Compliance Today

  1. Meet Betsy Wade: A lifelong learner

    Compliance Today - December 2020  | Author: Debbie Troklus  | December 2020 

    DT: Thanks for taking the time to be interviewed for Compliance Today. What is your background, and how do you feel it has prepared you to work in compliance?...

  2. Is your telehealth environment ready for 2021?

    Compliance Today - December 2020  | Author: Carol L. Amick  | December 2020 

    As all of us can attest, 2020 has been a unique year, one that we are unlikely to ever forget! When you think about that time-honored interview question, “Where do you see yourself in five years?” I don’t think anyone can say they expected to be dealing with a pandemic that could have significant changes in the delivery model for healthcare for the future...

  3. Investigating violations of your organizational code of conduct

    Compliance Today - December 2020  | Author: Christine Davenport  | December 2020 

    Most organizations have a code of conduct, but have you thought about your code in relation to conducting investigations of issues that may have been reported via your hotline? The principles established in your code could be particularly significant when investigating an allegation related to human resources (HR). Although compliance professionals have a tendency to immediately turn to regulations (which is a good place to start), often your own internal organizational documents provide a lot of useful guidance as well...

  4. Challenges of maintaining compliant provider arrangements during and after a public health emergency

    Compliance Today - December 2020  | Authors: William J. Spratt, Jr., Danielle C. Gordet  | December 2020 

    The COVID-19 pandemic has required many healthcare providers to enter quickly into new or modified arrangements for the delivery of essential healthcare goods and services. Some of these arrangements may conflict with the Stark Law (Section 1877 of the Social Security Act) and its regulations and may expose providers to administrative sanctions by the Office of Inspector General (OIG) pursuant to the federal Anti-Kickback Statute (AKS). In response to the unique circumstances of the pandemic, the secretary of the Department of Health & Human Services (HHS) and the OIG published temporary waivers[1] and a policy statement[2] to provide compliance assistance...

  5. Trust the numbers: Risk-based work prioritization for compliance programs

    Compliance Today - December 2020  | Authors: Chris A. Gideon, Jessica A. Luna  | December 2020 

    The role of compliance in overall company risk management is expanding now more than ever. We are being asked to do more, know more, and help with more; the line of what our role is as compliance versus the role of operations is blurring. Simultaneously, we are expected to deliver on government and industry guidance by creating a compliance program that is, by all accounts, effective at protecting the business, ensuring compliance with applicable laws and regulations, and setting the business up for success...

  6. Turning the page on 2020 for HCCA

    Compliance Today - December 2020  | Author: Gerry Zack  | December 2020 

    The year 2020 won’t be remembered fondly by many people. We’ve been enduring the health and economic effects of a pandemic, social unrest, and, here in the United States, devastating wildfires throughout the western part of the country. It’s been so bad that we now see “2020” used as a verb, often followed by the word “it.”...

  7. Can you see the big picture?

    Compliance Today - December 2020  | Author: Catherine Boerner  | December 2020 

    I am not sure how you measure or interview to find out how well you or someone else can see the big picture. I have been told by professional recruiters that very few people are really good at it. A compliance team working together, with a variety of strengths and weaknesses, can be amazing if they are able to lean on each other and at least one team member is good at seeing the big picture...

  8. Onboarding new compliance professionals during the COVID-19 pandemic

    Compliance Today - December 2020  | Author: Margaret Hambleton  | December 2020 

    Effective onboarding of new employees is one of the keys to employee engagement, success, and retention. Employee onboarding is different from employee orientation in that onboarding is the process of integrating the employee into the organization. Orientation, on the other hand, is acquainting the employee with the organization’s policies, procedures, mission, vision, and values. Onboarding new compliance professionals takes special care in that they require integrating with many other functions of the organization to build trust and credibility. Given the current challenges in the workplace, it is critical to support new compliance professionals to help them be effective in their...

  9. Emergency preparedness: The never-ending story

    Compliance Today - December 2020  | Author: Nancy J. Beckley  | December 2020 

    December signals the end of the year and sets the stage for the coming year. December is the ideal month to wrap up 2020 compliance processes, conduct a compliance program effectiveness review, update the compliance risk assessment, set the stage for the 2021 compliance program, and conduct another review and update of your emergency preparedness plan...

