New OIG General Compliance Program Guidance – Effective November 6, 2023

Changes to Existing Healthcare Compliance Program Guidance

On November 6, 2023, the Office of Inspector General (OIG) released changes to the existing healthcare compliance program guidance previously issued. The new guidance is voluntary and serves as a guide for organizations to help establish and implement their compliance programs. Moreover, it reflects the OIG’s current perspective and approach to combatting fraud and abuse in the healthcare industry.

The General Compliance Program Guidance (GCPG) document addresses:

1. Healthcare Enforcement
2. Compliance Program Infrastructure
3. Compliance Program Adaptations for Small and Large Entities
4. Other Compliance Considerations, such as risk areas that may not be within the scope of a healthcare company’s compliance program. The GCPG also makes more readily accessible OIG resources (e.g., advisory opinions, special fraud alerts, OIG reports, and publications) and processes for FAQs and providing informal feedback on various topics.  

Compliance Program Adaptations for Small and Large Entities

With regard to Compliance Program Adaptations for Small and Large Entities, the OIG acknowledges the ability to “right-size” a compliance program based on the size and type of healthcare organization and offers flexibility for small businesses to adapt their compliance programs. More specifically, the OIG includes guidance on how smaller organizations with limited resources, such as small physician practices, can incorporate an effective compliance program that meets all the seven elements of a compliance program. 

This guidance includes:

1. Remedies for having a compliance contact
2. Tackling policies, procedures and training
3. Having a mechanism(s) for reporting compliance concerns that is appropriate for the company size
4. Processes for conducting risk assessments
5. Auditing and monitoring
6. Enforcing standards
7. Procedures for responding to violations and other noncompliance

For larger companies, the OIG makes recommendations for developing and monitoring a compliance program that is conducive to the needs of a larger organization. The recommendations highlight the role of the compliance officer, compliance personnel, and Compliance Committee, as well as Board oversight. 

Click here to view and download the complete OIG General Compliance Program document.  

Questions or feedback on the General Compliance Program Guidance may be submitted to compliance@oig.hhs.gov.