Do you groan when you hear the words “corporate compliance”? Do you think, “Oh gosh, not more of that topic”? Do you find compliance programs confusing, overly complex and hard to implement and maintain effectively? If the answer to any of those questions is yes, here’s some good news for you.
The American Health Care Association (AHCA) is revising the 2000 manual titled Corporate Compliance: Designing a Comprehensive Process, also affectionately known as the “Redbook.” This manual was the first national industry guidance for nursing homes on designing and implementing corporate compliance programs.
On September 30, 2008, the Office of Inspector General (OIG) issued revised compliance guidance for nursing homes. The guidance did not alter the OIG’s 2000 discussion of the mechanics of setting up and maintaining a Skilled Nursing Facility (SNF) compliance program. So, the basic “process” parts of compliance programs have not changed. These include the designation and roles of a compliance officer and a compliance committee; the elements of an effective compliance program; employee training expectations; reporting mechanisms for suspected violations; and other procedural aspects of compliance programs.
Instead, the OIG’s revised guidance focused on new or enhanced “risk areas,” or operational issues that the OIG believes are especially vulnerable to fraud and abuse. Many of the issues emphasized in the 2008 revised guidance focus, directly or indirectly, on quality of care, including accurate MDS assessments and data; comprehensive and accurate care plans; the role of medical directors; prevention of medication errors; prevention of falls; and other care areas.
In an effort to help providers incorporate these new or enhanced “risk areas” into their compliance programs, AHCA contracted with Poyner Spruill to redesign and republish AHCA’s 2000 SNF compliance guidance. In addition to addressing the OIG’s new risk areas, we also decided that this would be a great time to simplify the SNF compliance guidance and to simultaneously publish it a) free of charge to AHCA members and b) in a format compliance officers and/or committees can use to teach compliance in their facilities.
To accomplish this, AHCA is publishing sections of the revised SNF compliance guidance on its member website monthly and then hosting a monthly webinar in which Poyner Spruill, AHCA staff and industry professionals teach that month’s section to webinar attendees. To date, we’ve held two such sessions. The first focused on compliance program-building tools (including key terms you need to know), the reasons to have a compliance program, the elements of an effective program and a section on how to get started in creating or updating your compliance program. The second session, held in November, focused on the role and duties of compliance officers and compliance committees. In that session, we included several compliance officers from provider companies who shared their actual experiences, challenges and successes involving compliance programs.
If you missed those sessions, and want to catch up, you can view the materials and the recorded sessions on the AHCA website. The monthly webinars, with corresponding written material on the AHCA website, will continue in 2009, starting with a session on January 27, 2009. That session will focus on developing effective lines of communication for your compliance program, including both employee education methods and ways for employees, contractors and volunteers to report suspected violations of applicable laws addressed by the compliance program.
The sessions will continue on a monthly basis through November 2009. Sessions are held from 2:00 p.m. until 3:00 p.m. ET the fourth Tuesday of each month, and you can register on the AHCA website for them free of charge if your facility is an AHCA member. We will continue to include compliance officers and committee members as often as possible so that attendees hear not only what the lawyers and AHCA staff think, but also how real-world providers involved with compliance actually implement and operate these programs.
Also in 2009, our sessions will begin to focus on the new risk areas identified by the OIG in its September 2008 supplemental guidance. This is, in short, the “new” material the OIG has published. Our goal is to take some of these complex laws and make them simpler, and to include tips on how to teach these laws to your staff with real-world examples that make them understandable. The OIG has offered us “technical assistance” in that effort, and we expect to take advantage of that offer.
The OIG has just released its 2008 Annual Report on health care fraud and abuse enforcement efforts (see related story below). That report demonstrates the OIG’s ongoing commitment to identifying and rectifying health care fraud and abuse across all sectors of health care. It also suggests that as the OIG continues to show increased collection of civil and criminal money penalties, Congress will continue to view fraud and abuse as an effective method of reducing health care expenditures. So, in short, compliance programs are not going away and if recent indications are reliable, the OIG fully intends to focus anew on fraud and abuse, specifically in the long-term care industry. So now is a great time to reevaluate your company’s compliance program, update and revise it, or, at the very least, use available resources like the AHCA webinar programs as a means to ensure that your program is current and effective.