Health care providers in the United States operate in a complex regulatory and business environment that presents many risks. Providers need to manage compliance risks inherent in operating in this environment. The United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) assesses risks across HHS programs, including Medicare and Medicaid, to inform its priorities in audits, evaluations, investigations, administrative enforcement, and other activities. As a government agency that values transparency, OIG maintains and continually updates information on its website that can inform providers about risk areas for those operating in Federal health care programs.
OIG uses information gained from audits, evaluations, and enforcement actions to educate providers through guidance that can inform voluntary compliance efforts. OIG’s goals in promoting health care industry compliance are for providers to: (1) comply with Federal health care program requirements, (2) self-identify compliance issues as they arise, and (3) appropriately address such issues.
OIG and providers share an interest in identifying and mitigating risks, and providers should use OIG’s information to guide their own risk analysis, identify compliance issues, and take corrective action when issues arise, including fulfilling report and return obligations under the sixty-day rule and self-disclosing fraud issues. As OIG continues to use all its tools to identify and address risks for HHS programs, health care providers should use the resources OIG shares with the public to guide their own compliance efforts and reduce organizational and individual risks.