WHY COMPLIANCE

 

Most medical and life science professionals entered into the profession to treat or help with cures or treatments for patients.  Their attention is best left to the healing process and staying current with treatment protocols.  Compliance and Risk Dynamics (CRD), a third party group can help a practice deal with potential issues that can include:

 

·       Heightening employee awareness of requirements

·       Conduct bench marking exercises

·       Integrate components of the Sarbanes-Oxley Act

·       Understanding the requirements and implications of the U.S. Sentencing Guidelines

·       Assure billing integrity

·       Review security

·       Review compliance with HIPPA privacy requirements

·       Review availability and use of OIG Safe Harbors  

·       Privacy issues/potential for identity theft

·       Set up routine reporting mechanisms

·       Conduct effectiveness evaluations

·       Review professional agreements to avoid Stark II issues

 

Many healthcare practices, upon review, have Compliance plans, rather than programs.  A plan is often contained in a binder on a shelf.  A true Compliance program requires effort, communication and should be spread throughout the organization through training, communiqués, and practice.  A Compliance Effectiveness Review (CER) can be conducted to point out potential risks for the practice.

 

A solid compliance program can be monitored by a contracted Compliance Officer, much like many small to mid-sized companies employ part-time Chief Financial Officers.  Does your practice have a compliance committee?  Who runs the meetings?  This can best be accomplished by an independent facilitator.

The complexities of practices and regulatory oversight require constant vigilance to thwart potential exposure.   The issues listed below can have a detrimental effect to the health and productivity of a practice:

 

·       Conflict of interest

·       Information security

·       Kickback arrangements

·       Employment of excluded persons

·       Contract management

·       Employee issues

·       Quality of care

·       Employment and use of non-licensed personnel

·       Antitrust issues

·       Cost reporting

·       Transaction code sets

·       Upcoding

·       Environmental issues

·       Foreign regulations

·       Pharmaceutical sales practices

·       Tax issues

·       JCAHO

 

Effective programs allow the compliance professional direct access to the executive officers of the organization.  No more can the importance of compliance be minimized as a staff responsibility

 

 

Deficit Reduction Act of 2005

 

Back in February of this year, President Bush signed the Deficit Reduction Act of 2005 (the “Act”)… and, what it means to you and your corporate compliance program (or lack thereof) could be huge!! 

 

 

Medicare Part D

Beginning January 2006

 

CMS is creating rules and guidelines for manufacturers, benefit managers, drug plans and the provider community.  Any entity where drugs are prescribed needs to review their protocols and procedures to assure compliance with Medicare regulations.