On April 16, 2008, the Office of the Inspector General (OIG) published its draft 2008 Supplemental Compliance Program Guidelines for Nursing Facilities (the Supplemental Guidelines). These proposed guidelines supplement, rather than replace, the OIG’s 2000 Nursing Facility Compliance Program Guidance (the Original Guidelines). Comments on the Supplemental Guidelines must be submitted to the OIG on or before June 2, 2008. 

The OIG intends for the Original Guidelines and the Supplemental Guidelines to together offer a set of guidelines for nursing facilities and skilled nursing facilities (collectively, NFs) to develop, implement and continually refine their compliance programs. These guidelines are a starting point for reviewing particular practices and for developing compliance policies and procedures to reduce or eliminate potential risks.

For a more detailed discussion of these Supplemental Guidelines, please see the article written by Arent Fox partner Jill Steinberg and associate Marianna Miyazaki, published in the AHLA’s “Health Lawyers Weekly.” The article is available here.

Fraud and Abuse Risk Areas

The primary focus of the Supplemental Guidelines is to detail those fraud and abuse risk areas to which NFs must pay particular attention while drafting their compliance programs.  These areas include:  

• Quality of Patient Care
• Anti-Supplementation
• Submission of Accurate Claims
• Medicare Part D
• The Federal Anti- Kickback Statute
• Health Insurance Portability and Accountability Act (HIPAA)
• Physician Self-Referral Laws

Other Compliance Considerations

In addition to offering detailed discussions of specific liability risk areas, the Supplemental Guidelines discuss how NFs can best maintain a compliance program. The OIG recommends that each facility’s governing body and senior management make a formal commitment to compliance. Similarly, the OIG believes that NFs should actively commit resources and time to creating an organizational culture that “values, and even rewards, the prevention, detection, and resolution of problems.”

How We Can Help

It is imperative for NFs to create and maintain an effective compliance program. NFs should also consider commenting on the Supplemental Guidelines. The proposed guidelines are available here.

If you have any questions about the OIG’s guidelines, compliance programs or nursing facilities generally, please feel free to contact Jill Steinberg or Marianna Miyazaki.