Chapter 4: Evaluation Processes, Investigations, and Noncompliance Response

Government and Professional Resources

Risk areas are the driving factor in the monitoring and auditing activities of a compliance program. When identifying risk, most organizations take into account a number of resources. Program assessment should also take into account various government and professional guidance and resources.

The OIG annual Work Plan, updated monthly, is one such often-used resource—but it should not be the only resource. Reviewing other program integrity and enforcement activities of any regulatory body with oversight for activities performed by the organization will be important. There can be a multitude of governing rules, regulations, and activities in addition to the OIG. Those of interest to the organization will depend on the nature of the organization and the laws and regulations it is subject to, but they may include the Office for Civil Rights (OCR), the Food and Drug Administration (FDA), the Office for Human Research Protections (OHRP), and the U.S. Department of Justice (DOJ), just to name a few.

The following provides an overview of some common government and professional resources healthcare organizations can use when planning their compliance monitoring, auditing, and program assessment activities.

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