  10. DME monitoring

    Compliance Today - December 2020  | Author: John Falcetano  | December 2020 

    Durable medical equipment (DME) is a risk concern for any DME supplier. In fact, there is specific compliance program guidance for DME provided by the Office of Inspector General. The Office of Inspector General’s Compliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics and Supply Industry provides both general and specific guidance as to various internal anti-fraud and abuse controls suppliers can voluntarily implement.[1] The guidance identifies and discusses compliance risk areas that are susceptible to fraud and abuse that compliance professionals can monitor...

  11. Leverage resiliency during challenging times

    Compliance Today - December 2020  | Author: Jay P. Anstine  | December 2020 

    I don’t have to tell you the work you do is difficult. Whether it is responding to unexpected issues, navigating complex or political ones, or managing competing high-risk deadlines, each day our ability to stay positive is fired upon from multiple vantage points. Now there’s a global threat making our ability to be resilient even more challenging. In October, I focused on the individuals we serve. This month, I want to focus on another individual—you. In order to ensure your own career longevity, focus on your resiliency skills. In the spirit of getting you to ponder what resiliency looks like...

  12. Compliance and top management: One team or grudge match?

    Compliance Today - December 2020  | Author: Kim P. Danehower  | December 2020 

    As a compliance professional, you are sometimes greeted with groans or comments such as, “Oh no, compliance is here. Everyone, straighten up!” followed by a huge laugh. Other times, compliance may be seen as the only barrier to a manager’s latest pet project getting off the ground. It is a fair guess that this has happened at least once in every compliance professional’s career...

  13. Compliance for medical facilities in the age of COVID-19

    Compliance Today - December 2020  | Author: Donn Herring  | December 2020 

    The core message of compliance is fairly simple: Follow the rules...

  14. Fraud and abuse risks associated with research misconduct

    Compliance Today - December 2020  | Authors: Laura J. Campbell, R. Patrick Weitzel  | December 2020 

    Research misconduct proceedings focus primarily on fabrication, falsification, and plagiarism in scientific and medical research; research practices that seriously deviate from commonly accepted methods within the relevant scientific community may also yield research misconduct concerns. (Honest errors or differences in interpreting data do not constitute research misconduct. Research is not limited to published data; it also includes proposing, conducting, and recording research.)...

  15. Rethinking conflict of interest training

    Compliance Today - December 2020  | Author: Stacy Pritt  | December 2020 

    As part of a robust corporate compliance program, many organizations will require periodic disclosures of financial interests and relationships, including some familial relationships and certain outside activities, from board members, senior leaders, and other designated employees. For healthcare-centric organizations, such as large multidisciplinary healthcare providers and academic medical centers, researchers, faculty, physicians, advanced practice providers, and other key personnel must also periodically disclose their financial interests to the organization...

  16. The future of telehealth may hinge on healthcare compliance

    Compliance Today - December 2020  | Author: Mike Braham  | December 2020 

    Even though telehealth technologies and services have been around for years, widespread adoption among healthcare providers and patients has been relatively slow. However, what was once thought to be a five-year horizon for pervasive telehealth adoption by both physicians and patients was transformed in just five weeks during the rise of COVID-19. As the need for patients to see their doctors, therapists, and other healthcare practitioners remotely has become a necessity, the future of telehealth moved to now—and the future of compliance in healthcare will depend on how well remote patient services are implemented today...

  17. Report finds some Medicare risk assessments may be profit driven

    Compliance Today - December 2020  | Author: Sascha Matuszak  | December 2020 

    A recent report[1] released by the U.S. Department of Health & Human Services Office of Inspector General found that billions in Medicare payments were paid out for risk assessments performed by third parties, often in-home assessments, which may have exaggerated risks and not resulted in more care...

  18. SEC issues final rule on whistleblower provisions

    Compliance Today - December 2020  | Author: Sascha Matuszak  | December 2020 

    On September 23, the United States Securities and Exchange Commission (SEC) published its final rule[1] on several questions regarding the agency’s whistleblower program. Among the rulings were a rejection of a change that would have limited payouts on very large fraud cases, the removal of all internal whistleblower protections offered by the SEC, and a restriction of “related action” cases in which whistleblowers could receive rewards from more than one agency...

