Jeannine LeCompte, Publishing and Research Coordinator
A hotline forms a part of any long-term care facility’s internal reporting system, as mandated by the Office of Inspector General’s (OIG) Seven Basic Compliance Elements for an effective compliance program. But what exactly is meant to be reported?
A hotline is primarily meant to allow staff and other individuals to report anything that is, or appears to be, a violation of law, rule, regulation, or company policy. In this regard, all potential users of the hotline should be made aware that they have a legal obligation to report any activity, or lack of activity, which is or might be considered a breach of legal guidelines.
Reportable activities could include employee misconduct, any suspected violations of company compliance policies, and, of course, suspected violations of federal, state, or local laws. Resident rights violations should also be reported, as well as breaches of Medicare or Medicaid rules and regulations, theft, bribery, environmental hazards, and any type of criminal activity.
Other, more subtle, violations can include breaches of the rules governing self-referrals (also known as Stark violations), kickbacks, fraudulent billings, and conflicts of interest in the supplier and user chain.
Information obtained over the hotline may also provide valuable insight into management practices and operations, whether reported problems are actual or perceived. This means that issues raised by staff, contractors, residents, or family members, whether they deal with illegal activity or not, can all be of great value in helping guide the facility toward overall best practice.
Examples of issues which could be raised in this manner might be the way in which staff are treated, breakdowns in the facility’s logistical supply chain, examples of favoritism, or any of a host of non-criminal issues which may hinder the facility’s operations.
In addition, hotline reports may reveal failures in company policies, such as security breaches, inadvertent understaffing, and other administrative issues. If left uncorrected, these types of issues may later take on more severe ramifications, as any action which might negatively affect the care given to residents can be construed as fraud, waste, and abuse by the OIG.
It is also important to ensure that the hotline reporting facility is available on a 24-hour basis, and that there is always a quick and thorough response to any allegation.
Finally, the principle of non-retaliation has to be an established part of the reporting process. Any employee, resident, contractor, or resident’s family member must be completely assured that raising allegations of any type of breach will not result in the victimization of the person making the report.
