CCT OIG Compliance Guidance 5 — Questions and Answers
Question 1: An OIG Self-Disclosure Protocol (SDP) submission is most appropriate when an organization:
- Suspects it may have violated the Anti-Kickback Statute or submitted false claims (Correct answer)
- Wants to request a new Medicare billing number after a corporate reorganization
- Needs to appeal a Medicare claim denial through administrative channels
- Seeks to renegotiate the terms of an existing Corporate Integrity Agreement
Correct answer: Suspects it may have violated the Anti-Kickback Statute or submitted false claims
The SDP allows providers to voluntarily disclose potential fraud violations to the OIG in exchange for the opportunity to negotiate a reduced settlement multiplier.
Question 2: OIG guidance highlights that an effective compliance program must have adequate 'resources and authority.' This means:
- The compliance officer must also serve as the organization's general counsel
- The compliance function must be funded and empowered independently of operational pressures (Correct answer)
- Compliance staff must be authorized to conduct criminal investigations
- The compliance budget must equal at least 1% of total organizational revenue
Correct answer: The compliance function must be funded and empowered independently of operational pressures
OIG guidance stresses that compliance programs must be adequately resourced and that compliance officers must have authority to act without interference from those they oversee.
Question 3: Under OIG guidance, what is the recommended approach when a compliance audit identifies potential overpayments from a federal healthcare program?
- Write off the overpayment as a business expense without disclosure
- Investigate, quantify, and return the overpayment within the 60-day 'report and return' window (Correct answer)
- Offset the overpayment against future claims submissions
- Wait for the MAC to identify the error before taking action
Correct answer: Investigate, quantify, and return the overpayment within the 60-day 'report and return' window
The ACA's 60-day rule requires providers to report and return identified overpayments within 60 days, and OIG guidance reinforces this obligation as central to compliance.
Question 4: Which of the following best characterizes the OIG's 'General Compliance Program Guidance' (GCPG) released in 2023?
- A mandatory federal regulation replacing prior sector-specific CPGs
- An updated voluntary framework applicable across all healthcare industry segments (Correct answer)
- A criminal enforcement policy replacing civil monetary penalty authority
- A guidance document exclusively for nursing facilities and long-term care providers
Correct answer: An updated voluntary framework applicable across all healthcare industry segments
The 2023 GCPG is a modernized, voluntary compliance framework that applies broadly across the healthcare industry and updates the foundational seven-element structure.
Question 5: OIG compliance guidance specifically warns against 'physician inducement' arrangements where:
- Physicians are paid fair market value for legitimate medical director services
- Hospitals provide physicians with benefits intended to influence their referral patterns (Correct answer)
- Physician group practices share risk under a capitated managed care contract
- Physicians serve on a hospital board and receive standard director compensation
Correct answer: Hospitals provide physicians with benefits intended to influence their referral patterns
Arrangements where hospitals provide physicians with items of value—such as free office space, staff, or equipment—specifically to influence referral patterns can violate the AKS.
Question 6: When OIG issues a 'Management Implication Report,' it is intended to:
- Notify individual managers that they face personal criminal prosecution
- Communicate audit findings and recommendations directly to HHS leadership for systemic change (Correct answer)
- Replace a Corporate Integrity Agreement when the provider's risk is low
- Summarize exclusion decisions made during the prior fiscal quarter
Correct answer: Communicate audit findings and recommendations directly to HHS leadership for systemic change
Management Implication Reports convey OIG audit and evaluation findings to HHS management so that agency-wide policy or operational improvements can be pursued.
Question 7: According to OIG compliance guidance, which factor most undermines the credibility of a compliance program?
- Employing a dedicated compliance officer with no clinical background
- Having the compliance officer report to both the CEO and the board
- Compliance officer reporting to the general counsel with no independent board access (Correct answer)
- Conducting unannounced internal audits without prior notice to department heads
Correct answer: Compliance officer reporting to the general counsel with no independent board access
OIG guidance warns that placing compliance under legal counsel without independent board access can compromise independence, as legal and compliance interests may conflict.
CCT OIG Compliance Guidance 5
An OIG Self-Disclosure Protocol (SDP) submission is most appropriate when an organization: