Health Law Attorney BlogOIG Releases New Industry-Specific Compliance Program Guidance for Nursing Facilities
On November 20, 2024, the Office of Inspector General (OIG) released its updated Industry-Specific Compliance Program Guidance (ICPG) for nursing facilities, marking an important step in its broader compliance initiative. This guidance builds upon and updates the 2000 Compliance Program Guidance (CPG) and the 2008 Supplemental Compliance Program Guidance (Supplemental CPG) for Nursing Facilities, carrying forward key risk areas and considerations while addressing new and evolving compliance challenges. The OIG notes that the absence of a previously identified risk area in the updated ICPG does not mean that such risks have become irrelevant, and nursing facilities are encouraged to continue addressing them as needed. Both the 2000 CPG and 2008 Supplemental CPG will remain available as archived resources on the OIG website. The 2024 ICPG introduces updates that align compliance programs with contemporary healthcare practices, emphasizing quality of care, resident safety, and leadership accountability.
A Shift in Focus and Structure
The 2024 ICPG introduces a more structured and focused framework to support nursing facilities in developing effective compliance programs. Unlike the 2000 guidance, which largely centered on fraud prevention, the new ICPG places quality of care and resident safety at the forefront. This shift reflects OIG’s recognition of the direct relationship between care quality and compliance. Leadership accountability is another critical focus, with the guidance emphasizing the active role of governing bodies, owners, and investors in ensuring compliance programs are operationalized and continuously monitored. This approach highlights the importance of integrating compliance into an organization’s culture and leadership practices.
Modern Challenges and Risk Areas
The ICPG reflects the complexities of modern healthcare delivery by expanding the scope of identified risks. In addition to foundational issues like billing compliance and anti-kickback concerns, the 2024 guidance includes Medicare Part D compliance, HIPAA privacy and security, and civil rights compliance. These additions reflect broader changes in the healthcare industry, where electronic health records, data privacy, and equitable access to care have become pivotal concerns.
The guidance also expands on risks associated with relationships between nursing facilities and third parties, such as hospices, hospitals, and vendors. By spotlighting these relationships, the ICPG encourages nursing facilities to maintain vigilance in their dealings with external entities.
Quality of Care: A Compliance Priority
The 2024 ICPG places a heightened emphasis on quality of care, linking operational deficiencies to compliance risks under laws such as the False Claims Act. It provides detailed recommendations for ensuring:
- Appropriate staffing levels and competencies.
- Comprehensive care planning and implementation.
- Effective medication management protocols.
- Proactive incident reporting to address and mitigate adverse events.
- Resident safety through clearly defined and enforced safety protocols.
This expanded focus aligns with recent federal mandates on staffing and resident safety, establishing quality of care as an essential component of compliance efforts.
Training, Documentation, and Leadership Engagement
The 2024 guidance underscores the importance of role-specific, competency-based training for all staff, including temporary and contracted personnel. This represents a shift from the general training recommendations in the 2000 guidance, reflecting OIG’s understanding that effective compliance programs require tailored and practical education.
Documentation and reporting also receive enhanced attention. Accurate Minimum Data Set (MDS) coding, thorough documentation of compliance efforts, and robust incident reporting mechanisms are essential components of the updated guidance. These measures not only protect facilities from liability but also foster transparency and accountability.
Leadership engagement is another critical focus. The ICPG encourages nursing facility executives, board members, and investors to actively monitor compliance and quality performance. This top-down approach ensures that compliance programs are not merely symbolic but are integrated into the day-to-day operations of the organization.
Adapting to a Modern Healthcare Landscape
Recognizing the growing reliance on technology, the 2024 ICPG provides updated guidance on the use of electronic health records (EHRs), data analytics, and cybersecurity. These updates reflect the need to address compliance risks associated with technological advancements while leveraging these tools to enhance care delivery and operational efficiency. Facilities are encouraged to view compliance as a dynamic process that evolves alongside industry changes.
Nursing Facility Supplemental: Reimbursement Overview
As part of the ICPG, this supplemental document provides a detailed overview of Medicare and Medicaid reimbursement systems, particularly for those new to the nursing facility sector. It updates the Reimbursement Overview section included in the 2008 Supplemental Compliance Program Guidance for Nursing Facilities, reflecting the significant changes to reimbursement systems since that time. The Reimbursement Overview offers context for risk areas described in the 2024 ICPG, supporting nursing facilities in better understanding and addressing compliance risks related to reimbursement practice.
What This Means for Nursing Facilities
The updated guidance is more than a compliance checklist—it’s a roadmap for creating robust, proactive programs that prioritize care quality and accountability. Nursing facilities should take this opportunity to assess their current practices, identify gaps, and implement changes that align with the new framework. By doing so, they can meet regulatory expectations while fostering a culture of excellence in care delivery.
The 2024 ICPG represents a significant evolution in compliance guidance for nursing facilities. It builds on the foundation of the 2000 CPG, modernizing its principles and aligning them with today’s healthcare realities. For nursing facilities, this is a chance to not only comply but to lead the way in delivering safe, high-quality care to their residents
For more detailed guidance and compliance support, feel free to contact Clinton Mikel at (cmikel@thehlp.com ; (248) 996-8510), or your contact your regular HLP attorney.