Corporate Compliance. If you work in healthcare, you have most likely heard the words. Set in a statute as a part of the Patient Protection and Affordable Care Act (ACA) as a condition of Medicare and Medicaid provider enrollment, Sections 6102 and 6401 of the ACA mandate that skilled nursing facilities (SNF), as well as other healthcare providers, adopt Corporate Compliance standards by March 23, 2013.

Well before the ACA, the Office of the Inspector General (OIG) offered guidance in relation to compliance as a part of best practice. Much of this guidance has been incorporated as required components of the mandate:

Guidance and Required Components of Corporate Compliance

(1) The development and distribution of written standards of conduct, as well as written policies, procedures and protocols that promote the nursing facility’s commitment to compliance (e.g., including adherence to the compliance program as an element in evaluating managers and employees) and address specific areas of potential fraud and abuse, such as claims development and submission processes, quality of care issues, and financial arrangements with physicians and outside contractors;

(2) The designation of a compliance officer and other appropriate bodies (e.g., a corporate compliance committee) charged with the responsibility for developing, operating and monitoring the compliance program, and who reports directly to the owner(s), governing body and/or CEO

(3) The development and implementation of regular, effective education and training programs for all affected employees

(4) The creation and maintenance of an effective line of communication between the compliance officer and all employees, including a process, such as a hotline or other reporting system, to receive complaints, and the adoption of procedures to protect the anonymity of complainants and to protect whistleblowers from retaliation;

(5) The use of audits and/or other risk evaluation techniques to monitor compliance, identify problem areas, and assist in the reduction of identified problems;

(6) The development of policies and procedures addressing the non-employment or retention of excluded individuals or entities and the enforcement of appropriate disciplinary action against employees or contractors who have violated corporate or compliance policies and procedures, applicable statutes, regulations, or Federal, State, or private payor health care program requirements; and

(7) The development of policies and procedures with respect to the investigation of identified systemic problems, which include direction regarding the prompt and proper response to detected offenses, such as the initiation of appropriate corrective action, repayments, and preventive measures

Simply put, facilities must have a written document detailing the necessary procedures to meet compliance standards.  This document must be provided to the staff upon hire, and consistently reinforced through ongoing (and well documented) training. The facility must designate a compliance officer with the necessary credentials and authority to enforce compliance standards, including through disciplinary action when warranted. The officer will be charged with the development of systems and tools to monitor compliance, investigating violations and providing protection to staff that reports such violations. Additionally, the facility must periodically evaluate the compliance plan and update as needed.

We have always recommended that providers incorporate compliance language into their Policy & Procedure Manuals and staff job descriptions. Annual performance evaluations should refer back to the employee’s job description to ensure that standards are met and any deficiencies are addressed. Additionally, staff development programs should include regular in-services to further emphasize compliance.

It is important to note that the guidance from the OIG states that there is no “one size fits all” approach to compliance. Rather, providers are encouraged to tailor the compliance plan to the needs of the facility - taking into account facility size and special programs (such as memory care or subacute specialties), staffing, corporate structure, and culture.

Providers can look to the OIG Compliance Program Guidance for Nursing Facilities (published in March 2000)  or the OIG Supplemental Compliance Program Guidance for Nursing Facilities (published in September 2008). These documents “collectively offer a set of guidelines that nursing facilities should consider when developing and implementing a new compliance program or evaluating an existing one” , and may provide a “roadmap” for the evaluation and refinement of a provider’s current compliance program.