On April 24, 2023, the OIG formally announced that it will be modernizing its existing Compliance Program Guidance (“CPG”).
The OIG has provided a CPG for various industry subsections since 1998. Each CPG was developed in an effort to set forth voluntary compliance standards to be utilized in identifying and preventing fraud and abuse in federal health care programs. In September 2021, the OIG published a request for information (“RFI”), wherein OIG requested insight on how providers use CPG and what improvements could be made to provide more relevant and accessible guidance.
Providers and other industry representatives made recommendations including, but not limited to, creating industry-specific guidance, consolidating existing CPG, enabling user-friendly access to CPG, and ensuring ongoing updates to identify the OIG’s current positions on new and emerging risks in health care.
In response to its review of the comments provided from the RFI, OIG is announcing the following updates:
First, the OIG will no longer publish updated or new CPG in the Federal Register. All current, updated, and/or new CPG will instead be available on a specific section of the OIG website dedicated to compliance guidance.
- Second, the OIG will begin to publish CPG in a different format than it has previously. Beginning by the end of 2023, the guidance will be published in two distinct categories: By the end of 2023, OIG will publish a general CPG that will apply to all individuals and entities in the health care industry. This general CPG will include compliance program basics and general OIG processes and resources.
- Starting in 2024, the OIG will publish industry-specific CPGs for the various types of providers, suppliers, and other participants in the health care industry. These industry-specific CPGs (“ICPGs”) will be designed to provide guidance in relation to the fraud and abuse risk areas for each industry subsector. OIG notes that it intends to start with ICPGs for nursing facilities and Medicare Advantage.
For now, the existing CPGs will continue to serve as the OIG’s formal guidance to the applicable industry subsections. The existing CPGs can be found on the OIG’s compliance website.
Reed Smith will continue to monitor for updates from OIG regarding compliance guidance. If you have any questions about this or any other compliance-related issues, please do not hesitate to reach out to the author of this post or to the health care attorneys at Reed Smith.