The federal government’s top watchdog is working on sector-specific guides to assist nursing homes in keeping in compliance with federal regulations. Particular attention will be given to some challenging high-interest areas, officials indicated.
The new guides would build on the success of the General Compliance Program Guidance reference guide released by the US Department of Health and Human Services Office of Inspector General in November, according to Robert Deconti, chief counsel to the inspector general at OIG.
“The GCPG… represents a culmination of what we have learned over the last 30 years and our look to the future,” Deconti said in an address delivered at a Health Care Compliance Association conference Monday. “We have heard from compliance professionals that the practical tips, questions, and scenarios presented in the GCPG are especially useful. The GCPG aims to serve as a tool that compiles many of the applicable rules and guidance in one place, so compliance officials don’t have to spend time hunting for them.”
That resource for healthcare providers and their compliance professionals will be supplemented by upcoming “industry specific CPGs” or ICPGs covering skilled nursing facilities and Medicare Advantage, Deconti told attendees.
Future ‘risk areas’
Like other federal regulators, OIG has increasingly turned its attention to nursing homes in recent years — repeatedly targeting fraud allegations, as well as auditing state survey processes and making suggestions for collaborative efforts on skilled nursing workforce improvements.
Providers may be glad to have an additional resource tailored to the sector if the heightened regulatory environment continues.
Deconti also hinted at two key “risk areas” that OIG thinks will be at the forefront of regulatory efforts in the coming months and years. The first is artificial intelligence.
“I expect that as compliance professionals you are going to be among the very first to spot where the AI has created a program integrity vulnerability, and maybe you will be using your own AI tool to detect it,” Deconti explained. “I anticipate that the compliance department will likely be on the front lines dealing with situations where the provider used AI algorithms to bill for things that did not actually happen, or services that the patient did not need.”
The alleged use of AI in Medicare Advantage coverage denials has already been the cause of a class action lawsuit.
OIG also will be taking a closer look at private equity and its impact on finances in healthcare.
“One of the topics that I have challenged our office to consider is the growing prominence of private equity and other forms of private investment in health care,” Deconti said, “and how this investment raises concerns about the impact of ownership incentives (for example return on investment) and how those incentives may affect the delivery of high quality, efficient health care that is in the patient’s best interests and that is accurately billed to the federal government.”
