Medicare Compliance & Reimbursement

Understand what the OIG expects from healthcare governing boards.

You need to regularly analyze compliance concerns and evaluate your company’s compliance program. That’s the word from the HHS Office of Inspector General (OIG) which spells out exactly what it expects from your organization in its Practical Guidance for Health Care Governing Boards on Compliance Oversight, a joint guidance document developed with the American Health Lawyers Association, the Association of Healthcare Internal Auditors, and the Health Care Compliance Association.

Published in the April 20 Federal Register, the OIG’s guidance is specifically targeted for healthcare governing boards to understand what the OIG expects of them as they oversee their organization’s regulatory compliance.

Thankfully, the OIG followed up the lengthy 200-page Federal Register publication with a nicely condensed, 15-page document providing the basic information that boards need, according to Michael Gennett, a Miami-based healthcare attorney and partner with Akerman LLP.

Good news: “For compliance professionals, there’s nothing new here,” Gennett says regarding the document.” The guidance identifies the usual primary areas of concern: appropriate billing, evaluating referral relationships, determining whether the organization is billing for medically unnecessary services or services not provided at all, and privacy concerns.”

Does Your Organization Have a Focus on Compliance?

Still, the OIG’s guide is worth paying close attention to. “The guidance comes at a time when the OIG is beginning to scrutinize boards and their members who are not taking an active role in identifying compliance issues, or who are not actively evaluating the effectiveness of the organization’s compliance program and the people involved,” Gennett points out. And the guidance does emphasize the board’s role in establishing a culture of compliance in a healthcare organization.

The guidance is also a weighty reminder for healthcare organizations that analyzing compliance concerns and evaluating the company’s compliance program is a function that they should perform regularly, not just when there’s a problem, Gennett notes. ‘Boards are responsible for assuring that staff within the organization or outside compliance consultants are staying abreast of changes in reimbursement and licensing requirements, and communicating those requirements throughout the organization.”

The guide focuses on four areas:

1. Roles of, and relationships between, the organization’s audit, compliance, and legal departments;

2. Mechanism and process for issue-reporting within an organization;

3. Approach to identifying regulatory risk; and

4. Methods of encouraging enterprise-wide accountability for achievement of compliance goals and objectives.

Note: The condensed document, “Practical Guidance for Health Care Governing Boards on Compliance Oversight,” is available at oig.hhs.gov/compliance/compliance-guidance/docs/Practical-Guidance-for-Health-Care-Boards-on-Compliance-Oversight.pdf.