Jeannine LeCompte, Compliance Research Specialist
The establishment of a compliance officer and a compliance committee forms the second element of the US Department of Health and Human Services’ Office of Inspector General’s (OIG) “Seven Basic Compliance Elements” of a compliance program.
The OIG acknowledges that a small nursing facility may not have the resources to hire or appoint a full-time compliance officer. If that is the case, a part-time compliance officer at the site is perfectly acceptable. Multi-facility providers can appoint one compliance officer at the corporate level and create compliance liaison officers at each facility.
No matter how the compliance officer position is filled, each facility should have a person in its organization who can oversee the nursing facility’s compliance with applicable statutes, rules, regulations, and policies.
The purpose of a compliance officer and compliance committee is to provide a structure that brings the public and private sectors together to reach mutual goals of reducing fraud, waste, and abuse; improves operational functions; improves the quality of healthcare services, and reduces the cost of healthcare.
There are numerous benefits to following these guidelines. In addition to fulfilling its legal duty to ensure that it is not submitting false or inaccurate claims to government and private payers, a nursing facility gains the benefits listed below by having a compliance officer and compliance committee in their organization:
- The formulation of effective internal controls to ensure compliance with statutes, regulations, and rules;
- A concrete demonstration to employees and the community at large of the nursing facility’s commitment to responsible corporate conduct;
- The ability to obtain an accurate assessment of employee and contractor behavior;
- An increased likelihood of identifying and preventing unlawful and unethical behavior;
- The ability to quickly react to employees’ operational compliance concerns and effectively target resources to address those concerns;
- Improvement of the quality, efficiency, and consistency of providing services;
- A mechanism to encourage employees to report potential problems and allow for appropriate internal inquiry and corrective action;
- A centralized source for distributing information on healthcare statutes, regulations, and other program directives;
- A mechanism to improve internal communications;
- Procedures that allow the prompt, thorough investigation of alleged misconduct; and
- Through early detection and reporting, minimized loss to the government from false claims, thereby reducing the nursing facility’s exposure to civil damages and penalties, criminal sanctions, and administrative remedies.
Finally, in the event of any unfortunate incidents with regard to billing errors or employee fraud, the OIG will take into account all sincere efforts by the nursing facility to comply with applicable statutes and regulations as well as government and private payer healthcare program requirements. This can best be shown through the establishment of an effective compliance officer and compliance committee.
