Is Your Compliance Program in Place and Effective?

Is Your Compliance Program in Place and Effective?

While compliance programs have been utilized by many health care providers for years to detect and correct noncompliant activity, the importance of such programs has been recently amplified in connection with the Patient Protection and Affordable Care Act (PPACA). Previously, compliance programs were often an optional tool for organizational compliance. Under PPACA, however, all health care providers will be required to implement and maintain effective compliance programs as a condition of enrollment in Federal health care programs, including Medicare. Especially in light of PPACA, compliance programs will remain a beneficial tool for health care organizations to detect and prevent noncompliant behavior and to demonstrate compliance in the event of a government audit. In practice, compliance programs for various types and sizes of health care organizations will be different; yet, core components are found in effective compliance programs of organizations of any size. The Office of the Inspector (OIG) has identified seven components as a starting point for any organization or provider to develop an appropriate compliance program:

-Internal Monitoring and Auditing - These activities are important at the commencement of a compliance program for baseline data and as an ongoing activity to show effectiveness of the program and to identify violations or risk areas.

-Written Standards and Procedures - Written standards and procedures are crucial to a compliance program as the documents which inform organization members of the compliance requirements with which they must comply.

-Designation of a Compliance Officer or Compliance Contacts - A compliance officer or compliance contacts oversee the compliance program to ensure that all functions are being implemented. Such individual(s) are identified to the members of the organization for reporting possible violations or compliance concerns.

-Training and Education - An organization’s members must be trained on the standards and procedures to which they will be held accountable. An organization should determine who needs training on various compliance functions, what type of training will be most effective to meet the organization’s needs and how often training should occur.

-Investigation of Alleged Violations and Appropriate Disclosures - When compliance issues are detected, an investigation should be conducted to determine if violations of law or the compliance program have occurred and, if so, action taken to remedy such violations. Depending on the type of violation, criminal or civil disclosures or return of overpayments may be necessary, as well as internal discipline.

-Open Lines of Communication - Methods for allowing an organization’s members to communicate about compliance issues should be implemented and well-publicized and could include providing contact information for the compliance officer and an anonymous hotline or reporting tool.

-Enforcement of Disciplinary Standards - An organization should alert its members to the disciplinary actions that will be imposed for failure to adhere to the compliance program and should apply sanctions consistently.

Health care organizations are well-advised to implement a compliance program or review the effectiveness of existing compliance programs. An effective compliance program can be of great benefit in identifying and responding to risk areas and possible noncompliant behavior. Additionally, compliance programs will soon be required for participation in Federal healthcare programs.

Nutile Pitz & Associates has attorneys Certified in Healthcare Compliance through the Compliance Certification Board (CCB). Contact us today for more information on compliance programs and assistance with all stages of the development and implementation of an effective program.