Spotlight on Responsibility and Accountability: OIG’s New Compliance Guidance for Health Care Governing Boards


On April 20, 2015, the Office of the Inspector General of the U.S. Department of Health and Human Resources (“OIG”), in collaboration with the American Health Lawyers Association, the Association of Healthcare Internal Auditors, and the Health Care Compliance Association, published guidance directed in particular at health care organizations’ boards of directors and trustees regarding compliance oversight.[1] This guidance reaffirms that federal enforcement authorities are increasingly focused on boards, both as a check on potential violations by management and for potential liability on the part of boards and individual board membership.

This guidance reflects the heightened challenge for boards to ensure their organizations’ compliance with applicable federal and state laws concerning, among other things, referral relationships and arrangements, billing issues (such as upcoding and submitting claims for services not rendered and/or medically unnecessary services), privacy breaches, and quality-related events.

The focus on governing boards not only mandates enhanced compliance oversight but also might require boards to obtain legal, billing-audit, and other professional advice independent of management, especially in the context of an official government investigation or where, at the conclusion of a matter, the board faces duties imposed upon it by Corporate Integrity Agreements (“CIAs”) or other settlement obligations.

The following suggestions are essential for creating and maintaining a program that can best promote effective corporate compliance as well as offer protection to governing boards:

Board Oversight

Auditing and Correcting Potential Risk Areas


ENDNOTES

[1] OIG, Association of Healthcare Internal Auditors, American Health Lawyers Association, and Health Care Compliance Association, Practical Guidance for Health Care Governing Boards on Compliance Oversight (April 20, 2015),available here.

[2]U.S. Sentencing Commission, Guidelines Manual (2013), available here.

[3] OIG, Compliance Guidance, available here.


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National Law Review, Volume V, Number 124