Compliance Today

  1. Meet Barbara J. Vimont: A lifetime of compliance

    Compliance Today - September 2020  | Author: Charles E. Colitre  | September 2020 

    CC: Barb, before you became involved in compliance, I know you were working in medical records. Tell us about how that transition came about...

  2. The impact of the final ONC and CMS interoperability rules on health information

    Compliance Today - September 2020  | Authors: Michaela Andrawis, Lyra Correa, Miriam Ricanne Swedlow  | September 2020 

    On March 9, 2020, the U.S. Department of Health & Human Services (HHS), through the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS), published separate, but related, final rules implementing the interoperability and patient access provisions of the 21st Century Cures Act (Cures Act).[1] The earliest compliance date for the rules is November 2, 2020,[2] and healthcare entities will find that there is a lot to do between now and then...

  3. Tackling health IT challenges with a proven risk management strategy

    Compliance Today - September 2020  | Authors: Gerry Blass, Jason Tahaney  | September 2020 

    Whether we want to believe it or not, healthcare data breaches are prevalent throughout the industry. Even more alarming, an evaluation of recent cyber and ransomware attacks indicates that the size or type of healthcare organization is immaterial to would-be attackers. Hospitals, clinics, long-term and elderly care providers, dental and optometry practices, plastic surgeons, and medical testing facilities have all experienced cyberattacks since 2016.[1] In fact, a Ponemon Institute study cited that 89% of healthcare organizations have experienced a data breach.[2]...

  4. DOJ updates its guidance on corporate compliance programs

    Compliance Today - September 2020  | Authors: Gabriel Imperato, Anne Novick Branan  | September 2020 

    On June 1, 2020, the Criminal Division of the United States Department of Justice (DOJ) issued an update to its guidance in the Evaluation of Corporate Compliance Programs (Guidance) used by prosecutors to probe corporate compliance programs.[1] DOJ’s Fraud Section first released the Guidance in February 2017,[2] incorporating principles from the DOJ’s Justice Manual. Prior to the 2020 revisions, DOJ revised the Guidance in April 2019, expanding its applicability to the entire DOJ Criminal Division...

  5. A compliance framework for evaluating medical directorship need

    Compliance Today - September 2020  | Authors: Kathryn Culver, Tynan Kugler, Lyle Oelrich  | September 2020 

    Physicians around the country are entering into medical directorship agreements with hospitals, health systems, and other healthcare institutions to fill the important role of medical director. Medical directorship agreements help facilitate an organization’s ability to comply with regulatory and accreditation guidelines; promote the delivery of quality patient care; and provide clinical and administrative leadership to other physicians, clinical staff, and executive management. However, medical directorships continue to face increasing governmental and regulatory scrutiny, such as that demonstrated by the examples of settlements that follow. Healthcare organizations should be aware of key compliance considerations in evaluating the need for medical directorships...

  6. How to communicate your compliance message

    Compliance Today - September 2020  | Authors: Beth Friedman, Rita Bowen  | September 2020 

    Effective communication goes well beyond the basic exchange of information. It requires the ability to listen to others and articulate your message in ways that promote understanding and connection. People want to be heard and understood. As healthcare faces an unprecedented crisis with the coronavirus pandemic, we’re seeing an accelerated movement toward teamwork and industry collaboration...

  7. 'Obedience to the unenforceable'

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

    You may have heard this expression before. It’s been around for many years. The earliest use of it that I could find is in a July 1924 article “Laws and Manners” by John Fletcher Moulton (a.k.a. Lord Moulton),[1] although I am not certain whether he was the first person to use it. It’s been used in many contexts. In 1991, Independent Sector wrote an entire publication on organizational ethics in the nonprofit community based on the concept of obedience to the unenforceable.[2]...

  8. How do we know we are OK? Audit!

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

    One of the best ways to know if everything is OK and in compliance is simply to do audits. I am not talking about a statistically valid sample of 30 or 60 records; I am talking about looking at five random records or picking five that are not random. I guess you could call it monitoring. The whole point is for the compliance department to sit down with directors/managers and discuss the process...

