Great Customer Support

The Elements of an Effective Compliance Plans for Healthcare Businesses

In the early beginnings of compliance plans for healthcare businesses, both big and small, there was a strong suggestion that all healthcare businesses, practices, hospitals and the like adopt a compliance program.  The caveat was that there was no directive to ensure that the plan actually worked or was comprehensive enough to ensure the mitigation of potential issues, False Claims Act matters, kickbacks, and the like.

By around 1998, healthcare businesses were to have a plan in place, put it on a shelf, and if anyone asked to review it, most practices that did implement a plan would pull it off that shelf, dust it off and provide it to the requester.  

Times have changed.   

Healthcare compliance impacts every single health organization, providers and related businesses.Given the federal government’s enhanced efforts to investigate and audit, the compliance program has taken on even greater importance.

Now, healthcare organizations and providers must be able to show the plan is in effect and that it includes all basic elements required, as well as that it is constantly monitored and adjusted to compensate for constant changes in healthcare.  In a nutshell, they must be able to prove that the compliance program actually works.

Failure to comply can result in criminal charges, significant penalties, and debarment from Medicare/Medicaid and other health plans.A healthy, amoebic compliance program can prevent issues, promote both legal and ethical compliance, and ensure that businesses and practices meet their obligations associated with ethical matters.

Compliance plansare designed to aid in the reduction and detection of fraud, as well as waste and abuse, within the healthcare arenaand pursuant to the HHS/OIG.The OIG is the primary investigator of health care fraud within the Medicare programs.Each Medicaid agency is required to investigate Medicaid fraud and abuse, along with the Medicaid Fraud Control Units (MFCU) that exist in an overwhelming number of states.

  • The MFCU has the ability to prosecute for criminal acts and civil violations
  • The HHS/OIG has the power to bring criminal charges, impose civil charges and assess penalties, which range from just over $11,000 to approximately $23,500 per violation

The Patient Protection and Affordable Care Act requires “all healthcare organizations to develop and implement formal healthcare compliance programs,” while also better defining the importance of healthcare compliance.As such, compliance programs and adherence thereto are a continuous effort to abide by ethical, legal, and standards which exist in the healthcare arena.   

In order to ensure compliance plans are followed, the culture of compliance is mandated from the top and trickles down through every person in the organization.There is no level within a practice, nor an organization,that is immune to it.This aids in preventing the significant penalties, civil assessments and even criminal charges.  At the end of the day, compliance run through an entire organization.   

There are multitude of items which aid in developing and implementing an effective compliance plan for healthcare organizations.  These include:

  • Developing open lines of communication throughout the organization from the CEO, Chief Compliance Officer and others in complianceto supervisors, staff, managers, directors and everyone else not listed
  • Implementing comprehensive written policies that must be monitored and followed by all employees
  • Conducting effective and recurring training for all personnel
  • Naming a Chief Compliance Officer and a Deputy Compliance Officer, as well as a Compliance Committee to support the goals of the compliance program and ensure proper focus is placed on complying with what the plan mandates
  • Ensuring that the compliance plan is written and continuously updated, with all personnel informed of the changes
  • Conducting recurring audits and investigations to ensure that the compliance plan is working correctly
  • Enforcing discipline for those who do not follow the plan
  • Taking prompt action when violations of the plan are noted (through audit and investigations).  This includes recording the violation and immediately taking corrective action, as well as puttingnew rules into place which will prevent a repetition of such violations in the future

There are many more issues to consider, but since the PPACA mandates all of this, it’s in the best interest of every healthcare organization and practice to take heed, or risk facing the consequences, which can be financially costly and also result in the inability to treat certain patients in the future.    

White Collar, llc can be your best friend in ensuring that your plan is in compliance.  But we don’t stop there.  We will also regularly monitor it for failures and audit/investigate any issues that require corrective action.We have a combined 100+ years of experience in this area, and can truly make a difference in your practice and/or organization.