Compliance Program Administration

Question 1

What are the OIG recommendations concerning training?

Answer 1

The OIG recommends that employees at all levels be trained annually in a general compliance training session under the supervision and coordination of their compliance officer. The company must “communicate effectively its standards and procedures to all employees and affected physicians, independent contractors, and other significant agents by requiring participation in training programs and disseminating publications that explain specific requirements in a practical manner.”

This requirement includes compliance officers. While the length of the training is not specified, previous settlements (Caremark and BCBS) have included one- to two-hour training requirements). Based on settlement history, a minimum of one hour should be a minimum standard for imparting substantive material.

As far as teaching methods, OIG is fairly open, suggesting using a variety of methods. The most successful incorporate a live trainer and classroom discussion using the case-study method. As computer-based training and distance learning become more economical to produce, training may move to these platforms because most institutions must provide some type of self-study program for their offsite employees anyway.

Question 2

What is the target audience for additional training?

Answer 2

The following groups of employees should attend targeted, more detailed sessions that cover laws and regulations that directly affect their work: corporate officers, managers, employees whose job primarily focuses on submission of claims for reimbursement or affect the accuracy of claims submitted to the government, marketing and sales personnel, medical records personnel, IT, and finance and cost-reporting personnel. The more detailed sessions should be offered at least annually and possibly more frequently as appropriate to individuals’ work responsibilities.

Question 3

What is the timeframe for training new employees?

Answer 3

While the OIG does not give a specific timeframe to train new employees (Medicare requires 90 days), it is recommended that training occurs within the first 30 to 60 days of employment. This should be a minimum standard, as most successful compliance programs incorporate integrity training into their new employee orientation, completing this requirement within the first one to two weeks.

Question 4

What is one important component of compliance training?

Answer 4

The standards of conduct is an important component of any compliance training program because it outlines the institution’s policies, procedures, and expectations of employees.

A code of conduct should be distributed to all employees when they first begin work and should be required to read it before they attend their integrity training session.

The code of conduct should be regularly updated to meet all new state and federal regulations, and employees’ knowledge and commitment should be certified.

Question 5

What are the OIG’s individual documentation requirements?

Answer 5

In the Compliance Program Guidance for Third-Party Billing Companies, the OIG details tracking requirements more stringently than ever before:

• at the end of every training session, all employees must sign and date a certification that reflects their knowledge and commitment to the code of conduct;
• employee certification should be kept in the employee personnel file;
• the certification needs to be updated annually;
• contracted consultants must attend training and sign a similar certification;
• consultant certifications should become part of the contract and remain in this file as documentation.

Question 6

What are the employee performance evaluation requirements?

Answer 6

According to the OIG, meeting the annual compliance training requirement should be a factor in the annual evaluation for each employee. Attendance and participation in training programs should be made a condition of continued employment and failure to comply with training requirements results in disciplinary action up to and including termination. This training requirement should be made emphatically clear to employees as part of the training process.