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Background Information:

On January 17, 2017, a group of compliance professionals and staff from the Department of Health and Human Services, Office of Inspector General (OIG) met to discuss ways to measure the effectiveness of compliance programs. The intent of this exercise was to provide a large number of ideas for measuring the various elements of a compliance program. Measuring compliance program effectiveness is recommended by several authorities. This list will provide measurement options to a wide range of organizations with diverse size, operational complexity, industry sectors, resources, and compliance programs.

Measuring Compliance Program Effectiveness Element #2:

This week we are going to look at what the OIG recommends for an effective Compliance Program-the Officer and the Committee, which is compliance element #2. In March 2013, the section of the ACA, 7 Elements of Compliance, went into effect for any organization that receives Medicare or Medicaid money.  At that time, everyone was to have on staff, or hired, a consultant that would represent their organization as a compliance officer and officiate over the compliance committee. This person would also be a go to for staff communications and the board of directors in making sure the organization was continuing to act in a transparent way and avoiding any fraudulent activities.  It has always been highly recommended that the administrator of the organization and the DON not act as the compliance officer.  Too many ethical issues surround that scenario, no matter how small or large the organization.

Once the compliance officer was assigned or hired, a committee needed to be structured. This committee would act as a support system and discussion group for the compliance officer.  It was to be made up of a variety of department heads already in the facility who would report out issues in their department, that needed to be monitored, so any red flags could be addressed immediately, and fraudulent acts could be avoided.  Every organization is different on how they structured their compliance committee, but the underlying message of all compliance programs, is diligence in addressing and avoiding fraudulent activities.

Below, is the list that was outlined on January 17, 2017 of what is important in a compliance program under Element #2:

Effective Compliance Program Element 2: Compliance Program Administration

  1. Maintain a compliance budget (e.g., contribute to planning, preparing, and monitoring financial resources).
  2. Report compliance program activity to the governance board/committee.
  3. Coordinate operational aspects of a compliance program with the oversight committee.
  4. Collaborate with others to institute best compliance program.
  5. Coordinate organizational efforts to maintain a compliance program.
  6. Define scope of compliance program consistent with current industry standards.
  7. Assure that the compliance oversight committee’s goals and functions are outlined.
  8. Evaluate the effectiveness of the compliance program on a periodic basis.
  9. Maintain knowledge of current regulatory changes and interpretation of laws.
  10. Assure the credibility and integrity of the compliance program.
  11. Recognize the need for outside expertise.
  12. Oversee a compliance education program.
  13. Verify the organization has defined the authority of the compliance officer at a high level.
  14. Verify the governing board understands its responsibility as it relates to the compliance program and culture.
  15. Assure that the role of counsel in the compliance process has been defined.
  16. Define the responsibilities, purpose, and function for all compliance staff.
  17. Assure staffing for the compliance program.
  18. Verify compliance risk assessments are conducted periodically.
  19. Participate in the development of internal controls and systems to mitigate risk.
  20. Incorporate relevant aspects of regulatory agencies’ focus into compliance operations.
  21. Oversee integration of the compliance program into operations.
  22. Develop an annual compliance work plan.
  23. Demonstrate independence and objectivity in all aspects of compliance program.
  24. Maintain an independent reporting structure to the governing body (e.g., Board, Physician Practice Executive Committee).

The link to the OIG site as to what to measure and how to measure is below. They created a table of categories of Board of Directors, Compliance Budget, Compliance Committee, Accountability, Compliance Officer, Staffing, Compliance Plan, Culture, Incentives, Performance Evaluations, Risk Assessments, Compliance Work Plan, Legal Counsel’s Role, and Job Descriptions.  If you have ever done an audit with me on where you are currently in the building of you compliance program, a lot of these measures are in the audit.  There is a lot of valuable information in these eight pages of tables and I highly recommend you review them.  If you want to review the what and how’s to measure element #2, the link is https://oig.hhs.gov/compliance/101/files/HCCA-OIG-Resource-Guide.pdf .

Should you have any questions or want a consultation of your program, please contact me at karen@bcgdata.net.