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Raising the Effectiveness of Your Compliance Program

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Complying with the myriad state and federal laws and regulations that govern healthcare practices can seem like an overwhelming chore. However, establishing effective compliance programs really works to the benefit of your practice. Compliance programs aim to promote the prevention of criminal conduct and enforce governmental rules and regulations without impeding quality and efficient service to patients. When you establish an effective program and well-maintained systems to keep the program running, compliance becomes much less of an administrative burden and instead provides welcome comfort that your healthcare practice is operating efficiently, legally, and with a minimal level of risk. Designing and implementing an effective compliance program with the help of a seasoned Los Angeles healthcare law attorney allows you to focus on providing quality care to your patients.

At the Law Offices of Art Kalantar, our regulatory healthcare compliance attorney is well-versed in establishing, maintaining, and improving compliance programs for healthcare organizations. We will help strengthen your compliance systems in order to take the burden of compliance off your shoulders. We have years of experience developing and maintaining compliance programs in order to effectively and efficiently deal with California state law as well as federal Medicare, DEA, FDA, HIPAA and other regulatory issues.

Effective Compliance Programs Reduce Your Liability and Regulatory Risk

Effective compliance programs ensure that your healthcare organization complies with applicable laws and regulations, promotes a culture of honesty and integrity, maintains the highest ethical and professional standards, prevents fraud and abuse, detects compliance issues at early stages, allows for prompt and efficient corrective action where compliance issues are detected, and builds trust and confidence for both employees and patients. Combined, these factors are an absolute gain for your healthcare entity.

The OIG’s Compliance Guidelines

The Office of the Inspector General (OIG) has issued guidance on implementing an effective physician compliance program at your healthcare practice. The OIG’s guidance does not detail a specific plan that must be followed by every practice but instead identifies seven elements of an effective program that should form the basis of any healthcare entity’s compliance system. The guidance was initially voluntary, but under the ACA the advised elements are now mandatory.

The OIG identifies seven components to be used as a basis for crafting an effective compliance program. The components combine to serve three key purposes of compliance programs: Prevention, detection, and correction. The Law Offices of Art Kalantar can help you understand and implement the OIG’s guidance. The OIG’s seven elements are as follows, along with some of our suggestions for implementation:

Implement written compliance and practice standards. Physician practices must establish and adopt written policies and procedures to guide and promote the entity’s compliance efforts. We recommend that these policies are approved by your organization’s governing body and that they are reviewed and updated at least annually.

Designate a compliance officer. The OIG advises that physician practices must identify and appoint an individual within the organization to serve as compliance officer, who will be responsible for monitoring compliance efforts and enforcing standards of practice. You may want your compliance officer to report directly to the CEO or Board of Directors to avoid any concerns regarding conflict of interest. Your healthcare compliance attorney can help determine the best structure and hierarchy for your compliance officer.

Conduct regular training and education. Your entity should conduct regular and ongoing training in issues including compliance, fraud, waste, abuse, reporting, the Anti-Kickback Statute, and the False Claims Act, in addition to other compliance issues. Training should be part of your process for bringing on new employees and should be held regularly for current employees. Training processes should be documented.

Conduct internal monitoring and auditing. Healthcare practices should conduct regular, ongoing monitoring and audits of the compliance processes and procedures to make sure they are operating as intended and that violations are not slipping through the cracks. We recommend annual risk assessments that include targeted reviews of any compliance issues that have occurred in the prior year, and that your organization monitors the implementation of any corrective actions identified during your reviews.

Establish reporting systems and develop open lines of communication. Practices should set up systems to allow employees to report potential or perceived compliance violations without fear of retaliation. Confidential hotlines are a useful reporting tool, as they allow employees to feel truly safe and anonymous when reporting. Promote your reporting systems regularly so that employees know their venues.

Establish policies to respond to vulnerabilities. Practices must develop and implement policies for responding to potential violations, including corrective actions that must be taken to respond to vulnerabilities or offenses. Your system must allow for prompt responses to compliance issues to avoid exacerbating any liability. Investigations should not only respond to the instant issue but also identify the root causes of any problems or vulnerabilities.

Input and enforce disciplinary standards. Your entity must maintain well-publicized guidelines for enforcing standards of conduct, including appropriate disciplinary measures for employees who fail to comply with the established requirements. These policies should apply equally to all levels of your organization, including employees, board members, and vendors. Compliance should become an integral and welcome part of your organization’s culture.

Improving Healthcare Regulatory Compliance Programs in Los Angeles and Beyond

For help with healthcare regulatory compliance in Los Angeles and California statewide, call the Law Offices of Art Kalantar in Beverly Hills at 310-773-0001 for a free consultation.

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