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Preparing for the OIG’s General Program Compliance Updates

November 20, 2023
November 20, 2023

The first updates to the Office of the Inspector General (OIG) General Compliance Program Guidance (GCPG) in nearly 30 years took effect on November 6, 2023. While the guidance does not create new laws or legal obligations, the GCPG does modernize the original OIG guidance and makes it more accessible. 

It should also be noted that there is more to come. This release is specifically directed to federal healthcare providers, but it will likely be followed by industry-segment specific CPGs (ICPGs) with the next areas of focus expected to be managed care plans and skilled nursing facilities. It is anticipated that the next round of guidance will be available in 2024.

The General Compliance Program Guidance

The GCPG provides information about relevant Federal laws and acts as a reference guide for the healthcare compliance community and other healthcare stakeholders. The GCPG provides guidance for hospitals, home health agencies, clinical laboratories, third-party medical billing companies, durable medical equipment and supply companies, hospices, Medicare Advantage plans, skilled nursing facilities, physicians, ambulance companies, and pharmaceutical manufacturers. The GCPG offers voluntary guidance that discusses general compliance risks and programs. The GCPG is not binding on any individual or entity.

What follows are some highlights from the recent updates.

Quality and Patient Safety

The new guidance recommends that compliance programs include quality and patient safety within their scope. This has been an often-discussed topic in healthcare compliance; however, many compliance programs still do not include quality and patient safety. The OIG now recommends that healthcare organizations include quality and patient safety in their compliance programs to provide more insight into quality and patient safety issues and to help the organization reduce the risks associated with incidents resulting in patient harm.

Risk Assessments and Quality Audits

In addition, the new guidance recommends that compliance committee members receive regular reports on quality and patient safety issues as well as information on the adequacy of patient care. It also recommends establishing and implementing a regular process for performing quality audits, including an assessment of if staffing levels are sufficient to reduce risk and ensure patient safety. The OIG recommends risk assessments be conducted annually and that the Compliance Committee be responsible for the audits, rather than the Compliance Officer, in order to better demonstrate an organizational focus on these issues. In addition, upon the completion of the audit, it is recommended that findings be reviewed and used to develop an action plan to address the findings.

Voluntary and Flexible 

The OIG has emphasized that compliance is completely voluntary and not binding on individual organizations. In addition, it offers resources that are designed to be flexible regardless of the size of the healthcare organization. A section of the GCPG update is devoted to ways in which the compliance program can be “right-sized” to the needs and size of any organization and even recommends specific strategies that will help all organizations implement the guidance. The additional focus on right-sizing compliance programs to meet the needs of the entity is helpful for compliance departments when assessing and prioritizing resources and budget requests.

OIG Resources

The new guidance includes links to a wide variety of compliance resources. The U.S. Department of Health and Human Services (HHS) OIG’s official release of the new guidance includes an entire section of helpful, free resources. Resources include compliance toolkits, advisory opinions, healthcare fraud and enforcement standards, recommendations for your compliance program’s infrastructure, provider compliance training and more.

Compliance Solutions

While the OIG provides resources in support of this new guidance, the process of building a culture of compliance is an evolving process with many moving parts. HealthStream has compliance solutions that can help your organization build a culture of compliance that prioritizes clinical quality and safety while satisfying federal requirements.

HealthStream can help support your compliance program with innovative technology, adaptive learning, and organizational management tools. The compliance education tools can identify any gaps in compliance and assign a personalized employee learning program to address the gaps with engaging content. HealthStream also provides reporting on course completions and proficiency. Contact HealthStream today to learn more about the tools that can help your organization build a culture of compliance.