Field Report: OIG Compliance Program Effectiveness Guide

Indeed, it was another “Dantastic” Monday as Inspector General Dan Levinson took the podium to deliver the keynote at the 21^st Annual Compliance Institute in National Harbor, Maryland. 

Dan opened with the discussion of a January Health Care Compliance Association (HCCA) U.S. Department of Health and Human Services Office of Inspector General (HHS/OIG) roundtable meeting of a “horizontal collection of expertise to help come up with a very valuable product”.   

The document was created as a result of the discussion at the January 17, 2017 meeting: “Measuring Compliance Program Effectiveness”.  The Guide contains 500 tips and resources for compliance professionals to work with in establishing the effectiveness of a compliance program. 

The seven divisions of the Guide are based on the seven compliance program elements of an effective compliance program:

1. Standards, Policies, and Procedures
2. Compliance Program Administration
3. Screening and Evaluation of Employees, Physicians, Vendors and other Agents  
4. Communication, Education, and Training on Compliance Issues 
5. Monitoring, Auditing, and Internal Reporting Systems 
6. Discipline for Non‐Compliance
7. Investigations and Remedial Measures

Compliance professionals are encouraged to target the element of the guide to their professional need in their organization and to “keep in mind the importance of incremental gain”.   

Also noted during the keynote was the OIG’s attention to key problem areas including prescription drug abuse, home health services and Medicaid program integrity. 

Home health services were described as “part of the new landscape in healthcare”.  Monitor Monday listeners have been regularly updated on the Illinois pre-claim demonstration (currently halted) and the pending implementation in Florida (currently on hold).  The reason for the pre-claim review demonstration is in part to stem the rampant fraud and abuse in the submission of claims for home health services. 

Dan mentioned a False Claims Act (FCA) case of $375 million wherein a physician in Texas was taking advantage of the home health benefit to submit false claims.

Medicaid program integrity, according to Dan’s comments, is “becoming more opaque” in that more Medicaid programs are moving to managed care and it becoming more difficult to ensure that tax payor dollars are used appropriately. For example, are providers qualified? Is the population being service appropriately?  A key area of concern is the personal care services area, wherein Dan cited a case that an attendant failed to watch the Medicaid beneficiary and the beneficiary “turned up dead”.  He referred attendees to the OIG Advisory on attendant services.

Dan closed his remarks by commenting on the significant OIG “cover” at the Compliance Institute operating in the themes of prevention, detection and enforcement.   

    Inspector General Dan Levinson