Last week, the Office of the Inspector General (OIG) 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 OIG develops compliance program guidance as “voluntary, nonbinding guidance documents to support health care industry stakeholders in their efforts to self-monitor compliance with applicable laws and program requirements.” The guidance is meant to be used hand-in-hand with OIG’s General Compliance Program Guidance, which applies to all individuals and entities involved in healthcare. The skilled nursing provisions are based on OIG’s ongoing concerns following its work monitoring staffing levels, infection control, emergency preparedness, background checks for employees, reporting of adverse events experienced by residents, inappropriate use of medications and more.
In the Nursing Facility ICPG, the OIG describes:
- Risk areas for nursing facilities
- Recommendations and practical considerations for mitigating those risks
- Other important information the OIG believes nursing facilities should consider when implementing, evaluating, and updating their compliance and quality programs.
In addition, the OIG has outlined 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 in the Nursing Facility ICPG include:
- Quality of Care and Quality of Life
- Medicare and Medicaid Billing Requirements
- Federal Anti-Kickback Statute
- Other Risk Areas including related party transactions, physician self-referral law, anti-supplementation, HIPAA privacy, security breach notification rules, and civil rights
Per the OIG guidance, “There is an enhanced and coordinated effort by OIG, CMS, the Department of Justice and other law enforcement partners to pursue nursing facilities that provide grossly substandard care or subject residents to dangerous or unhealthy living conditions.” “OIG believes that the Nursing Facility ICPG may help nursing facilities proactively detect, assess, and remediate these quality and safety concerns before residents are harmed and before these concerns give rise to an enforcement action.” Mass Senior Care strongly recommends nursing facilities closely review the Nursing Facility ICPG.