Recently the OIG released the 7th of 11 videos that cover major health care fraud and abuse laws, the basics of health care compliance programs, and what to do when a compliance issue arises. The videos are from the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative.
Compliance Programs, simply stated, are a set of internal policies and procedures written and implemented within a health care provider that comply with the law. Effective compliance programs, (1) Enhance organizational performance, (2) Improve quality of care, and (3) Reduce overall cost. The OIG stresses that Compliance programs are way for providers to be proactive instead of reactive. They allow an organization to identify problems on the front-end and correct them before they become systemic and costly.
Compliance Program Guidances (CPGs) put out by the OIG, provide principles to follow when coming up with an effective compliance program that suits a provider’s organizational needs. There are seven basic elements to an effective compliance program:
1.Written policies and procedures: have up-to-date policies and procedures and implement them as the organization grows and changes.
2.Designate a Compliance Professional: have a designated Compliance Officer to monitor changes in the law and keep your policies as up-to-date as possible.
3.Effective Training: educate employees about policies and procedures so they are better able to identify a problem, should the occasion arise.
4.Effective Communication: facilitate a way for employees to communicate with the designated compliance professional, such as an open door policy or comment box, as a way to report misconduct and prevent retaliation.
5.Internal Monitoring: conduct regular audits to identify a potential problem and correct it before it becomes costly.
6.Enforcing Standards: ensure effective enforcement of the compliance program within your organization by holding employees responsible for knowing compliance standards.
7.Response to Issues: promptly respond to issues by looking into the problem and taking steps to resolve it.
The HEAT “Compliance Basics” video gives organizations a better insight into what to put into an effective compliance program to be proactive in identifying problems and/or issues, and to resolve them before they become costly.
For more information on this topic, please contact Abby Pendleton or Adrienne Dresevic at 248-995-2810 or visit The Health Law Partners at www.thehealthlawpartners.com.