OIG Publishes Voluntary Supplemental Compliance Program Guidance for Nursing Facilities

  1. Home
  2. News & Insights
  3. OIG Publishes Voluntary Supplemental Compliance Program Guidance for Nursing Facilities

On September 30, 2008, the United States Department of Health and Human Services, Office of the Inspector General (the “OIG”) published OIG Supplemental Compliance Program Guidance for Nursing Facilities (the "2008 Guidance"). The 2008 Guidance supplements the OIG's 2000 Compliance Program Guidance for Nursing Facilities (the "2000 Guidance") and will help nursing facilities develop compliance programs that address major Medicare and Medicaid fraud and abuse problems related to poor quality of care, billing federal health care programs and kickbacks.

Contained in the 2008 Guidance are new compliance recommendations and an expanded discussion of fraud and abuse risk areas present in a nursing facility environment. Five main categories of risk areas are highlighted in the 2008 Guidance, including quality of care, submission of accurate claims, the Federal Anti-Kickback statute, "other" risk areas, and HIPAA privacy and security rules.

Apparent in the 2008 Guidance is the OIG's increased enforcement focus on relationships between nursing homes and their referral sources, such as hospices. The Guidance, for example, includes a list of questions for a nursing home to ask itself when identifying potential kickback risks. The Guidance also contains a list of "potentially aggravating considerations" for a nursing home to look for when trying to determine arrangements at greatest risk of prosecution, such as whether the arrangement has a "potential to interfere with, or skew, clinical decision-making.”

The OIG indicated that the Guidance provides "voluntary guidelines to assist nursing facilities in identifying significant risk areas and in evaluating and, as necessary, refining ongoing compliance efforts." According to the Guidance:

A successful compliance program addresses the public and private sectorsʼ common goals of reducing fraud and abuse, enhancing health care providersʼ operations, improving quality of health care services, and reducing their overall cost. Meeting these goals benefits the nursing facility industry, the Government, and residents alike.

The Guidance will help compliance professionals address areas such as staffing, resident care plans, medication management, appropriate use of psychotropic medications, resident safety and self reporting. Discussed within the Guidance is the importance of submitting accurate claims and issues related to reporting resident case-mix data, therapy services, screening for excluded individuals and entities, and restorative and personal care services.

The Guidance, in conjunction with the 2000 Guidance, offers insight into those areas the OIG considers to be of high concern. Nursing homes should update existing compliance programs based on the information contained in these documents.

For more information or individualized consultation regarding drafting an initial compliance plan or updating and implementing your existing compliance programs, please contact a member of the Reinhart Health Care Practice.


Related Practices