The Season For Compliance Is Upon Us

Patrick V. Trotta, CPA

Overview of Presentation

• Purpose of Corporate Compliance

• Elements of a Corporate Compliance Program

• Benefits derived from Corporate Compliance

• Monitoring the effectiveness of Corporate Compliance Program

Purpose of Corporate Compliance

• System designed to prevent, detect, and address financial improprieties and inadequate care

• Identifies financial/care issues before they lead to government intervention

• Uses internal controls to monitor adherence to applicable statutes, regulations and program requirements

Purpose of Corporate Compliance (cont.)

• Fosters organizational culture that promotes commitment to Ethical and Effective behavior

• Encourages employees and others to report potential problems

• Minimize financial loss to the government, the taxpayers, and the nursing facility

Purpose of Corporate Compliance (cont.)

• Enhance resident satisfaction and safety through delivery of improved quality of care

• Improves the facility’s reputation for quality and integrity

Elements of a Corporate Compliance Program

• Office of Inspector General (OIG) has determined 7 elements that are fundamental to an effective compliance program

• Suggestions on how facilities can best establish internal controls and prevent fraudulent activities

• OIG’s elements not mandatory or exclusive

OIG’s Seven Fundamental Elements

1. Policies, procedures, and standards of conduct

2. Designation of a compliance officer & compliance committee

3. Training & education

OIG’s Seven Fundamental Elements (cont.)

4. Effective lines of communication

5. Enforcement & discipline

6. Monitoring & audit of compliance system

7. Prompt response to detected offenses & corrective action plan

(1) Policies, Procedures, and Standards of Conduct

• Written

• Best practices

• Interdisciplinary focus

• Applies to employees, contractors, and vendors

• Reviewed and updated

(2) Designation Compliance Officer & Compliance Committee• Responsible for developing, operating, and

monitoring the compliance program

• Should be autonomous

• May have several different roles

• Focus on financial and quality of care

• Reports to ownership, governing body, and CEO

(3) Training & Education

• Fundamental to Compliance Program

• Begins with orientation and ongoing tracking

• Appropriate to position

• General to all employees

(4) Effective Lines of Communication

• Between compliance officer and all employees

• Reporting system to receive complaints and grievances

• Hotline

• Protect the anonymity of complaints and grievances

(5) Enforcement & Discipline

• Condition of employment (excluded individuals/entities)

• Compliance a factor in evaluation of job performance

• Appropriate and timely action

• Communication

(6) Monitoring & Audit of Compliance System

• Periodic process to assess effectiveness of Compliance Program

• Continuous quality improvement

• Proactive process

• Internal and external audits

(7) Prompt Response to Detected Offenses & Corrective

Action Plan• Immediate investigation

• Follow up on suspected noncompliance

• Develop corrective action

• Self disclosure

Benefits Derived From Corporate Compliance

• Mandatory requirement for compliance programs by March, 2013

• Different requirements depending upon facility type (e.g., large chain v. small provider)

• Reduces exposure to civil damages and penalties, criminal sanctions, and administrative remedies

Benefits Derived From Corporate Compliance (cont.)

• Survey results

• Effective internal controls ensure compliance with government statutes and regulations and organizational standards

• Ethical culture develops employee satisfaction and stable workforce

Benefits Derived From Corporate Compliance (cont.)

• Ability to quickly react to operational compliance concerns and effectively allocate resources

• Financial control

• Billing and collection control and compliance

Monitoring The Effectiveness of Corporate Compliance Program

1. Compliance monitoring team

2. Identification of risk areas

3. Assessment steps

(1) Compliance Monitoring Team

• Compliance officer

• Compliance committee

• Internal audit staff

• Consultants

• Lawyers

• Independent auditors

(2) Identification of Risk Areas

• Quality of care and residents rights

• Employee screening

• Vendor relationships

• Billing and cost reporting

(2) Identification of Risk Areas (cont.)

• Record keeping and documentation

• Sufficient staffing

• Comprehensive care plans

• Medication management

(2) Identification of Risk Areas (cont.)

• Resident safety– Resident interactions

– Staff screening

• Submission of accurate claims– Proper case mix reporting

– Therapy services

– Screening for excluded individuals/entities

– Restorative and personal care services

(2) Identification of Risk Areas (cont.)

• Anti-kickback statute– Free goods and services– Service contracts– Discounts– Hospices– Bed reservations

• Other– Physician self referrals– Medicare Part D– HIPAA

(3) Assessment Steps

• Base line assessment

• Regular review of effectiveness

• Mandated outside audit (??)

Final Thoughts & Questions

Patrick V.Trotta, CPADirector, Elder Care Provider ServicesGlass JacobsonPatrick.trotta@glassjacobson.com(410) 356-1000www.glassjacobson.com/ElderCare