The Department of Health and Human Services Office of Inspector General (OIG) is charged with fighting Medicare and Medicaid fraud, abuse and waste. The OIG conducts audits and investigations, files lawsuits and issues penalties to enforce healthcare fraud and abuse laws. The OIG website offers compliance resources for providers: https://oig.hhs.gov/compliance
The OIG has published two sets of voluntary compliance guidance for nursing facilities:
The OIG’s Semi-Annual Report to Congress
OIG database of Excluded Providers
Information about the Self-Disclosure Protocol
Resources to help your board exercise oversight over compliance
The OIG Work Plans. Every year, the OIG issues a Work Plan for the upcoming Fiscal Year. The Work Plan tells providers what the OIG will be investigating in the upcoming Fiscal Year. By reading the Work Plan, providers can address high-risk compliance areas and improve their performance in areas of government concern–and stay out of hot water.