The Department of Health and Human Services' Office of Inspector General (OIG) has released jointly developed guidance to help healthcare providers' boards address compliance issues.
The OIG developed the guidance in collaboration with the American Health Lawyers Association, the Health Care Compliance Association and the Association of Healthcare Internal Auditors, due to the complementary roles that internal auditors, executives and the legal sector play in the compliance process. It is vital that healthcare organizations clearly define and document the relationship between the legal, compliance and audit spheres, defining both departmental boundaries and expectations for collaboration, according to the document. Hospital boards should regularly assess each function's performance and independence.
Hospital boards should also develop and enforce standards for how to report compliance-related information, the guidance states, by requesting periodic reports on risk management and compliance from multiple functions and engaging leadership from various spheres to get the most relevant, accurate information about operations and risks. They must also make sure both the board and management have clearly defined protocols for risk-area identification, which may incorporate internal or external sources. "For instance, boards and management may identify regulatory risks from internal sources, such as employee reports to an internal compliance hotline or internal audits," the guidance states. "External sources that may be used to identify regulatory risks might include professional organization publications, OIG-issued guidance, consultants, competitors or news media."
Despite the key roles that a provider's audit, compliance and legal sectors play, compliance involves the entire organization, the guidance states. To emphasize this, it suggests boards regularly assess employees' ability to further compliance goals at the individual, departmental or facility-wide level, and possibly withhold incentives or offer bonuses to promote these efforts.
Healthcare compliance is particularly fraught post-Affordable Care Act, and many chief compliance officers say increased emphasis on it has made their position more important than ever. Corporate compliance is doubly important amid increased scrutiny of potential false claims or kickback schemes, FierceHealthPayerAntiFraud previously reported.
To learn more:
- here's the guidance (.pdf)