Jeannine LeCompte, Compliance Research Specialist
The designation of a compliance officer in a skilled nursing facility forms a critical part of element two of the Office of Inspector General’s (OIG) seven elements of a compliance program. The importance of this position cannot be overstated: practical experience has shown that it is through the establishment of a compliance program that the risk of unlawful or improper conduct is significantly reduced.
A compliance officer, along with a corporate compliance committee, is charged with the responsibility for developing, operating, and monitoring the compliance program, and reporting directly to the owner(s), governing body, and/or CEO.
The OIG makes it mandatory that every nursing home provider should designate a compliance officer to serve as the focal point for compliance activities. This responsibility may be the individual’s sole duty or added to other management responsibilities, depending upon the size and resources of the nursing facility and the complexity of the task. A compliance officer must be of a suitably senior position and authority, and should have direct access to the nursing facility’s president or CEO, governing body, all other senior management, and legal counsel.
In addition, the compliance officer should have sufficient funding and staff to perform his or her responsibilities fully. Coordination and communication are the key functions of the compliance officer with regard to planning, implementing, and monitoring the compliance program.
According to the OIG, the compliance officer’s primary responsibilities should include the following:
- Overseeing and monitoring implementation of the compliance program;
- Reporting on a regular basis to the nursing facility’s governing body, CEO, and compliance committee (if applicable) on the progress of implementation, and assisting them in establishing methods to improve the nursing facility’s efficiency and quality of services, and to reduce the facility’s vulnerability to fraud, waste, and abuse;
- Periodically revising the program in light of changes in the organization’s needs, and in the law and policies of government and private payer health plans;
- Developing, coordinating, and participating in a multifaceted educational and training program that focuses on the elements of the compliance program, and seeking to ensure that all relevant employees and management understand and comply with pertinent federal and state standards;
- Ensuring that independent contractors and agents who furnish physician, nursing, or other healthcare services to the residents of the nursing facility are aware of the requirements of the nursing facility’s compliance program with respect to residents’ rights, billing, and marketing, among other things;
- Coordinating personnel issues with the nursing facility’s Human Resources/Personnel office (or its equivalent) to ensure that (i) the National Practitioner Data Bank has been checked with respect to all physicians and licensed independent practitioners (as appropriate) and (ii) the List of Excluded Individuals/Entities has been checked with respect to all employees, medical staff, and independent contractors;
- Assisting the nursing facility’s financial management in coordinating internal compliance review and monitoring activities, including annual or periodic reviews of departments;
- Independently investigating and acting on matters related to compliance, including the flexibility to design and coordinate internal investigations (e.g., responding to reports of problems or suspected violations) and any resulting corrective action (e.g., making necessary improvements to nursing facility policies and practices, taking appropriate disciplinary action, etc.) with all nursing facility departments, subcontracted providers, and healthcare professionals under the nursing facility’s control;
- Participating with facility’s counsel in the appropriate reporting of self-discovered violations of program requirements; and
- Continuing the momentum of the compliance program after the initial years of implementation.
The compliance officer must also have the authority to review all documents and other information that is relevant to compliance activities, including, but not limited to, medical and billing records, and documents concerning the marketing efforts of the nursing facility and its arrangements with other healthcare providers, including physicians and independent contractors.
