The OIG Plans to Remodel Compliance Guidance ProgramsThe HHS Office of Inspector General’s (OIG) announced on April 25th that after nearly 23 years, the compliance guidelines for individual and small group physician practices will undergo a major overhaul. The first round of the upgrades could be rolled out by the end of 2023, according to the Federal Register notice “Modernization of Compliance Program Guidance Documents.” The planned revisions are part of the agency’s overarching modernization plan.

The revision project will begin with the general compliance program guidance (GCPG) that can be used by any person or organization involved in the health care industry. The GCPG will address topics such as:

  • federal fraud and abuse laws,
  • compliance program basics,
  • operating effective compliance programs, and
  • OIG processes and resources.

The OIG plans to publish the GCPG by the end of calendar year 2023. Industry-specific guidance will follow in 2024.

The OIG has indicated it will create individual guidelines “for different types of providers, suppliers, and other participants in health care industry subsectors or ancillary industry sectors relating to federal health care programs.” The agency currently anticipates that the first industry-specific guidelines will address Medicare Advantage and nursing facilities.

The OIG also made it clear that the voluntary compliance guidelines will remain voluntary. The goal has been, and will continue to be, to create a voluntary set of guidelines and identified risk areas that the OIG believes individuals and entities engaged in the health care industry should consider when developing a new compliance program or evaluating an existing one.

RT Welter specializes in assisting practices in developing, reviewing and updating their compliance programs. We will be tracking the OIG planned revisions as they are announced and will be able to help clients navigate the changes and develop strong and efficient compliance programs that align with new guidance.