Nelson Mullins attorneys Hannah Cross and Jordan Brunson authored a May article in COSMOS Compliance Universe discussing the Health and Human Services OIG’s updated compliance guidance for nursing facilities, the first major revision in 16 years. They highlight key risk areas such as quality of care, billing practices, anti-kickback concerns, HIPAA, and civil rights. The article also underscores the growing role of corporate leadership in compliance and notes the guidance’s new web-based, interactive format aimed at improving oversight and reducing risk.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released an updated Nursing Facility: Industry Segment-Specific Compliance Program Guidance, reflecting a renewed approach to voluntary compliance best practices.[1] This latest guidance—issued at the end of 2024—builds upon OIG’s historical efforts to support nursing facilities in developing and maintaining effective compliance programs but modernizes the framework to align with evolving regulatory expectations, enforcement priorities, and industry challenges. The 2024 guidance marks the first update to the industry-specific guidelines in 16 years.

Over the past two decades, the regulatory and operational landscape for nursing homes has undergone significant transformation, necessitating a more dynamic approach to compliance. The COVID-19 pandemic alone proved that nursing facilities’ compliance programs needed modernization. A 2022 report by OIG highlighted an eight-state review that unearthed over 2,200 areas of potential noncompliance with life safety and emergency preparedness requirements following surprise visits to 150 nursing facilities.[2] And a review of facility-initiated discharges highlighted the intricate challenges of caring for residents with mental health disorders and raised concerns as to whether facilities have the capacity to appropriately care for those residents.[3]

OIG’s updated guidance acknowledges key industry shifts, including increased enforcement actions under the False Claims Act, heightened scrutiny on quality of care and patient safety, evolving Medicare and Medicaid reimbursement models, consolidation around nursing facility operators and new investment opportunities in the same, and the growing role of managed care organizations. Additionally, technological advancements, such as electronic health records and data analytics, have introduced both opportunities and compliance challenges. The COVID-19 pandemic further underscored vulnerabilities in infection control, emergency preparedness, and staffing shortages, prompting regulators to place greater emphasis on these areas. By addressing these changes, OIG’s revised guidance aims to equip nursing homes with practical tools to navigate modern compliance risks, enhance internal oversight, and foster a culture of ethical conduct that aligns with today’s healthcare environment.

Read more here.