The medical industry is a deeply complex and complicated machine. There are so many facets to medical care that it requires many levels of proper procedure and policy, one of which includes OIG compliance.
While caring for patients is the number one priority, it is also essential to make sure that care is provided in a professional and legal manner.
If you are working in management at a Hospital, or even running a medical facility yourself, there are many hoops to jump through to ensure your compliance with OIG.
In this article, you will receive a simple breakdown of some of the key points surrounding OIG compliance. It may be complicated, but it’s something that each and every medical professional must be aware of and stick to rigorously.
Who is the OIG?
OIG is a generic name given to the Office of Inspector General. This title is applied in many industries and is the name given to the oversight department of any given federal or state agency.
The aim of the OIG in each industry is to prevent illegal, inefficient or unethical practices from taking place.
In essence, no matter which federally regulated industry you are working in, there will be an OIG to answer to. OIG in healthcare is based within the DHSS, the Department of Health and Social Services.
They work to make sure no medical malpractice is taking place, while meticulously investigating anyone who may be acting unlawfully within the field of medicine.
What is OIG Compliance All About?
What, then, is OIG compliance exactly? Since the introduction of the Patient Protection and Affordable Care Act in 2010, OIG compliance for hospitals became a mandatory part of the healthcare business.
Before this, it was a recommended compliance, but now it is mandatory. This act, known colloquially as Obamacare, introduced more affordable healthcare and free healthcare to every citizen.
Along with this came a need to fiscally regulate all medical professionals, healthcare providers, and third-party medical manufacturing companies. The OIG demand that these parties all keep accurate records, financial reports, and more, to stop illegal sales, improper care, or illegal profits being made through healthcare.
Does OIG Compliance Affect Your Hospital?
The short answer here is yes. All medical professionals must be OIG compliant, from dentist surgeries to hospitals, doctor’s offices to nursing homes. Effectively, anyone who bills or charges for Medicare or Medicaid must be regulated by the OIG.
The OIG wants to be sure that any charges back to the government are legal, necessary, and proper, while no one is fraudulently charging for any of these services.
However, it is important to note that even private healthcare professionals who do not bill for government-subsidized care still have a level of OIG compliance to adhere to.
They still have to declare OIG compliant billing and patient care documents at a federal level, so not even private companies are immune to OIG compliance.
Appoint an OIG Compliance Officer
The first thing your organization needs to do is to appoint an OIG compliance officer to run this program. It is essential that a team is created to actively create, audit, monitor, and constantly update OIG compliance policies within your organization.
This is no small task, so you need to make sure you have someone very organized and meticulous doing this job. Any mistakes can lead to huge financial punishments for your organization and, in the case where someone deliberately defrauds Medicare or Medicaid, criminal charges could be brought.
Hire Specialist Attorneys
If this is all a lot for you to manage, there is always the option of externally hiring a team of attorneys and auditors to help. Many organizations choose this route, as having a third party looking over your paperwork with a fresh, unbiased eye can help examine everything a little deeper.
Not only can they audit your previous work and help you find any gaps or mistakes, but they can also help write or rewrite your policies from the ground up.
Write Detailed Policies and Procedures
To be fully OIG compliant, your hospital needs to write detailed policies and procedures covering all the necessary and required aspects. This does not mean simply borrowing a policy book from elsewhere, it means developing a fully customized rulebook for your own business.
While having a standard starting point for most hospitals is reasonable, each business is run differently, so your policies must reflect the unique working nature of your hospital.
When writing your policies there are a few things that must be included, and a few records that must be kept. Some of the most important ones are as follows:
Coding and Billing
One of the main OIG issues is proper coding and billing. This is because one of their main aims is to ensure that no Medicaid or medicare money is being fraudulently claimed or spent by medical professionals.
Your coding and billing team must work effectively, efficiently, and legally, whilst having strict auditing procedures in place to make sure that no one is cheating the system.
“Medical Necessity”
One of the other ways people try to fraudulently make money out of medical insurance is by ordering procedures, tests, or medicines that are not necessary for a patient’s treatment, thus getting some sort of financial kickback from whoever they order from.
This is, quite rightly, illegal, and will be quickly picked up by an OIG compliance officer. Ensure your hospital’s staff are keeping documents proving which treatments were a “medical necessity” so that no illegal ordering or selling of medical property can take place.
Patient Record-Keeping
On the patient care side of things, record-keeping is key. Any lost, misplaced, or poorly documented patient care records can cause issues legally and with the patient’s care. For this reason, OIG compliance requires a strict policy surrounding patient documents and record-keeping.
Though this is not everything covered by the OIG rules, it’s the basic start that you need to have in place at the very least. Hire professionals, build your teams, and train your entire staff base on how they need to be OIG compliant.
Only then can you relax in the knowledge that you are doing everything you can to prevent fraud and promote proper patient care.
If you are a health care provider yourself, you can do a little research and read more online to learn about the preventative methods and precautions the training covers.
