BC Advantage - 2019 Issue 12
OIG Compliance 101 - Ensuring the Next Generation is Prepared
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Article Overview
This article explains why OIG compliance is a required part of participation in federal health care programs and outlines the major components of an effective compliance program. It is written for health care providers, compliance staff, auditors, and practice leaders who want a broad understanding of compliance program structure, risk awareness, training, monitoring, and corrective response processes. The article also discusses general fraud-and-abuse risk areas, organizational culture, and the role of outside compliance support.
Why This Topic Matters
Compliance programs are a core operational safeguard for health care organizations participating in federal programs. Understanding the broad framework helps organizations assess readiness, strengthen internal controls, and support ongoing compliance efforts.
Article Sections
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Introductory overview
Introduces the topic of compliance readiness and the importance of preparing new health care professionals for organizational responsibilities.
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Federal compliance framework and guidance
Summarizes the federal compliance context, including the authority for required programs and the general guidance referenced by the article.
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The Seven Fundamental Elements of an Effective Compliance Program
Reviews the major components of an effective compliance program and the organizational practices associated with each element.
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Risk assessment as an additional element
Discusses the role of risk assessment in tailoring a compliance program and keeping it aligned with business circumstances.
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Five Practical Tips for Creating A Culture of Compliance
Presents practical organizational themes related to compliance culture, risk awareness, financial relationships, and when to seek assistance.
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What to do next
Provides contact and service information for readers seeking compliance support or related assistance.
What You Will Learn
- How federal health care compliance requirements are framed at a high level
- The major elements commonly associated with an effective compliance program
- Why training, communication, monitoring, and corrective action matter in compliance operations
- How risk assessment supports compliance program design and maintenance
- General categories of fraud-and-abuse risk areas discussed in compliance education
- Why organizational culture and support resources are important for compliance efforts
Who Should Read This
- Health care providers
- Compliance officers
- Practice managers
- Auditors
- Billing and coding professionals
- Health care administrators
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