You might be wondering–Why must every health care entity maintain and operate a compliance program? These programs are important for many reasons, including avoiding legal liability, but they also demonstrate your organization’s commitment to honesty, ethical behavior, and acting responsibly in favor of their clients. When done properly, a good compliance program motivates employees to report issues as they appear, creates a process by which the company can audit prior records, and helps prevent potential unethical conduct and even inadvertent mistakes. Without this program, your chances of culpability will increase. At Robinson & Casey PLLC, our team of professionals has amassed much experience with implementing compliance programs at behavioral health facilities. Let’s talk about the significance of an effective healthcare compliance program with the professionals.
What A Healthcare Compliance Program Entails/Healthcare Compliance Program Consulting
A sufficient healthcare compliance program is a proactive measure that reduces the risk of liability, most notably related to regulations concerning fraud, waste, and abuse, but can also impact the Stark Law, HIPAA and 42 CFR Part 2, Anti-kickback statutes, etc. Programs of this nature are intended to educate and prevent; audit, identify and correct; and if not fully avoided, to reduce the fines and penalties that stem from healthcare investigations. Healthcare organizations that have applied a healthcare compliance program prior to an offense will be viewed more favorably than those organizations which have neglected the responsibility. The Office Of the Inspector General (OIG), will consider the existence of a compliance program that pre-dated any government investigation when the appropriateness of administrative penalties is addressed. Additionally, these programs can work to prevent investigations and qui tam cases. To prevent investigations, one must adhere to the following steps:
- Identify and correct improper payments or other actions
- Respond to a hotline and other complaints
- Follow the rules of monitoring and self-auditing as it relates to the program
Monitoring and self-auditing under a healthcare compliance program are vital for complying with federal overpayment or “reverse false claim” requirements, as well as reducing liability in other compliance areas.
Which Elements Are Needed For A Successful Program?
The main focus of every healthcare or behavioral health organization should be to promote a culture of compliance, which includes the adoption of a comprehensive compliance program. When an organization has this in their arsenal, it makes it simple to find and correct vulnerabilities, reduce fraud and abuse, and more importantly, it promotes safe and quality care. How do you achieve such a rigorous level of compliance? If you adopt the 7 core elements that we’re about to mention, it will be easy to address any and all shortcomings.
Using Written Policies, Procedures, and Standards Of Conduct
The proper policies, procedures, and standards of conduct should encourage organizations in their commitment to stay compliant and address specific areas of risk. They can achieve this by writing, reviewing, and updating them on a regular basis. When this information is in writing, it helps the employees of the organization to stick with the missions and objectives of the business.
Appointing A Compliance Officer & Committee
A compliance officer oversees the healthcare compliance program. The committee will include various functions within the business to support and advise the compliance officer. When both entities have been appointed, it’s their job to prevent, detect, and correct non-compliance issues. This element helps promote standards of conduct and establishes the needed communication for non-compliance matters.
Hosting Effective Training And Education
Every member of a healthcare facility should receive training on fraud and abuse laws. Training and education that is offered regularly will hold your employees accountable for staying on top of compliance issues and trends.
Creating Efficient Lines Of Communication
Creating an open line of communication allows the parties involved to consistently report on instances of non-compliance. Communication needs to be accessible, promote confidentiality, do an adequate job of conveying your organization’s message, encourage feedback, and provide outlets for anonymous reporting.
Internal Monitoring And Auditing
This is an ongoing process of evaluation and assessment for mitigating bad behavior, and it guarantees the effectiveness of education and corrective action. Internal monitoring and auditing includes the establishment of an annual work plan, keeping a close eye on risk, proactively auditing, and reviewing the compliance program. As a result, the compliance program will address any areas of concern while sustaining the efficacy of the program itself.
Standards Of Conduct And Disciplinary Guidelines
Standards of conduct create a set of rules, responsibilities, proper practices, and expectations of employees. Standards of conduct will only hold weight if they are continuously upheld through the company, regardless of position, title, or rank.
Responding Swiftly To Detected Offenses And Using Corrective Action
If you fail to oversee the implementation of timely and effective remedial action for offenses, it can create unwanted exposure for your business. The best ways to address the offenses include tracking and responding to compliance-based issues, using corrective action, and tracking the resolution of complaints.
Our Firm Will Help With Healthcare Compliance Program Consulting
If you own or operate a behavioral or conventional healthcare facility and want to stay current with the changing environment, Robinson & Casey Law is willing and able to provide assistance in accomplishing this with our healthcare compliance program consulting. To better understand the process, contact us today!
