In Case You Missed It: New OIG Normal Compliance Program Steering


On November 6, 2023, the HHS Workplace of Inspector Normal revealed a brand new compilation of compliance steerage underneath the title Normal Compliance Program Steering (GCPG) for the healthcare compliance neighborhood and different well being care stakeholders. According to the OIG’s April 24, 2023 announcement of its plan to challenge modernized, improved, and accessible steerage, the 91-page doc is now out there on the OIG’s web site. The OIG careworn that the GCPG is voluntary and nonbinding, although it used the phrase “ought to” all through the doc.

Whereas a lot of the data has been included in prior steerage, the OIG added insights and updates, together with a deal with high quality and affected person security. The GCPG is simple to navigate and incorporates the next predominant sections:

  • Well being Care Fraud Enforcement and Different Requirements: Overview of Sure Federal Legal guidelines
    • Along with the False Claims Act, Anti-Kickback Statute, and Stark Legislation, the listing consists of civil financial penalty authority associated to Data Blocking and HHS Grants, Contracts, and different Agreements, in addition to enforcement authority underneath HIPAA
  • Compliance Program Infrastructure: The Seven Parts
    • Emphasizes that the Compliance Officer ought to have the stature of a pacesetter and work together as an equal of different senior leaders
    • Emphasizes the significance of the Compliance Committee in proactive annual danger assessments
    • Promotes considerate consideration of acceptable incentives to encourage participation within the entity’s compliance program
  • Compliance Program Diversifications for Small and Giant Entities
    • Even for small entities, the Compliance Officer “should have no duty for the efficiency or supervision of authorized companies to the entity and, every time potential, shouldn’t be concerned within the billing, coding, or submission of claims.”
    • Giant entities “will doubtless want a division of compliance personnel with a wide range of abilities and experience to implement and monitor the group’s compliance program and tackle its manifold compliance wants.”
  • Different Compliance Issues
    • High quality and Affected person Security
    • New Entrants within the Well being Care Trade, together with know-how corporations, new traders, and organizations offering non-traditional companies comparable to meals supply and care coordination
    • Monetary Incentives: Possession and Cost – Observe the Cash, together with personal fairness possession, cost incentives, and monetary preparations monitoring
  • OIG Assets and Processes
    • Contains Compliance Toolkits, the OIG Work Plan, Advisory Opinions, Protected Harbor Laws, and Self-Disclosure Protocols

Every of the sections consists of “Suggestions” marked by a yellow circle with a star icon and “What to Do if You Determine a Drawback” marked by a yellow triangle with an exclamation level icon.

Be looking out for the OIG to challenge business particular compliance steerage (ICPG) for a number of sorts of suppliers, suppliers, and contributors in healthcare business subsectors. The primary two in 2024 are anticipated to cowl Medicare Benefit and nursing services. The OIG intends to replace the ICPGs periodically “to deal with newly recognized danger areas and compliance measures and to make sure well timed and significant steerage from OIG.” Revised steerage paperwork will change the unique compliance steerage paperwork which were issued over time beginning with hospitals in 1998. Compliance steerage paperwork will not be revealed within the Federal Register however will stay out there on the OIG web site with interactive hyperlinks to helpful assets.

Though the content material of the GCPG just isn’t fully new, it’s positively beneficial studying and a helpful useful resource for compliance professionals, governing our bodies, and traders in all sorts of well being care organizations, together with well being care suppliers, suppliers, life sciences corporations, and managed care plans.


For extra info, please contact Terri Harris at 336.378.5383 or tjharris@foxrothschild.com, or one other member of Fox Rothschild’s nationwide Well being Legislation Apply Group.

Leave a Reply