The Department of Health and Human Services Office of Inspector General (OIG) has unveiled its updated general compliance program guidance for the first time in over 15 years, signalling a significant shift to support the continuous growth of the health-care industry.
This revamp serves not only large entities dealing with complex risks and substantial resources but also smaller entities operating with more limited resources. The initiative acknowledges the diverse requirements of different-sized organisations and promotes the implementation of well-fitted compliance programs to cater to these individual needs.
In addition, OIG has released guidance on Corporate Responsibility and Health Care Quality, along with specific dashboards for acute and long-term care. These underscore the central role of quality and patient safety in fraud and abuse compliance and recommend entities to incorporate oversight over these aspects into their compliance and audit programs.
That being said, the OIG has also issued a warning to investors and governing bodies of health-care entities to rigorously inspect operations, incentive structures, and payment methods to safeguard compliance with federal fraud and abuse laws. An anticipation of further general health-care industry compliance program guidance has been announced. There will also be separate industry-specific guidance publications, with the first two addressing Medicare Advantage and skilled nursing facilities.
OIG has announced that it will no longer make compliance program guidance available via the Federal Register but will instead offer updates on its website.
The updated guidance lays emphasis on seven elements that include policies and procedures, leadership and oversight, training and education, communication and disclosure, consequences and incentives, risk management, and corrective actions. The OIG recommends that all elements are considered comprehensively by the healthcare industry to monitor, minimize, and mitigate risks effectively.
Entities are encouraged to establish a code of conduct and compliance policies that clearly communicate the organisation’s mission, goals, and ethical stipulations. Compliance policies should focus on federal fraud and abuse laws covering areas like billing, coding, sales and marketing, quality of care, patient incentives, and physician and vendor arrangements.
This detailed guidance aims to assist health-care professionals in integrating the recommended updates and identifying areas where new measures may need to be implemented. The compliance measures set out by the OIG could be crucial in forging a future path for successful health-care providers.
The original article was authored by three industry professionals: Olivia Seraphim, Janine Tougas, and Francine R. Michel; all employed at Kirkland & Ellis focusing on regulatory and transactional matters on behalf of healthcare entities and investors.
For further details, refer to the full article.