My name is Susan Gillin, I am an attorney
with the Office of Inspector General. We see cases every day where compliance programs
have failed and health care providers submit false claims to the health care programs.
So how do you implement an effective program? Here are six steps you can take toward that
goal. First, foster a culture of compliance. How
can you create a compliance-focused culture? Support your Compliance Program with sufficient
resources. Your staff will notice if you spend money everywhere but compliance. Committing
financial resources to promote compliance also shows that integrity is valued in your
organization. Also, no matter how much money you have, you
can support the compliance function with your attitude. Be creative, talk about compliance
issues in staff meetings, or celebrate employees who have brought compliance concerns to your
attention. After you’ve established that you are committed
to compliance, how do you get specific? Create useful policies and procedures. Your policies
should be specific to each job function in your organization. Review them frequently,
and update them. Most providers forget to update the policies once they’re set.
Include real life compliance issues you’ve faced, and make the policies available. Leave
multiple copies in common areas, and send them to your employees by email. Another great way to stay compliant is to
train your staff. Think of training as exercise. You can’t
exercise once a year and expect to see results, and the same is true for compliance training.
Offer training often. Your staff is probably not going to ask for more compliance training,
so you have to take the initiative. Be Creative. One compliance officer created
a jeopardy tournament with compliance questions, and had staff compete in teams for the right
answers. Stay current with compliance. Attend conferences,
read publications, and use networking opportunities to stay in the loop on developing compliance
issues and enforcement trends. Now that you’re doing great training, what’s
next? Promote communication. Encourage lots of it. How?
Be visible and approachable. Weave the compliance message through meetings and informal conversations.
Talk about your nonretaliation policy in a staff meeting. Encourage employees to use
the hotline. Give staff frequent opportunities to tell you what you’re doing right, and
what you’re doing wrong. One great way to encourage communication is
to use anonymous online surveys to give employees a chance to report whether your compliance
efforts are working. If you’re successfully communicating the
compliance message, you will likely get some issues reported. So how do you deal with those
issues? Take appropriate corrective action. Develop a system to track and respond to complaints
quickly and thoroughly. Investigate issues of potential non-compliance promptly, and
take appropriate corrective action. One approach that can work well is to have a team of staff
members who understand the issues be involved in the investigation. Just be careful to watch
out for conflicts of interest. Lastly, track the resolution of complaints and educate yourself
on the OIG self disclosure protocol. How do you make sure you remain compliant
with program rules and regulations? Conduct regular audits. Use some of those resources
you set aside to do this. Each year, figure out what your risk areas are. Those are what
you should be auditing. You can learn more about risk areas by reviewing the applicable
compliance program guidance on the OIG’s website.
Some common health care risk areas are coding, contracts, quality of care. If you submit
lots of claims to Medicare, audit them. Don’t wait for Medicare to tell you that you are
coding incorrectly. If you enter into lots of agreements with
physicians, hire a lawyer to make sure you are complying with the Anti-kickback Statute
and the physician self-referral law. If you find quality of care issues in your
practice, investigate the root causes, and consider hiring a consultant to help with
corrective action. Also, remember to review your compliance program.
Ask, are you meeting your benchmarks? Are people using the hotline? Are your corrective
action plans sufficient? Now you have six tools to implement your compliance
program. No matter the size of your practice or the number of employees, everyone can use
these tools to create and foster a culture of compliance.