Compliance 101: OIG Steps in to Help Health Providers Avoid Confusion

Are you a small health care provider without a place to turn for help with compliance issues? Is a lack of funding preventing you from seeking help with your questions? OIG is making it easier than ever for health care providers, practitioners, and suppliers to understand the dos and don’ts of a complicated health care system. On March 5, 2012, OIG launched it’s website “Compliance 101” where providers and suppliers can easily find basic guidance, which is categorized and contains various links to helpful spots on the OIG website where guidance documents can be found.

There’s a “Compliance Program Guidance” section that links to documents that provide principles to follow when developing a compliance program that will best suit the needs of a health care organization.  Fraud and abuse risks are identified so that providers can better watch out for them when creating a program. This series of voluntary compliance program guidance documents is directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, with the hopes of encouraging the development and use of internal controls to monitor adherence to statutes, regulations, and program requirements.

Videos and audio podcasts are linked on the website that offer provider compliance training. This part of the site was originally part of an outreach initiative that was developed as part of HHS’ and the U.S. Department of Justice’s Health Care Fraud Prevention and Enforcement Action team. Members of this team provide educational presentations on topics such as “A Toolkit for Health Care Boards” and “OIGs Self-Disclosure Protocol” which are designed to prevent fraud, waste and abuse.

Also included among the podcasts is a presentation by Inspector General Daniel Levinson, which is from the 2011 Health Care Compliance Institute Keynote address. In his address, Levinson provides some fundamental questions that Compliance professionals should be asking. “Are you prepared to operate in a more transparent health care system?” “Are you focused on quality as a compliance issue?” “Is your organization prepared for greater accountability?” Questions like this give providers an excellent starting point to gain perspective on their individual needs.

Physicians can find educational materials on the site that will specifically help them learn about the Federal laws designed to protect Medicare and Medicaid and program beneficiaries from fraud, waste and abuse.  OIG has included a link to it’s pamphlet, “A Road Map for New Physicians” that would be helpful to any physician. The materials included on this site summarize the five main Federal fraud and abuse laws (the False Claims Act, the Anti-Kickback Statute, the Stark Law, the Exclusion Statute, and the Civil Monetary Penalties Law) and provides tips on how physicians should comply with these laws in their relationships with payers (e.g., the Medicare and Medicaid programs), vendors (e.g., drug, biologic, and medical device companies), and fellow providers (e.g., hospitals, nursing homes, and physician colleagues).

Compliance 101 is an excellent starting point for a compliance professional and certainly a great place for smaller providers who lack the resources or team of trained professionals. For an excellent account of what to do if you are in this predicament, Wolters Kluwer’s Susan Smith has a great post on “How to Have a Compliance and Ethics Program for $1 a Day.” As she notes in her article, an effective compliance program may not be about spending money, but about management’s commitment.