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On the heels of New York’s Office of the Medicaid Inspector General (OMIG) releasing updated compliance requirements, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) announced today that it will also be updating and modifying its voluntary compliance guidance documents.

The OIG’s stated purpose for the modifications is to improve and modernize existing guidance and also issue new guidance, particularly for those industry segments that emerged over the last two decades, with the goal of producing “useful, informative resources – as timely as possible – to help advance the industry’s voluntary compliance efforts in preventing fraud, waste, and abuse in the health care system.”

Going forward, OIG’s published Compliance Program Guidance documents (CPGs) will fall within one of two categories:

  • A General CPG (GCPG) that is, as the title suggests, more general and is applicable to all individuals and entities involved in the healthcare industry. Typical topics will include:
    • federal fraud and abuse laws;
    • compliance program basics;
    • operating effective compliance programs; and
    • OIG processes and resources.

The GCPG will be periodically updated as changes in compliance practices or legal requirements warrant. OIG plans to publish the GCPG by the end of this year.

  • Industry-specific CPGs (ICPGs) will address compliance measures for different types of providers, suppliers, and other participants in healthcare industry subsectors or ancillary industry sectors relating to federal healthcare programs. ICPGs will focus on the fraud and abuse risk areas specific to each industry subsector, and will offer measures that individuals and entities within that sector can utilize to reduce these risks. Updates to ICPGs will address newly identified risk areas and compliance measures.

OIG anticipates that the first two ICPGs will address Medicare Advantage and nursing facilities and will be published sometime in 2024.

OIG stressed that neither its existing CPGs nor any forthcoming GCPG or ICPG constitutes a model compliance program. Instead, they are voluntary guidelines that identify risk areas “that OIG believes individuals and entities engaged in the health care industry should consider when developing and implementing a new compliance program or evaluating an existing one.”

Forthcoming guidance will be posted on the OIG’s website and distributed through its listserv.

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