(October 29, 2015): Last month we discussed why having a functioning, effective compliance program is important. If done correctly, a compliance program that is functional, effective, and well-documented is as important as your medical malpractice liability insurance. Indeed, the Affordable Care Act now requires compliance programs and many private payers now explicitly require compliance programs in their physician contracts.
But compliance programs don’t just materialize out of thin air. I have yet to be able to wave a wand or say an incantation that will bring a compliance program into being. In order to implement a functioning, effective compliance program, somebody has to perform specific tasks. In many practices, a physician (or the physician in a solo practice) is named the compliance officer. In other practices, it is a senior staff member, often the office manager. And sometimes the compliance officer does not have any other duties in the organization, particularly in large practices. All of these models can work. However, where the compliance officer or manager also has other duties, it is critical that those duties do not cause a conflict of interest with the compliance duties. If the compliance officer or manager has other duties in the practice, care must be taken that the individual is permitted enough time to carry out his or her compliance duties. I have seen numerous practices where being the compliance officer takes a back seat to being the office manager or the head of accounting. Those are practices that often run into compliance problems on down the line.
Even more importantly than having the appropriate amount of time, the compliance officer or manager must be given the authority to implement required policies, procedures and practices. All too often, the compliance manager or office is given the responsibility for implementing a compliance program, but not the needed authority. Particularly in solo and small practices, it is not uncommon for the physician to name him or herself as chief compliance officer and then delegate the day-to-day compliance duties to another individual, while the physician remains chief compliance officer on paper. Regardless of whether the individual conducting the day-to-day compliance activities is the actual chief compliance officer or a subordinate performing delegated duties, the most important aspect here is that the compliance staffer not find himself or herself constantly overruled or second-guessed by the physician(s). Unfortunately, I have seen too many cases where a compliance officer is not given the required authority to do what needs to be done or where a physician or group of physicians discounts the sound advice given by the compliance officer.
A physician practice should also implement a compliance committee. A compliance committee has two main functions. First, the compliance committee serves as an oversight body. Second, the compliance committee can be a tremendous help in carrying out compliance duties. In a small practice, the compliance committee might end up consisting of most of the staff members. Conversely, in a large practice, the compliance committee often consists of senior physicians and staff members, such as the head of human resources, the chief financial officer and representatives of other key departments. The composition of the committee and the number of members is not as important as the committee members’ ability to provide oversight and additional resources and manpower in implementing a compliance program.
In terms of oversight, the compliance committee should meet periodically and receive reports from the compliance officer about the steps he or she has taken implement the compliance program. Quarterly meetings are typical. The compliance officer or manager should chair the meetings. The compliance officer can and should report on implementation of policies and procedures, status of training, any incidents, payer audits and other related matters. The quarterly meetings should be documented and maintained among the practice’s key documents.
In terms of providing additional resources for implementing the compliance program, the compliance officer may have to depend on the representatives of other functions to actually perform or carry out specific duties. For example, the human resources department may be tasked with actually conducting background and sanctions screening or employee training, while the finance or accounting department may help with responding to payer audits or performing internal audits. In addition, other departments and functions can often smooth the way for the compliance officer to implement specific tasks, often by providing input into an initiative or suggesting more cost-effective means of achieving a goal. Finally, these other individuals can help a compliance officer by spreading the compliance message throughout an organization.
In summary, empowering a compliance officer and creating a functioning compliance committee are key to implementing an effective compliance program.
Next month: Basic policies and procedures
Heidi Kocher, Esq. is a health law attorney with the firm, Liles Parker, Attorneys & Counselors at Law. Liles Parker has offices in Washington DC, Houston TX, McAllen TX and Baton Rouge LA. Our attorneys represent dentists, orthodontists and other health care professionals around the country in connection with government audits of Medicaid and Medicare claims, licensure matters and transactional projects. Need assistance? For a free consultation, please call: 1 (800) 475-1906.