Thursday, January 27, 2005

OIG Issues Supplemental Program Compliance Guidance for Hospitals

Today the Office of Inspector General (OIG) of the Department of Health and Human Services issued "Supplemental Program Complaince Guidance for Hosptials". This supplemental guidance follows up on (and does not replace) the OIG's original Febuary 23, 1998 Compliance Program Guidance for the hospital industry.

The OIG issued a press release today announcing the updated voluntary compliance program guidance for hospitals to promote compliance with the rules and regulations for participation in Medicare and other Federal health care programs. The document will be on display at the Federal Register today and published on January 31, 2005.

Following is a excerpt from the preface to the supplemental guidance providing background on the OIG's position for issuing the supplemental guidance:

Continuing its efforts to promote voluntary compliance programs for the health care industry, the Office of Inspector General (OIG) of the Department of Health and Human Services (the Department) publishes this Supplemental Compliance Program Guidance (CPG) for Hospitals. This document supplements, rather than replaces, the OIG’s 1998 CPG for the hospital industry (63 FR 8987; February 23, 1998), which addressed the fundamentals of establishing an effective compliance program. Neither this supplemental CPG, nor the original 1998 CPG, is a model compliance program. Rather, collectively the two documents offer a set of guidelines that hospitals should consider when developing and implementing a new compliance program or evaluating an existing one.

We are mindful that many hospitals have already devoted substantial time and resources to compliance efforts. We believe that those efforts demonstrate the industry’s good faith commitment to ensuring and promoting integrity. For those hospitals with existing compliance programs, this document may serve as a benchmark or comparison against which to measure ongoing efforts and as a roadmap for updating or refining their compliance plans.

In crafting this supplemental CPG, we considered, among other things, the public comments received in response to the solicitation notice published in the Federal Register and the draft supplemental CPG,4 as well as relevant OIG and Centers for Medicare & Medicaid Services (CMS) statutory and regulatory authorities (including the Federal anti-kickback statute, together with the safe harbor regulations and preambles, and CMS transmittals and program memoranda); other OIG guidance (such as OIG advisory opinions, special fraud alerts, bulletins, and other guidance); experience gained from investigations conducted by the OIG’s Office of Investigations, the Department of Justice (DoJ), and the State Medicaid Fraud Units; and relevant reports issued by the OIG’s Office of Audit Services and Office of Evaluation and Inspections. We also consulted generally with CMS, the Department’s Office for Civil Rights, and DoJ.

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