OIG has developed a series of voluntary compliance program guidance documents directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal controls to monitor adherence to ...
What is OIG compliance?
OIG compliance programs provide oversight toward promoting ethical and lawful corporate conduct that focus on encouraging prevention, detection and resolution of occurrences of conduct that do not meet federal and state law, and a hospital or health system’s business policies.
What OIG means?
DHS Office of Inspector General (OIG) is an independent and objective audit, inspection, and investigative body. While part of the Department of Homeland Security, the OIG is also independent of the Department.
What does the OIG focus on?
OIG is focused on promoting the economy, efficiency, and effectiveness of Affordable Care Act (ACA) programs across HHS . We are conducting reviews of the health insurance marketplaces and related programs, as well as reviews of other health reform programs in Medicare, Medicaid, and the public health programs.
What is the OIG in healthcare?
Since its 1976 establishment, the Office of Inspector General (OIG) has been at the forefront of the Nation’s efforts to fight waste, fraud and abuse and to improving the efficiency of Medicare, Medicaid and more than 100 other Department of Health & Human Services (HHS) programs.
How does OIG investigate?
OIG initiates investigations based on information received from a variety of sources , including: OIG’s fraud, waste and abuse hotline; Departmental, GAO, and DOJ referrals; Congressional requests; and referrals from OSC regarding whistleblower disclosures.
What is the OIG report?
OIG reports contain findings of its audits and evaluations , assess how well HHS programs and grantees/contractors are working, identify risks to the people they serve and to taxpayers, and recommend necessary improvements.
What five 5 factors must a compliance plan include?
- Leadership.
- Risk Assessment.
- Standards and Controls.
- Training and Communications.
- Oversight.
What are the 7 elements of a compliance program?
- Implementing written policies, procedures, and standards of conduct.
- Designating a compliance officer and compliance committee.
- Conducting effective training and education.
- Developing effective lines of communication.
- Conducting internal monitoring and auditing.
What is healthcare regulation compliance?
Healthcare compliance is the process of following rules, regulations, and laws that relate to healthcare practices . Compliance in healthcare can cover a wide variety of practices and observe internal and external rules.
Is OIG required?
The OIG is required by law to exclude from participation in all federal healthcare programs individuals and entities on a number of grounds . Mandatory exclusions can be imposed for the following reasons: Conviction of program-related crimes.
How do I get an OIG check?
Therefore, to stay current on excluded individuals and entities, providers need to screen their workforce members and vendors on a monthly basis. Checking the LEIE can be done by using the OIG portal or by downloading the LEIE database to perform an OIG check or OIG search.
How do I become a OIG investigator?
All 1811s are required to complete basic criminal investigator training at the Federal Law Enforcement Training Center . Thereafter, agents are subject to annual physical fitness assessments, medical evaluations, and related skill certifications.
How does the OIG work?
OIG carries out its mission to protect the integrity of HHS programs and the health and welfare of the people served by those programs through a nationwide network of audits, investigations, and evaluations, as well as outreach, compliance, and educational activities.
What is a Medicare OIG audit?
Federal Audits
Under this authority, OIG conducts audits of internal CMS activities , as well as activities performed by CMS grantees and contractors. These audits are intended to provide independent assessments of CMS programs and operations and to help promote economy and efficiency.
Why is the OIG Work Plan important?
The OIG Work Plan thus outlines the federal government’s perspective and expectations of upcoming major management and performance challenges and can therefore become an important resource and reference for healthcare compliance programs.