  9. Audits are not corrective action

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

    The risk assessment process includes the following discrete steps: (1) an identification of potential risks (risks are defined as events that could cause harm if realized), (2) an assessment of the severity or impact of the risk, (3) an assessment of how vulnerable the organization is to the risk or how likely the risk is to occur, (4) an evaluation of the current controls in place to prevent the risk, (5) prioritization of the top risks, and (6) development of an action plan to address these top risks. Last month, I discussed the confusion that sometimes occurs when compliance professionals...

  10. Training your newly remote workforce

    Compliance Today - September 2020  | Author: Donnetta Horseman  | September 2020 

    In the face of the COVID-19 pandemic, many organizations have dramatically increased their remote workforce almost overnight. In addition to traditional compliance training topics, we find ourselves having to consider new compliance risks that in the past may not have been top of mind...

  11. From uncertainty to opportunity: The importance of investigations in a compliance program

    Compliance Today - September 2020  | Author: Mike D. Sandulak  | September 2020 

    During these past few months, uncertainty about the impact of current events and their effect on healthcare has dominated concerns in our industry. From wondering how to best protect our employees and patients during a global pandemic to whether there will be another surge of patients entering our facilities seeking care, uncertainty is affecting everyone and the decisions we make. Particularly during these times, an organization’s investigations program plays a vital role in aiding an organization through the uncertainty. Specifically, investigations provide the opportunity to identify new risks and problems early, thoroughly examine and document reports, and assist leadership in...

  12. Compliance monitoring

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

    In this month’s article on monitoring, we’ll focus on compliance monitoring and why it is a key part of any effective compliance program. One of the most important elements of compliance programs is having a process to identify actual or potential noncompliance so that management can take actions to correct the noncompliance and mitigate the risk of reoccurrence. Monitoring is that process...

  13. Changes

    Compliance Today - September 2020  | Author: Kelly M. Willenberg  | September 2020 

    What does change mean to you? One of my favorite definitions is “going from one phase to another.” Over the past six months, we have all experienced the feeling of not being totally prepared for the changes in the spring. Organizations and hospital systems were forced to look at their staff and, in some cases, eliminate positions. People found themselves out of jobs unexpectedly or in a different or modified role. Over and over I heard that the certification in healthcare research compliance (CHRC) was profoundly important to people as they maneuvered the transformation that followed. A national emergency showed...

  14. Compliance as a customer service agent: Divergent interpretations

    Compliance Today - September 2020  | Author: Joanne Freeman  | September 2020 

    One of the seven elements of an effective compliance program is the implementation of written policy, procedure, and standards of conduct.[1] Ethics, a part of conduct standards, is the moral compass of an individual and the principles that govern a person’s behavior. Ethics and morality are also a part of the culture and the systems that determine right and wrong in the workplace. Creating an environment of high ethical values should be the goal and responsibility of every employee and leader in an organization. Compliance leads the charge in “doing the right thing” and sets an example for others...

  15. Dos and don'ts of internal investigations for healthcare organizations

    Compliance Today - September 2020  | Author: Daphne Pierre Bishop  | September 2020 

    In December 2017, a nurse practitioner reported that she smelled alcohol on a physician’s breath during work. The physician was questioned about the incident and placed on an administrative leave pending an evaluation for alcohol abuse through the state medical association. The physician was subsequently diagnosed with alcohol use disorder, completed a treatment program, and returned to work subject to a mandatory five-year monitoring program.[1]...

  16. How to project manage a successful risk adjustment data validation audit

    Compliance Today - September 2020  | Authors: Ahmed Salim, Palak Desai  | September 2020 

    If you’re a Medicare Advantage organization, there are few terms scarier than a Risk Adjustment Data Validation (RADV) audit from the Centers for Medicare & Medicaid Services (CMS). CMS routinely conducts two types of RADV audits:[1]...

