department of Health and Human Services Office of Inspector General issued a six-page guidance document entitled, "Hospital Discounts Offered to Patients Who Cannot Afford to Pay their Hospital Bills" on Feb. 2, 2004. The ISMA provided a summary of this guidance in its Aug. 7, 2006ISMA Reports issue. On June 18, 2007, the OIG issued an addendum to the original guidance document.

Impaired Drivers

Indiana law does not require physicians to report patients who may be medically or physically impaired. However, Indiana law does provide immunity for physicians who voluntarily report patients to the Bureau of Motor Vehicles who the physician in good faith believes are not fit to operate a motor vehicle safely, as long as the physician has personally examined the patient within 30 days prior to making the report. IC 9-24-10-7.5.

The AMA has developed The Older Drivers Project, which includes education, patient counseling and ethical policies.

Disclosure of Financial Interest

Indiana law requires physicians to disclose ownership interests in facilities to which they are referring a patient and obtain a written statement from the patient that such disclosure was made. ISMA provided a summary of this law in its May 20, 2006, ISMA Reports. The law is available at IC 25-22.5-11-1 et seq.

Compliance Program

The Health and Human Services Office of Inspector General published the “OIG Compliance Program for Individual and Small Group Physician Practices" on Oct. 5, 2000.