At least 25% of spending in the healthcare industry is considered wasteful, and financial losses experienced across the industry consistently amount to tens of billions of dollars annually. These are just some of the things that OIG compliance guidelines help prevent.
Since 1976, the Office of Inspector General (OIG) has helped healthcare organizations prevent and fight against fraud, waste, and abuse. Operating under the Department of Health & Human Services (HHS), the OIG is essential for ensuring efficiency across multiple programs like Medicare and Medicaid.
With an OIG compliance program playing a central role in an organization’s structure, these businesses have a better leg up on risk identification and mitigation, waste reduction, and fraud prevention.
Why OIG Compliance Programs Are Essential
OIG compliance programs aren’t just meant to be seen as regulatory checkboxes; they are a suite of strategic guidelines and frameworks for healthcare organizations. This type of program serves as a proactive measure for more accountability within healthcare institutions.
Specifically, OIG compliance program guidelines directly link healthcare practices to patient safety and the quality of the practice itself. These things are often handled separately when, in reality, they should be connected to your compliance initiatives. This means that patient safety and quality, along with compliance management and maintenance, should all be included within the structure of your compliance program.
Organizations mitigate the risk of legal repercussions while upholding ethical standards in patient care delivery by adhering to OIG compliance guidelines and using a solution such as an OIG compliance plan template.
Considering the Impact an OIG Compliance Program Has on Business Operations
Consider the different areas of compliance that your organization needs to track consistently. The OIG has explicitly identified four higher-risk areas that physicians and employees of their practice(s) should be more familiar with, which are as follows.
- Coding and Billing
- Kickbacks and Self-Referrals
- Necessary Services
- Documentation and Improper Incentives
While there are additional areas of risk, these are the four primary areas that the OIG has identified as having the highest opportunity of vulnerability for physicians. Non-compliance can expose organizations to legal liabilities, cause reputational damages, and even jeopardize the practice’s financial health.
Maintaining compliance is a key way to mitigate potential liability within your practice, and it’s simpler when using designated software to help assess the health and status of your work plans. Overall, the impact compliance maintenance will have on your operations will consist of an enhancement in your market competitiveness, higher confidence in regulatory upkeep, and make training more efficient.
Where the Difficulty with OIG Compliance Derives
HHS OIG compliance program guidance is meant to help over 100 Health and Human Services programs become more efficient. While the goal of the OIG is efficiency, many healthcare companies encounter challenges in achieving and maintaining efficiency within their own compliance plans. From making these plans a priority to outlining your abuse risk areas, there is a lot of room for businesses to become overwhelmed.
Businesses run into a few common hurdles in terms of OIG compliance:
- The complexity of regulatory environments
- Lack of understanding of how to develop and outline training for employees
- Lack of understanding of how to properly assess your compliance status
Using an OIG compliance plan template is one of the most common solutions to help overcome these hurdles.
Simplifying OIG Compliance Tracking
Overcoming the challenges associated with OIG compliance requires a multifaceted approach that not only satisfies training needs but also risk mitigation strategies. This means finding a way to combine strategic planning, documentation automation, and resource allocation. By leveraging OIG compliance plan templates as a standard in your compliance program framework, you can expect less chance of error or overlooking certain opportunities for enhanced safety and a more efficient approach to policy.
