HHS OIG issues guidance to enhance standards in nursing facilities

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released the Nursing Facility Industry Segment-Specific Compliance Program Guidance (ICPG). The guidance provides voluntary recommendations aimed at helping nursing facilities boost compliance, reduce risks, and improve the quality of care for residents.

What happened

On November 20, 2024, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released the Nursing Facility Industry Segment-Specific Compliance Program Guidance (Nursing Facility ICPG). This new document offers voluntary, nonbinding recommendations to help nursing facilities develop tailored compliance programs. It builds upon the OIG’s previous General Compliance Program Guidance (GCPG) issued in November 2023, which outlined general compliance strategies for the healthcare sector. 

Going deeper

The Nursing Facility ICPG addresses critical compliance risk areas specific to nursing facilities, focusing on these institutions' operational challenges. These risks include:

• Quality of care and quality of life: Adequate staffing, detailed resident care plans, and proper medication management are essential. Deficiencies could lead to violations of federal regulations, submission of false claims, and actions under the False Claims Act.
• Medicare and Medicaid billing requirements: Facilities are urged to adhere to billing protocols, conduct audits, and ensure accurate documentation, particularly under the Prospective Payment System (PPS).
• Federal Anti-Kickback Statute (AKS): Nursing facilities must scrutinize arrangements involving referrals, goods, and services to avoid AKS violations. The guidance provides examples of risky scenarios and advises structuring arrangements to meet AKS exceptions or safe harbors.
• Other risk areas: These include compliance with Stark Law, HIPAA Privacy and Security Rules, civil rights laws, and anti-supplementation policies. The OIG recommends integrating these concerns into staff training and monitoring programs.

To mitigate risks, the Nursing Facility ICPG offers key strategies:

• Leadership commitment: Executives should oversee compliance programs and foster a culture prioritizing quality care and regulatory adherence.
• Competency-based training: Staff training should focus on compliance requirements and best practices, ensuring ongoing education.
• Regular risk assessments: Annual evaluations should address vulnerabilities and align strategies with facility-specific risks.
• Effective communication channels: Open communication and non-siloed collaboration between compliance and quality teams are crucial. Leadership should establish safe reporting mechanisms for staff to voice concerns.

See also: HIPAA Compliant Email: The Definitive Guide

Why it matters

The Nursing Facility ICPG demonstrates the need for these facilities to navigate complex regulations effectively while maintaining high standards of care. Non-compliance poses serious risks, including financial penalties, legal challenges, and reputational harm. By following the OIG’s recommendations, nursing facilities can improve resident outcomes, reduce regulatory risks, and bolster operational integrity.

Bottom line

The Nursing Facility ICPG is a strategic resource for nursing facilities aiming to enhance compliance and care delivery. While voluntary, the guidance equips facilities with actionable steps to address compliance risks and foster a culture of accountability. By integrating these recommendations, facilities can better serve their residents and strengthen their adherence to federal regulations.

FAQs

What are the benefits of following the Nursing Facility ICPG?

Adopting the guidance can help facilities:

• Improve resident care and quality of life.
• Mitigate risks of regulatory non-compliance.
• Avoid legal and financial penalties.
• Foster a culture of accountability and transparency.

How does the ICPG differ from the General Compliance Program Guidance (GCPG)?

The GCPG, issued in November 2023, provides broad compliance strategies applicable to the entire healthcare sector. The Nursing Facility ICPG, released in November 2024, offers more specific recommendations tailored to the unique operational challenges of nursing facilities.

How can nursing facilities tailor compliance strategies to their specific needs?

Facilities should evaluate their size, services offered, and resident demographics to identify unique risks and operational challenges. Tailoring compliance strategies may involve customizing training content, focusing on specific billing models, or addressing localized regulatory requirements.