Stomping out fraud in telehealth and ensuring nursing home resident safety are among the top 10 compliance priorities for the HHS' Office of the Inspector General in the coming year.
The priorities were outlined in a speech at the Health Care Compliance Association's 25th Annual Compliance Institute April 19.
The 10 priorities:
1. Protecting COVID-19 relief and response from fraud. The office said it is using risk assessment and data analytics to identify and target potential fraud and abuse that jeopardize the effectiveness of the COVID-19 relief and response programs.
2. Stomp out potential fraud amid the telehealth boom. The office said it aims to ensure telehealth programs can be expanded to boost patient access to care while keeping program integrity intact.
3. Ensuring nursing home patients are safe. The office remains focused on protecting nursing home residents from abuse, neglect and failure of care. This will be done by boosting state oversight and improving monitoring of care quality.
4. Advancing equity in healthcare services. The office plans to identify areas where HHS programs can help achieve better health equity, including care quality, care access and health outcomes.
5. Modernizing program integrity and compliance resources. The office wants to update compliance programs and make information easier to get. This includes modernizing guidance, compliance resources and data-sharing practices.
6. Tackling the substance use disorder epidemic. The office will boost oversight and enforcement to help address the substance use disorder epidemic. This will include partnering with public health agencies to ensure that patients can be connected with treatment.
7. Prioritizing cybersecurity. The office said it considers cybersecurity a fraud, waste and abuse issue, "making it a compliance issue, too." The office said that increased involvement by the compliance industry will help address cybersecurity concerns.
8. Enforcing the information-blocking rule. The office issued a proposed rule in April 2020 about information-blocking enforcement. While enforcement will not begin until the final rule is published, the OIG remains committed to ensuring it is followed.
9. Ensuring protections to spur value-based care. The office said that program integrity safeguards for new payment and care delivery models will help boost the adoption of value-based care.
10. Strengthening managed care program integrity. The office said it is boosting oversight of managed care organizations after finding weaknesses in efforts to identify fraud, waste and abuse. Its focus areas include the accuracy of risk adjustment, data quality and denials of care.
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