The Department of Health and Human Services Office of Inspector General (OIG) recently announced changes to its process for informing healthcare industry stakeholders of new or updated Compliance Program Guidance (CPG). Historically, sector-specific CPG has been published in the Federal Register. Going forward, the OIG will publish all current and updated CPG on its website.

Since 1998, the OIG has published CPG in connection with specific health care sectors, including hospitals; home health agencies; clinical laboratories; third-party billing companies; DMEPO suppliers; hospice providers; Medicare managed care organizations; skilled nursing facilities; ambulance suppliers; pharmaceutical manufacturers; and individual and small group physician offices. Healthcare industry stakeholders are encouraged to incorporate the OIG’s CPG into the implementation and operation of their compliance programs.

New Format for OIG’s CPG

Future CPG will be published directly on the OIG’s website, and will be presented in two formats:

  1. General CPG (GCPG): Guidance that is applicable to all healthcare industry stakeholders, addressing topics such as federal fraud and abuse laws, the operation of effective compliance programs, and OIG resources; and
  2. Industry-Specific CPGs (ICPGs): Guidance for providers, suppliers, and other participants in certain healthcare subsectors and ancillary service sectors, addressing relevant fraud and abuse risks.

When to Expect New CPG

The OIG expects to issue updated GCPG by the end of calendar year 2023. ICPGs are expected to be published in 2024, and the OIG has announced the first two likely ICPGs will be for Medicare Advantage plans and skilled nursing facilities.

Healthcare industry stakeholders are encouraged to sign up for the OIG’s listserv to receive timely updates about new or updated CPG documents once they are published. If you have any questions about OIG’s current CPG and how it affects your organization’s compliance program, the Healthcare Team at Sheppard Mullin is available to assist.