Updated: Wed, 11/14/2012 - 01:09

Compliance plans are critical for health care providers

 special photo David Fenstermacher
special photo David Fenstermacher
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Compliance plans are critical
for health care providers

President Barack Obama’s victory is a strong indication that the Patient Protection and Affordable Health Care Act of 2010 is here to stay. Health care providers and suppliers can no longer delay implementation of the act’s mandated compliance plans.

Before the health care act, the Office of Inspector General of the U.S. Department of Health and Human Services encouraged health care providers to develop voluntary compliance plans to best comply with the complex regulations governing federally funded health care programs such as Medicare. Despite such encouragement and the well-recognized importance of an effective compliance plan, few health care providers developed and actually use compliance plans. Now, the days of voluntary compliance programs are in the past. The health care act requires health care providers and suppliers to establish compliance programs as a condition of enrollment in federally funded health care programs.

The act charged Health and Human Services with promulgating yet-to-be-released regulations setting forth the “core elements” that must be included in mandatory compliance programs for health care providers and suppliers in each section of the health care industry.

In the interim, the federal agency has advised that the core elements will be based on a compliance plan prescribed in the Federal Sentencing Guidelines Manual, which include the following:

• Implementing written compliance policies, procedures and standards of conduct.

• Designating a compliance officer and compliance committee responsible for monitoring compliance efforts and enforcing practice standards.

• Conducting effective training and education on the compliance policies, procedures and standards of conduct.

• Developing effective lines of communication to facilitate communication with staff (updates and training) and allow anonymous reporting mechanisms.

• Conducting internal monitoring and auditing by performing periodic self-audits.

• Enforcing standards for employees through well-publicized disciplinary guidelines.

• Responding promptly to detected offenses and develop corrective action.

Health care providers currently without compliance plans meeting the criteria in the sentencing guidelines should adopt such a compliance plan as soon as possible. Not only will such a plan be required, an effective compliance program enables a health care provider to avoid or mitigate significant penalties associated with violations of existing health care regulations.

Enforcement initiatives against health care providers are ever increasing, particularly with respect to investigations of alleged health care fraud, and an effective compliance program should be a health care provider’s first line of defense.

The health care act brings in a new era where a compliance plan can no longer be an unused binder on a shelf. If you are a health care provider or supplier, you must develop, use and monitor a compliance program consistent with government mandates. A well-structured compliance plan can serve as a valuable tool to help your organization successfully navigate the complex and ever changing health care delivery landscape. An experienced health care attorney can assist your facility or practice in structuring a plan to implement a mandatory compliance program.

David L. Fenstermacher, Jr. is an attorney focusing on health care litigation and regulatory matters at HunterMaclean in Savannah. He can be reached at 912-236-0261 or dfenstermacher@huntermaclean.com.

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