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Navigating healthcare compliance in a new world: A snapshot of the OIG 2021 Work Plan

Gabriel L. Imperato (gabriel.imperato@nelsonmullins.com) is the Managing Partner of the Fort Lauderdale office of Nelson Mullins Riley & Scarborough and the Team Leader of the firm’s Health Care Criminal and Civil Enforcement, Litigation, and Compliance Practice. He is board certified as a specialist in health law by the Florida Bar. Ariel J. Cavazos (ariel.cavazos@nelsonmullins.com) is an Associate Attorney in the Orlando office of Nelson Mullins Riley & Scarborough and is on the firm’s Health Care Criminal and Civil Enforcement, Litigation, and Compliance Team.

While 2020 will undoubtedly always be referred to as the 21st century’s annus horribilis, the world experienced a similarly devastating pandemic more than a century ago. The pandemic of 1918 infected more than 500 million people, killing at least 50 million people worldwide.[1] While the pandemic of 1918 was fought and defeated with far fewer resources, healthcare providers were not tasked with navigating that pandemic with today’s overwhelming guidelines and laws set in place to defend against potential fraud, waste, and abuse. Today, the healthcare provider entities and systems combatting COVID-19 are burdened with federal and state regulations and a plethora of compliance standards, all while adapting to a new way to provide care and, in turn, ensuring adequate testing and treatment are received.

The Centers for Medicare & Medicaid Services (CMS) has provided emergency waivers and flexibilities, essentially providing a safety mask for healthcare entities and systems navigating the compliance world amid the COVID-19 pandemic. As we see vaccines distributed at a higher and more effective rate, the thought of normalcy has resurfaced, triggering the necessary discussions regarding what will happen once the public health emergency expires. Moreover, what would the healthcare compliance world’s layout look like once the “masks” come off?

With more than 30 million cases and more than half a million deaths related to COVID-19 in the United States,[2] it is no surprise that many of the recent works plans of the U.S. Department of Health & Human Services Office of Inspector General (OIG) cover a significant number of pandemic-related items. 

As known to any practitioner in the healthcare fraud and abuse sector, the OIG publishes work plans with monthly updates that set forth various projects, including OIG audits and evaluations that are underway or planned for the fiscal year and beyond by OIG’s Office of Audit Services and Office of Evaluation and Inspections.[3] It is imperative to monitor potential risk areas outlined by the Work Plan to guarantee compliance for a healthcare provider entity and system.

This article explores several general fraud and abuse topics and highlights issues relevant to the ongoing COVID-19 pandemic, including various telehealth services the OIG is monitoring with a magnifying glass. These items range from home health to behavioral health services; the Coronavirus Aid, Relief, and Economic Security (CARES) Act resources; and other laboratory testing and billing concerns.

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