decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Managed Care Model Compliance Plan / Using OIG's Managed Care Model Compliance Plan
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Article Overview
This article covers the Office of Inspector General’s model compliance plan guidance for managed care plans and explains the scope, limitations, and intended use of that guidance. It is relevant to compliance officers, managed care administrators, legal counsel, and program integrity professionals who need a high-level understanding of how OIG frames compliance planning for health plans. The article emphasizes that organizations should tailor compliance efforts to their own risk areas, resources, and operating structures, while considering broader federal and state requirements and related OIG materials.
Why This Topic Matters
Managed care organizations need to understand that OIG’s model is guidance, not a standalone compliance program, and that compliance planning must be adapted to each plan’s circumstances. This matters for governance, internal controls, and program integrity efforts across Medicare managed care environments.
What You Will Learn
- The purpose and status of OIG’s managed care model compliance plan
- How the guidance should be viewed relative to a plan’s own compliance program
- Why managed care plans must tailor compliance efforts to their organization
- What kinds of external OIG materials may inform compliance planning
- Why legal counsel and ongoing updates matter for compliance program development
Who Should Read This
- Managed care plans
- Compliance officers
- Health plan administrators
- Healthcare attorneys
- Program integrity professionals
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