  17. Open lines of communication in a skilled nursing facility

    Compliance Today - September 2020  | Author: April Bernabe  | September 2020 

    Many healthcare organizations, including skilled nursing facilities (SNFs), promote an open-door policy where employees feel comfortable approaching their supervisor and reporting any potential problem without fear of retaliation or retribution. In addition to having an open-door policy, healthcare organizations may also advocate following the chain of command when discussing issues ranging from insufficient staffing levels to lack of supplies for delivering care and unfair labor practices. These methods for communication are appropriately given emphasis in the SNF’s general employee orientation, employee handbook, and staff training and education...

  18. Compliance as a quality challenge: Working together to improve the organization

    Compliance Today - September 2020  | Authors: Denise A. Atwood, Nathan J. Ward  | September 2020 

    Under the traditional paradigm, the interests of quality and compliance are divergent. Compliance is a risk-averse function, looking to protect the healthcare organization from litigation, public relations problems, and audit failures. Quality, by contrast, is focused on improvement of patient care. These separate functions and paths can contribute to a siloed mentality...

  19. Survey shows uptick in compliance inquiries during the pandemic

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

    The Society of Corporate Compliance and Ethics & Health Care Compliance Association (SCCE & HCCA) conducted a survey in May 2020 to assess the impact of the COVID-19 pandemic on compliance professionals.[1] The survey found that the pandemic has significantly affected the daily work of compliance professionals, budgets for compliance functions are under pressure, and compliance teams are fielding an increasing number of calls...

  20. Ten defendants charged in billion-dollar healthcare fraud scheme

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

    The United States Department of Justice indicted ten individuals for a pass-through billing scheme that fraudulently billed private insurance approximately $1.4 billion dollars.[1] The individuals were charged for several different crimes, depending on their involvement with the scheme, including conspiracy to commit healthcare fraud and wire fraud, conspiracy to commit money laundering, and substantive money laundering...

  21. Deadline extended for parts of the Interoperability and Patient Access final rule

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

    The Centers for Medicare & Medicaid Services (CMS) adjusted deadlines for certain rules under the Interoperability and Patient Access final rule to account for disruptions caused by the COVID-19 pandemic.[1]...

  22. DOJ and the FTC issue updated vertical merger guidelines

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

    The United States government watchdogs issued new guidelines regarding how federal antitrust agencies will evaluate the impact of vertical mergers on June 30.[1] The new guidelines are the first revisions since the 1984 Non-Horizontal Merger Guidelines and mark the first time the Federal Trade Commission and the Department of Justice (DOJ) have jointly issued guidelines on antitrust issues...

  23. Meet Gabriela Behn: Prioritizing healthcare access

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

    MH: Compliance programs in public entities are very different from nonpublic entities in many ways and very similar in other ways. Can you tell our readers about your background, your current position at San Mateo Medical Center (SMMC), and how you developed your compliance program to address the unique risks for a public safety net hospital?...

  24. Helping organizations achieve compliance in the wake of the coronavirus

    Compliance Today - August 2020  | Authors: Kimberly Gillespie, Henry C. Fader  | August 2020 

    In response to the COVID-19 pandemic in the first half of 2020, the healthcare industry responded on many levels to help communities and save lives. To support this extraordinary effort, federal and state governments released numerous guidelines, directives, rules, Q&As, and regulations to remove barriers standing in the way of patient care at a time of national crisis. Many of these initiatives relaxed or countermanded policies, procedures, and accrediting standards, in all levels of care, including hospitals, skilled nursing facilities, and telehealth. Over time, however, we expect many of these initiatives to further morph and/or unwind. This will be challenging...

  25. Where do I fit in? The role of the CCO in a pandemic

    Compliance Today - August 2020  | Author: Joshua A. Boxer  | August 2020 

    Being a chief compliance officer (CCO) can sometimes be a thankless job. CCOs can be perceived as “police,” “internal affairs,” and “deal killers” by colleagues. “Here comes compliance.” CCOs know that this is generally untrue. Personally, I take offense to such stereotypes, although I understand the root of such thoughts. I pride myself on being a practical, business-minded CCO. While I am not afraid to take an unpopular opinion, my go-to problem-solving method is resolving compliance inquiries in a collaborative and amicable fashion. Obviously, it is not always possible. Compliance with healthcare regulations and business strategy are not mutually exclusive,...