decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Hospital Model Compliance Plan / Risk areas / Risk Areas
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Article Overview
This article reviews the hospital compliance risk areas identified by the Office of Inspector General and explains how hospitals are expected to think about fraud-and-abuse exposure across billing, referrals, patient interactions, privacy, and care quality. It also notes related OIG guidance sources that hospitals should consider when building or updating a compliance plan, including special fraud alerts and annual work plan priorities. The content is aimed at hospital compliance, billing, and legal teams seeking a high-level map of the subject areas covered in the full premium article.
Why This Topic Matters
Hospitals need a clear view of OIG-identified compliance risk areas to support internal controls, policy development, and oversight of billing and referral practices. Understanding the broader guidance context helps organizations prioritize review areas and align compliance planning with federal enforcement expectations.
What You Will Learn
- The main hospital compliance risk categories highlighted by OIG
- How OIG-related guidance sources support compliance planning
- Which operational areas hospitals should review when assessing fraud-and-abuse exposure
- Why hospitals should consider additional OIG guidance beyond the core risk areas
Who Should Read This
- Hospital compliance officers
- Hospital coders and billing staff
- Revenue cycle managers
- Health care attorneys
- Risk management professionals
- Administrative leadership
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