The Office of Inspector General for the U.S. Department of Health and Human Services aims to protect the integrity of federal healthcare programs, in addition to the health of beneficiaries.  

"In other words," said HHS-OIG's Andrew VanLandingham in a recent interview with Healthcare IT News, "our job isn't to run the programs, but to make sure they work well for all Americans."

VanLandingham, who is senior counselor, Medicaid Policy/Acting Health IT at the agency, will be presenting at HIMSS21 this summer, HHS-OIG colleague, Assistant Inspector General for Legal Affairs Lisa Re.

During that session, Re and VanLandingham will outline HHS-OIG's vision and values, as well as offering insight into future enforcement actions.

"We believe health technology should be used in the service of care to achieve better health and value," said VanLandingham.   

As one example, he pointed to telehealth, which has enormous potential to increase access to service and decrease burdens. At the same time, he said, "it's important that these new policies that have this great potential to improve care aren't compromised by fraud or abuse or misuse."

HHS-OIG has been studying and auditing telehealth from multiple angles, he says, though he also notes it's not just about searching for the flaws.  

"Even pre-pandemic, we looked at how high-performing [accountable care organizations] used telehealth … as one tool in their toolbelt," he said.  

Re explained that HHS-OIG's top enforcement priorities regard conduct that could impact patient safety or cause significant financial harm.   

The agency is also looking into conduct that "prevents interoperability between users."  

Speaking of preventing interoperability, VanLandingham and Re said that when it comes to civil enforcement, the goal is to be "tough but fair."

For instance, VanLandingham said, "It's important to remember info-blocking is an intent-based penalty. That helps us target folks and bad actors with the intent to engage in info-blocking.  

"I know there's a lot of trepidation out there, but it's important to understand that, because there's an intent element to info-blocking," he said. "It will be narrowing the scope of investigations."  

VanLandingham explained that the healthcare fraud space gets "tens of thousands of complaints."  

The agency has laid out five enforcement factors: patient harm; provider's ability to care for patients; duration of info-blocking; any financial loss to federal healthcare programs; and whether the actor was aware their conduct was likely to result in info-blocking. These factors, he said, are based on the agency's 35 years of experience in investigating very serious conduct.  

"I hope that gives the health IT community a better sense of how we go about targeting cases and investigating," he said.  

Re outlined a few recent instances of health IT enforcement activity, including a settlement with Athenahealth and an amendment to eClinicalWorks' corporate agreement.

Overall, she says she hopes attendees leave their presentation with a sense of what compliance requires.  

"Compliance must be implemented and infused into the corporate culture," she said.  

Andrew VanLandingham and Lisa Re will explain more in their HIMSS21 session, "OIG Enforcement, Oversight and Compliance." It's scheduled for Tuesday, August 10, from 11:30 a.m.-12:30 p.m. in Venetian Lido 3104.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.