  19. CMS set to implement hospital price transparency rule

    Compliance Today - December 2020  | Author: Sascha Matuszak  | December 2020 

    The Centers for Medicare & Medicaid Services (CMS) will implement hospital transparency rules on January 1, 2021. The agency has released a final rule,[1] guidance,[2] and answers to frequently asked questions[3] to help hospitals get compliant with the new rule. Additional resources are available on the agency’s dedicated page...

  20. Blue Cross Blue Shield nears settlement for $2.7 billion

    Compliance Today - December 2020  | Author: Sascha Matuszak  | December 2020 

    The Blue Cross Blue Shield insurance group has negotiated a possible settlement to sweeping antitrust lawsuits that alleged the group benefited from anticompetitive measures that included carving up markets between the group’s many partners and companies. The $2.7 billion settlement[1] still requires approval from 36 member companies before being signed off by a judge...

  21. Meet Mary Jo Gray: The pandemic drill

    Compliance Today - November 2020  | Author: Adam Turteltaub  | November 2020 

    AT: Usually when I do an interview, I sort of walk through the person’s career, but I want to start with both your beginning and where you are today. You began your career in healthcare during the AIDS crisis and were right in the middle of it, working at the New York City Health and Hospitals Corporation – Bellevue Hospital Center. And now here you are in another healthcare crisis with a communicable disease. There are a lot of parallels in terms of having to treat a deadly disease while trying to understand it and a healthcare system trying desperately...

  22. Using the seven elements as a common framework for effective compliance and quality programs

    Compliance Today - November 2020  | Authors: Mary Findley, Jennifer Rabaglia, Kathleen Murphy  | November 2020 

    Anyone who has been engaged over time in the healthcare quality and safety (quality) debate has probably come to the same epiphany: If you have seen one quality program, you have seen just that—one quality program. Quality, by its very nature, is somewhat subjective. Fundamentally, quality is defined as an assurance that the care provided meets or exceeds best practices or nationally recognized professional standards. Countless medical professionals have spent much of their careers trying to appropriately define those professional standards, or identify those best practices, so that they can be objectively measured. But quality is not just a set...

  23. The importance of due diligence in healthcare

    Compliance Today - November 2020  | Authors: Hailey Marsh, Jean Acevedo  | November 2020 

    Due diligence is defined by the Merriam-Webster dictionary as “research and analysis of a company or organization done in preparation for a business transaction.”[1] In reality, due diligence is so much more complex than just that definition, especially when it comes to the healthcare setting. Healthcare is unique in that there are multiple different risk areas, which many who are not familiar with the business side of healthcare would not know about. And, with the increasing number of private equity firms investing in varied healthcare sectors, we see the results of this naveté with increasing frequency. Due to these factors,...

  24. Emergency preparedness: Medicare and Medicaid provider and supplier requirements

    Compliance Today - November 2020  | Authors: Michael Kotch, Jan Elezian  | November 2020 

    Is your organization’s emergency preparedness plan current, tested, and functioning? Earlier this year, the Department of Health & Human Services (HHS) added auditing of organizational plans for emergency preparedness planning, which now includes emerging infectious disease preparedness planning, to its Work Plan.[1] Centers for Medicare & Medicaid Services (CMS) plans to audit internal controls over hospital preparedness for an emerging infectious disease epidemic, such as coronavirus disease 2019 (COVID-19), along with hospital compliance and CMS’s emergency preparedness requirements.[2] Hospitals that participate in the Medicare program must comply with federal participation requirements, including requirements that hospitals engage in all-hazards emergency preparedness...

  25. HIPAA at home: Remote workers and the Security Rule

    Compliance Today - November 2020  | Author: Nick Weil  | November 2020 

    As the COVID-19 pandemic continues throughout the country and the world, most employers have elected (or been directed) to send nonessential personnel home to work remotely. With the high uncertainty about when a vaccine will be available and how effective it will be,[1] it is safe to say remote work will be a short- to medium-term reality at least. It may also be a long-term reality; public health necessity could accelerate a preexisting trend toward telecommuting across all industries and all sectors. For months and years to come, compliance professionals should be prepared to answer questions and develop protocols for...