A History of Healthcare Compliance in the United States

These flashcards cover key concepts and terminology related to healthcare compliance as discussed in the lecture.

Compliance Program Guidance (CPG)

Guidance documents issued by OIG outlining compliance standards for various healthcare entities.

General Compliance Program Guidance (GCPG)

A modernized guidance applicable to all individuals and entities in the healthcare industry.

Office of Inspector General (OIG)

Federal office responsible for combating fraud, waste, and abuse in HHS programs.

Corporate Integrity Agreements (CIAs)

Agreements used to enforce compliance within healthcare organizations after investigations.

Certification of Compliance Agreements (CCAs)

Agreements requiring providers to certify their continued operation of existing compliance programs.

Fraud

Knowingly executing a scheme to defraud a healthcare benefit program.

Abuse

Practices that directly or indirectly result in unnecessary costs to the Medicare Program.

Limited English Proficiency (LEP)

Patients who require language assistance to access healthcare services.

Patient Protection and Affordable Care Act (PPACA)

Legislation mandating compliance programs for healthcare providers receiving federal funds.

Federal Sentencing Guidelines (FSGS)

Guidelines used to set uniform sentencing policies for federal crimes, including healthcare offenses.

Five-Principle Strategy

OIG's strategy for preventing healthcare fraud, waste, and abuse.

Physician at Teaching Hospitals (PATH) audits

Audits targeting medical record documentation at teaching hospitals.

General Accounting Office (GAO)

Agency that identified Medicare claims as high risk for fraud and abuse in 1992.

Office for Civil Rights (OCR)

Office responsible for enforcing federal civil rights laws and HIPAA privacy protections.

Healthcare Reform Law

Legislation encompassing the ACA and its subsequent amendments requiring compliance programs.

OIG's Modernization Initiative

Efforts to update compliance guidance resources to enhance accessibility and effectiveness.