Chapter 3 Flashcards
The Boards Role
- the right culture begins with the board
-the federal sentencing guidelines are very clear on the expected board commitment
-ongoing support is crucial
Caremark International Derivative Litigation
1996 U.S. civil settlement of Caremark International, Inc in which an imposed CIA precluded Caremark from providing health care in certain forms for a period of 5 years. Also suggest that the failure of a corporate director to attempt in good faith to institute a compliance and ethics program in certain situations may be a breach of a director’s fiduciary obligation
Ways to communicate compliance to the physicians
-discuss both business and clinical aspects of an issue
-emphasize clinical and fiscal improvements
-build trust through involvement
-involve physicians early in the process
-give physicians lots of data
-work one-on-one with them
-cultivate the early adopters and enthusiasts
-be a partner, not a dictator
-communicate, communicate, communicate
Incentives
The federal sentencing guidelines suggest offering incentives to those who follow the compliance and ethics program.
Can assist in staff buy-in
Areas where you need support for an effective compliance program
-the board
-management
-providers
-staff
-financial
Staffing
-Will be dependent on the size of the organization, may be a single part-time role for compliance officer and could have multiple compliance officers.
-since education is such a big part of compliance may also want to consider an education coordinator
-someone to accumulate and analyze data and auditors who can regularly review
-larger organizations considering staffing needs, it should be noted that every facility or location should have a compliance designate or compliance liaison
six tips for saving on furture costs of compliance
-embed quality into existing processes
-centralize common processes and controls
-improve human resources infrastructures
-improve information system processes
-emphasize training
-monitor marketing and compensation
What is the best reporting mechanism?
An open door
Chain of command
the hierarchy of reporting structure within an organization, which assumes all issues will be presented first to one’s immediate supervisor
Code of Conduct
-usually drafted by the Compliance Officer
-Shared with the board for input
-not a one size fits all - will have to tailor specific to your organization
-should include a detailed outline of procedures for handling questions about compliance or ethical issues, beginning with the chain of command or possible hotlines
-should include a description of the compliance program along with names of all compliance office personnel and members of the compliance committee
-must emphasize a zero tolerance for fraud and abuse, a commitment to submitting accurate and timely billing, and compliance with all laws and regulations
-attestation form to be completed annually
First step after getting the compliance program rolled out
conduct risk assessments
Risks that may be identified in your risk assessment
-cultural issues
-no controls in a business process
-new regulations, systems, products or leadership
-no policies, guidance or standards in a specific area
- a need for education or policy revision
-ineffective communication
-billing, documentation and/or coding issues
-third party relationships
-stark
Next steps after identifying risk
-analyzing and evaluating the risks and the management controls in place related to those risks
-prioritize
-after prioritized management develops mitigation plans
P-D-C-A
plan-do-check-act
Plan - meet with the compliance committee to discuss and document current position and posible next steps
Do-take baby steps
-Check - review lessons learned
-Act-decide how to incorporate what you’ve learned with what you still need to do
