As discussed in a prior Dentons On Call blog post and podcast, on November 6, 2023, HHS-OIG issued new General Compliance Program Guidance (GCPG) aimed broadly at all individuals and entities involved in the health care industry. The GCPG is intended to “update and consolidate compliance tools and resources consistent with contemporary industry practices and current law.”
HHS-OIG also indicated that, starting in 2024, it would be publishing industry segment-specific compliance program guidance (ICPGs) for different types of providers, suppliers, and other participants in the health care industry. Like the compliance program guidance documents issued by HHS-OIG in the late 1990s and early 2000s, the ICPGs will be tailored to fraud and abuse risk areas for each industry segment and will address compliance measures that participants therein can take to reduce those risks.
On February 21, 2024, HHS-OIG announced that its first round of ICPGs will address Medicare Advantage Organizations (MAOs). Historically, HHS-OIG did not issue compliance guidance for MAOs until it had first issued guidance for (i) hospitals, (ii) home health agencies, (iii) clinical laboratories, (iv) third-party medical billing companies, (v) DMEPOS suppliers, and (vi) hospices.
That HHS-OIG has chosen to issue compliance guidance for MAOs in its first iteration of ICPGs speaks volumes about the agency’s priorities. That said, the agency’s increased focus on managed care is not surprising. According to the Kaiser Family Foundation, between 2011 and 2023, the percentage of Medicare beneficiaries enrolled in MA plans grew from 26% to 51% and total MA expenditures increased from $124 billion to $473 billion.
Although HHS-OIG has not provided an exact release date for the ICPG for MAOs, the agency has been holding virtual listening sessions with MAOs and downstream entities to receive input on compliance matters and has stated that the guidance would be issued at some point “in 2024.”
