Compliance Guidance, Part II: Opportunity to Provide Feedback

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On February 21, 2024, the Office of the Inspector General (OIG) announced that it anticipates that the first two industry segment-specific compliance program guidance publications will likely be coming out in 2024 and will address Medicare Advantage and nursing facilities. The OIG further announced that it will address hospitals and clinical laboratories in the next round. In this short announcement, the OIG invited industry participants to provide feedback prior to the publications by emailing the OIG directly at Compliance@oig.hhs.gov.   This request for feedback can be analogized to comments being provided for a proposed rule in the Federal Register and should be utilized by industry stakeholders desiring input.

For hospitals, labs and nursing facilities, if there is a particular issue (whether in existing OIG guidance or from a prior advisory opinion, etc.) that gives you concern, we recommend providing feedback.  The last time the OIG released comprehensive compliance guidance for nursing facilities was in September 2008, and the last time it issued comprehensive guidance for hospitals was in 2005. The last time the OIG issued comprehensive guidance for laboratories was in 1998.  Obviously, the industry has changed dramatically since those comprehensive publications were issued.

It is also of note that the OIG has designated oversight of managed care as a priority area for 2024. Given that 54% of Medicare enrollees received care through Medicare Advantage plans in 2023,¹ OIG has developed a strategy to align its audits, evaluations, investigations, and enforcement of managed care. The three primary goals are:

1. promote access to care for people enrolled in managed care;
2. provide comprehensive financial oversight; and
3. promote data accuracy and encourage data-driven decisions.  

We recommend review of the Managed Care Strategic Plan, released in August 2023, and for industry participants to consider providing feedback to the OIG.

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