When people in healthcare talk about federal compliance requirements they are often referencing “the OIG”, and they mean Office of Inspector General of the U.S. Department of Health & Human Services. The OIG is the regulatory body tasked with fighting waste, fraud, and abuse in health programs funded and administered by the Federal government (including Medicare, Medicaid and TriCare). The OIG investigates and prosecutes those it perceives to be acting outside the bounds of law (outside of federal compliance requirements) in order to be paid by and therefore benefit from Federal government programs. During 2017, the OIG won or negotiated over $2.4 billion in health care fraud judgments and settlements, not including State Medicaid monies recovered as part of any joint Federal/State effort. Be it as a physician in private practice, an addiction treatment center operator or a home health agency owner, every healthcare business should be familiar with the OIG and its role as the police of healthcare. Click here to learn more about the OIG.
Of course, the OIG wouldn’t have much to do unless there were federal compliance requirements in place to police. Providers, at a minimum, can not only be aware of the need for meeting regulatory compliance standards, but must also have compliance plans in place that address all of the OIG elements. On the shelf “canned” compliance plans open both business owners and even business employees up to criminal penalties when they aren’t effectively used. So, providers must not only be aware of but also have compliance plans and they must use the compliance plans they have in place. Clearly, federal compliance requirements are many, and healthcare businesses and providers have an enormous burden to address in order to stay off the radar off the OIG.