YOUR ACCREDITATION, ASAM LOC CERTIFICATION, AND BASIC COMPLIANCE PROGRAM CONSULTANT
SUSAN@SMJASSOCIATE.COM
FREQUENTLY ASKED basic compliance program QUESTIONS
Please send us your questions at susan@smjassociate.com
Adopting a compliance program, regardless of market sector, is best practice for any organization. Certain healthcare providers are required by law to adopt compliance programs. Various regulatory entities address compliance program requirements. The Centers for Medicaid and Medicare Services (CMS), The Office of Inspector General (OIG), The Social Security Act (SSA), and the Affordable Care Act (ACA), all address compliance program requirements. In short, if you are a healthcare provider and receive federal funding, you are required to have a compliance program.
Effective compliance and ethics programs:
1. Promote a culture of ethical behavior and commitment to compliance with the law.
2. Aid in the detection and prevention of wrong-doing.
3. Raise awareness of organizational expectations.
4. Reduce risks and liabilities associated with government inquiries and prosecution.
5. Establish frameworks/controls to promote integrity in financial accounting and reporting.
6. Result in decreased levels of misconduct, higher employee engagement, performance, and retention, improved corporate reputation, recruitment advantages, and a healthy bottom line.
Chapter Eight of the Federal Sentencing Guidelines identifies seven basic elements of an effective compliance and ethics program. Although there is no one-size-fits-all approach to a compliance and ethics program, having these elements in place is critical for organizations:
1. Standards, Policies, and Procedures
2. Compliance Program Administration
3. Communication, Education, and Training
4. Monitoring and Auditing
5. Internal Reporting Systems
6. Discipline for Noncompliance
7. Investigation and Remediation Measures
By law, governing bodies of healthcare organizations have a duty to carry out compliance plan oversight obligations. Board members should be active in providing oversight for the compliance program. Board members set the tone for the compliance program ensuring the organization is committed to a culture of compliance. The Federal Sentencing Guidelines and the Office of Inspector General's voluntary compliance program guidance documents are tools to help boards ensure they are meeting requirements of an effective compliance program.
Yes, absolutely. There is no one-size-fits-all compliance program. Size, resources, and scope all impact infrastructure. Some organizations may not have the resources to implement an effective compliance program. Contracting with an outside vendor may afford organizations the opportunity to implement an effective compliance program. Using an outside vendor may result in significant cost savings for the organization. An outsourced compliance program eliminates subjectivity and interoffice politics increasing program effectiveness, and ensuring there are no internal conflicts of interest. Having a compliance program, whether internal or outsourced, is a value proposition that will yield long-term results. Pay now or pay later.....organizations must decide.
RESOURCE DIRECTORY
US Department of Health and Human Services/Office of Inspector General
Health Care Compliance Association
Federal Sentencing Guidelines, Chapter 8
Center for Medicare and Medicaid Services
OIG Exclusions Database
Office for Civil Rights US Department of Health and Human Services
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