The U.S. Office of Inspector General (OIG) enforces the General Compliance Program Guidance. This comprehensive document governs patient care, worker safety, and privacy and confidentiality of protected health information (PHI). In November, updates for 2024 appeared in the OIG General Compliance Program Guidance, including recommendations for Medicare, nursing facilities, and other industry-specific entities.Â
The updates provide more detailed guidance for preventing fraud, waste, and abuse, maintaining organization-level compliance programs, and considering infrastructural issues in healthcare compliance.
Updated Focus Areas for Addressing Fraud, Waste, and Abuse
The OIG General Compliance Program Guidance for 2024 provides more details about crucial healthcare laws like the Stark Law, False Claims Act, and Anti-Kickback Statute. The 2024 update also addresses the Information Blocking Rule for the first time. This rule removes incentives for providers to interfere with the open exchange of electronic medical records (EMRs) and makes it easier to investigate individuals allegedly involved in information blocking.
The 2024 guidance directs healthcare organizations to prioritize Health Insurance Portability and Accountability Act (HIPAA) compliance, given increased cybersecurity threats in recent years. Organizations should ramp up their risk assessment efforts.
The updated OIG General Compliance Program Guidance also focuses more on improving the quality of patient care and identifying the factors that undermine care. The guidance recommends for the organization’s compliance committee to take the following steps:
- Include committee members who oversee patient safety and quality assurance
- Receive regular reports from high-level leadership on patient care quality practices
- Direct compliance officers to cultivate positive relationships with clinical and administrative leaders and conduct regular compliance audits
Additional Recommendations for Organizational Compliance Programs
The OIG General Compliance Program Guidance 2024 version provides more details on establishing and managing organization-wide compliance programs. For instance, the guidance recommends that all personnel have easy access to compliance policies and procedures, including using plain language and offering language translations.
Compliance officers have access to more information about their responsibilities and roles. In particular, they:
- Must not take on any roles that are financial or legal
- Report directly to the organization’s board or C-suite leadership
- May serve as the organization’s privacy officer but must have sufficient resources to fulfill this role
The 2024 compliance program guidance allows the use of incentives to encourage employees to participate in the company’s compliance program. Enhanced participation can result in greater recognition, additional compensation, or other forms of encouragement proportionate to an individual’s job or position.
Healthcare organizations that contract with third-party vendors should provide them with compliance training. Vendors may receive waivers from training if they show that their internal training programs are sufficient.
All claims audits should include a clinical review of medical necessity. This criterion is already included in many internal audits, but the 2024 guidance imposes more widespread expectations of this practice.
Previously, only corporate integrity agreements required the tracking of financial arrangements. The updated guidance recommends financial tracking between referral sources and their recipients. Tracking should include proper documentation, assurances of consistency with contractual terms, and assessments conducted at fair market value.
Finally, the updated guidance calls for compliance training that aligns with employees’ specialized roles and job duties. In addition to formal training sessions, organizations should provide more informal means of communicating training topics, such as newsletters and video messages.
Organizational and Infrastructure Issues
Healthcare entities must be mindful of updates that reflect the organizational structure, member composition, and third parties. For instance, personnel and companies entering the healthcare industry for the first time must receive adequate training on all compliance laws regarding fraud, waste, and abuse.
Healthcare investors and boards must understand how their financial arrangements could become factors contributing to non-compliance. They should also be aware of applicable regulations and understand what contributes to effective compliance programs in their organizations.
Finally, organizational size matters when complying with healthcare regulations and understanding what resources are available. Compliance officers and key decision-makers should consult the OIG General Compliance Program Guidance to learn how to adapt their compliance programs according to their entities’ size and infrastructure.
The Support You Need for Evolving Compliance Regulations
Responding to changes in healthcare compliance can be challenging, even for the most experienced compliance officers and leaders. Compliance software from Compliancy Group helps you stay ahead of the curve by alerting you of important regulatory changes. It also provides access to comprehensive training, including advanced courses for continuing education credits and compliance certification. Other benefits of our software include receiving anonymous reports of non-compliance, tracking employee training progress, conducting risk assessments, creating reports for high-level leaders, and delegating or automating tasks.
At Compliancy Group, we understand the necessity of staying on top of evolving industry regulations. Contact us today if you need assistance with the new OIG compliance program guidance or other healthcare compliance issues.
