The components

When attempting to formulate a work plan that encourages a culture of compliance that HHS-OIG would find satisfactory, it is helpful to understand what the OIG Work Plan consists of.

According to the OIG, the following factors are used to determine which potential projects should be undertaken during the fiscal year^[4] :

• Mandatory requirements for OIG reviews, as set forth in laws, regulations, or other directives;

• Requests made or concerns raised by Congress, HHS management, or the Office of Management and Budget (OMB);

• Top management and performance challenges facing HHS;

• Work performed by other oversight organizations;

• Management’s actions to implement OIG recommendations from previous reviews; and

• Potential for positive impact.

These projects work to protect more than 100 programs administered via HHS agencies, such as the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the Administration for Children and Families (ACF), and the Centers for Medicare & Medicaid Services (CMS).^[5] It is highly feasible that your healthcare organization’s compliance program is and will be affected by the types of projects and items that the OIG add into their Work Plan.

A list of active and archived Work Plan items can be easily found on the OIG’s Work Plan website. The active items generally cover OIG audits, evaluations, and inspections that are either planned or currently underway. The list is organized by the date that item was announced, revised, or completed, starting with the most recent items. The Work Plan additionally notes which agency is affected by the work item, and includes a link to the audit report or brief upon completion of the project.

Recent changes to the OIG Work Plan format

The OIG Work Plan was previously updated and re-published once or twice each year with a two-year framework for all planned audits and projects. In June 2017, the OIG began to update the Work Plan on a monthly basis. In the OIG’s own words, the monthly updates would “enhance transparency around OIG’s continuous work planning efforts….”

Transparency is particularly important for the healthcare industry, which continues to grow and become more complex and convoluted with each passing year. A 2018 Global and U.S. Health Care Outlook analysis compiled by Deloitte acknowledged that “health care stakeholders face…significant strategic and compliance challenges related to government programs, health care payment and delivery system reforms, and new billing and coding requirements.”^[6] To face these challenges, healthcare compliance programs have come to rely on technology as a necessary organizational and communicative tool.

The transition from an annual publication of HHS’s most significant management and performance challenges to a dynamic, web-based Work Plan makes a lot of sense. The previous release of so much information only once or twice a year placed a huge burden on compliance programs to sift through the OIG Work Plan and plan out their own respective work plans at least a year or two in advance. If HHS drastically changed focus on some aspect of their Work Plan from the previous fiscal year to the current one, it could potentially wreak havoc on a compliance program’s carefully planned audit schedule; weeks or even months of preparation may have been wasted when the time could have been better spent elsewhere. The ability to change direction and respond to relevant, timely issues within the fiscal year weighed heavily on HHS-OIG and made it equally cumbersome for healthcare compliance programs to adjust as well.

The new monthly update schedule allows the OIG to treat the Work Plan as a constantly evolving document; relevant information and changes to the Work Plan itself can now reach healthcare compliance programs at a faster pace. Compliance programs no longer have to wait for the annual or bi-annual Work Plan to be published in order to learn about revisions, postponements, or cancellations of ongoing reviews and activities. The current incarnation of the OIG Work Plan now demands that your compliance program’s work program evolve alongside it.

Conclusion

Successful healthcare compliance programs are always proactively searching for the next resource or material that will teach them what is currently relevant to the healthcare industry, and how this will affect their ability to comply with the constantly shifting regulations and laws. In the current healthcare industry, it is now more important than ever for compliance programs to pay attention to the OIG Work Plan.

The OIG Work Plan is a highly useful tool that compliance programs can use to evaluate risks and formulate a plan from. Programs should adopt a habit of frequently checking whether the Active Work Plan Items list has been updated, at minimum, once or twice a month. Keeping track of the OIG Work Plan essentially gives healthcare organizations a glimpse into the upcoming future, straight from the source itself. Your organization should pay attention to issues that the government department in charge of enforcing federal laws and statutes related to health deems as important. Doing so will allow your organization to focus on the current important matters in the healthcare industry and guard against any unpleasant surprise audits or reviews.

Takeaways

• Learning about the OIG Work Plan and monitoring every update can be crucial to keeping your healthcare organization fit, functional, and out of trouble.

• The Work Plan summarizes new and ongoing activities and challenges that the OIG believes must be addressed.

• The Work Plan is now updated monthly to create clarity and reduce confusion in the healthcare industry.

• Every healthcare compliance program should make full use of the Work Plan to map out their future activities and audits.

• By focusing on the source of healthcare oversight, your organization will be sure to stay ahead of the curve.