As a follow up to the U.S. Health and Human Services (HHS) Office of the Inspector General (OIG) General Compliance Program Guidelines document (GCPG), OIG in late November 2024 published the updated Nursing Facility Industry Segment Specific Compliance Guidelines (Nursing Facility ICPG). This is the first update to the Nursing Facility ICPG since 2008.
The Nursing Facility ICPG describes:
- Risk areas for nursing facilities
- Recommendations and practical considerations for mitigating those risks
- Other important information OIG believes nursing facilities should consider when implementing, evaluating, and updating their compliance and quality programs
The guidelines are voluntary and non-binding, meaning they do not represent a regulatory requirement. The OIG also notes that the guidelines are not one-size fits all and must be tailored to the unique nature of each facility.
In the Nursing Facility ICPG, OIG has paid special attention to four risk areas. Within each risk area, the OIG explains the relevance of the topic, cites the requirements of participation (RoP) or other applicable laws that relate to that topic area, and provides recommendations for mitigating those risks. The four risk areas are:
- Quality of Care and Quality of Life
- Medicare and Medicaid Billing Requirements
- Federal Anti-Kickback Statute
- Other Risk Areas, including related party transactions
In regard to the federal anti-kickback statute risk area, OIG includes a discussion of the statute’s implications in two scenarios: (1) a hospital offers (or a nursing facility solicits) payments to accept a discharged hospital patient; and (2) a hospital offers (or a nursing facility solicits) payments to reserve or hold beds to ensure that the nursing facility has sufficient capacity to accept the hospital’s patients when the hospital needs to discharge patients to the nursing facility.
MSCA members should review the Nursing Facility ICPG with special attention on risk areas that are relevant to their operations.