Office of Inspector General Compliance: Protecting the Healthcare Industry from Fraud, Waste, and Abuse
Safeguarding Healthcare with Verified Providers and Ethical Practices
Detecting Risk, Reducing Waste, and Building Trust
OIG Compliance: Healthcare Integrity in Action
The last thing you want is to be on the wrong side of an Office of Inspector General (OIG) violation.
With non-compliance settlements accounting for billions of dollars paid each year, staying compliant with OIG regulations is critical for those in the healthcare industry—and not something to be left to inexperienced hands.
Vālenz Health® is here to help you stay compliant with data-driven solutions tailored to your unique needs. Catch non-compliance issues before they snowball into costly lawsuits or settlements by partnering with our team today.
Smarter Compliance for a Safer Healthcare System
What is an OIG Compliance Program?
An Office of Inspector General (OIG) compliance program is a set of internal policies and procedures that helps your organization comply with relevant federal laws. A smartly designed, proactive program not only helps you maintain compliance with today's regulations; it also provides a framework for efficiently and effectively implementing future requirements.
The best OIG compliance programs typically include:
- Written policies and procedures
- A designated compliance officer or committee
- Effective training
- Effective communication
- Internal monitoring and compliance audits
- Enforcement of guidelines
- Prompt response times
Every compliance program will be uniquely designed based on a specific organization's operations, structure, and areas of risk. Your compliance program should account for your particular staffing and contracting programs, mix of services, and patient demographics and payer mix.
OIG COMPLIANCE PROGRAM GUIDANCE
To help healthcare organizations design effective, tailored compliance programs, the Office of Inspector General (OIG) has developed a comprehensive General Compliance Program Guidance (GCPG) guide, geared toward different segments of the industry.
The guide includes:
An overview of applicable federal laws, such as the Anti-Kickback Statute, Physician Self-Referral Law, False Claims Act, and more
Compliance best practices and recommendations
Adaptations for small and large healthcare organizations
And much more
However, the GCPC is just a starting point. It should be used to outline your initial compliance strategy, after which your team should personalize your compliance program to account for your organization’s unique needs, including any activities that you outsource to third parties.
Remember: OIG compliance is never “complete.” Your program should evolve with your business and with changing regulations to focus not just on risk containment but also on best care and management practices.
Protecting Patients, Plans, and Reputations
Why You Need an OIG Compliance Program
An Office of Inspector General compliance program is about so much more than just avoiding federal violations.
The right strategy can help you reduce fraud, waste, and abuse (FWA) within your organization; minimize your healthcare spend; and deliver trusted, higher-quality care to patients.
In 2024, the Department of Justice retrieved more than $2.9 billion in settlements and judgements under the False Claims Act, with $1.67 billion of those payments coming from healthcare-related settlements. One organization alone paid more than $300 million to settle non-compliance violations.
Without a proper OIG compliance program, your healthcare organization could face the same fate.
Federal OIG requirements aim to minimize fraud, waste, and abuse within Medicare, Medicaid, and other Health and Human Services programs. By complying with these requirements, your organization can set the same standard for private payers, too.
Payment integrity and provider screening solutions like those offered by Valenz can help you detect FWA issues, including billing inconsistencies and improper payments before they happen, minimizing your monetary risk and protecting the bottom line of every stakeholder involved.
Because fraud occurs on all levels, these initiatives can protect you regardless of severity, saving you an average of 10%–30% from contracted network discounts.
With its focus on preventing fraud, OIG compliance programs promote healthcare integrity, protecting patients from unsafe or unethical practices.
The result: Patients receive only the highest-quality care from providers and facilities they can trust, improving their care outcomes to live strong, vigorous, and healthy lives.
Take the Complexity Out of OIG Compliance
OIG Compliance Monitoring and Management with Vālenz Health®
At Valenz, we're committed to delivering smarter, better, faster healthcare for all—and OIG compliance monitoring is an important part of that vision.
That's why we created Provider Staff Sanction Monitoring, a customizable compliance monitoring program that allows you to compare your providers, staff, and vendors against the OIG Exclusion List, the System for Award Management list, and all available state Medicaid databases, helping you identify possible issues before they occur.
Ensure compliance, validate licenses, and safeguard your organization from OIG violations with the level of support that fits your needs.
Get OIG-Audit Ready with Compliance Solutions
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