Compliance Toolkits

Resources to help providers ensure they are in compliance with health care laws.

Toolkit: To Help Decrease Improper Payments in Medicare Advantage Through the Identification of High-Risk Diagnosis Codes

This toolkit offers Medicare Advantage (MA) organizations information that will enable to replicate Office of Inspector General's (OIG's) techniques to identify and evaluate high-risk diagnosis codes to ensure proper payments and provide better care for enrollees.

Adverse Events Toolkits: Medical Review Methodology and Clinical Guidance for Identifying Patient Harm

These toolkits are technical resources to assist the health care community, government agencies, and researchers in identifying and measuring adverse events in hospitals or other inpatient settings.

Toolkit: Analyzing Telehealth Claims to Assess Program Integrity Risks

This toolkit provides detailed information on methods to analyze telehealth claims to identify program integrity risks associated with telehealth services.

Measuring Compliance Program Effectiveness

This guide includes ways to measure the effectiveness of compliance programs. Measuring compliance program effectiveness is recommended by several authorities, including the United States Sentencing Commission. This list will provide measurement options to a wide range of organizations with diverse size, operational complexity, industry sectors, resources, and compliance programs.

Handout: A Toolkit for Health Care Boards

This toolkit is part of the OIG's award-winning Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. End of
Translation Learn how to promote quality of care and evaluate compliance program effectiveness.

OIG Toolkit to Identify Patients at Risk of Opioid Misuse

OIG has developed two toolkits that provide detailed steps for using prescription drug claims data to analyze patients' opioid levels to identify certain patients at risk of opioid misuse or overdose.