Compliance Today

  1. Meet LaQuenta Clarke: A compliance 'ROCK' star

    Compliance Today - January 2021  | Author: Adam Turteltaub  | January 2021 

    AT: Thanks for taking the time to talk with us. You serve as corporate compliance manager for Shriners Hospitals for Children. Before we start exploring your work there, I think it would be good if you could tell people a bit about Shriners. Can you give us some background on the organization?...

  2. Healthcare compliance investigations during a global pandemic

    Compliance Today - January 2021  | Authors: Alyssa Lawrence, Hannah Kent  | January 2021 

    Alyssa S. Lawrence (alyssa.lawrence@miami.edu) is Senior Director, Compliance, and Hannah G. Kent (hannah.kent@miami.edu) is Compliance Specialist at University of Miami Health System in Miami, FL...

  3. Compliance investigation and reporting in skilled nursing facilities

    Compliance Today - January 2021  | Author: April Bernabe  | January 2021 

    The nursing home industry is subject to numerous federal and state statutes, rules, and regulations, and skilled nursing facilities (SNFs) are required to investigate and report occurrences and events that meet defined criteria. Federal and state criminal and civil enforcement actions related to substandard quality of care can also lead to various governmental investigations. SNFs that have an established compliance and ethics program that includes robust investigation and reporting are in a better position of meeting fiduciary duties to provide quality care while navigating the challenges of evolving regulatory and enforcement actions...

  4. The ABCs of an effective investigative process: Part 1

    Compliance Today - January 2021  | Authors: Ahmed Salim, David M. Rapasadi, Palak Desai  | January 2021 

    Investigations are essential to running an effective compliance program. A well-defined investigation sets forth how individuals report potential compliance concerns and mentions any remedial measures once the investigation has concluded. These practices also create a culture of compliance within an organization by assuring employees and surrounding community members. The organization’s commitment to corporate integrity and creating a thorough investigative process can be challenging and exhaust a number of limited resources. In order to create a strong investigative process, an organization should look internally to determine what processes they have in place and whether any new processes should be implemented...

  5. Ten compliance concerns related to information blocking

    Compliance Today - January 2021  | Authors: Josh D. Mast, Cheri Whalen  | January 2021 

    While information blocking was solidified as a legally defined term and compliance effort in the 21st Century Cures Act of 2016,[1] it wasn’t until the Office of the National Coordinator for Health Information Technology (ONC) released the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program final rule that the industry received a framework on which to base compliance efforts.[2] Currently, compliance dates are April 5, 2021, for requests related to data elements in the U.S. Core Data for Interoperability (USCDI) version 1 and October 6, 2022, for all electronic health information (EHI).[3]...

  6. New year, new address for HCCA

    Compliance Today - January 2021  | Author: Gerry Zack  | January 2021 

    Think of this month’s letter as part two of the letter I started last month. As we begin 2021, many of us are optimistic that better days lie ahead. When the COVID-19 pandemic became a serious threat last March, we did what many organizations did; we made a lot of quick decisions to protect our employees and our members, resulting in a remote workforce, the cancellation of in-person conferences, and gradual conversion to or development of virtual events. I discussed many of these changes last month...

  7. 'Help me prove we are doing this right'

    Compliance Today - January 2021  | Author: Catherine Boerner  | January 2021 

    I like to approach compliance audits with the “Help me prove we are doing this right” mindset. I think gathering information from various departments or seeking help understanding how a process works can go much smoother when you are asking employees at various levels of the organization to help...

  8. The year ahead

    Compliance Today - January 2021  | Author: Margaret Hambleton  | January 2021 

    Happy New Year!...

  9. New year, new training

    Compliance Today - January 2021  | Author: Donnetta Horseman  | January 2021 

    2020 has finally come to an end. Although it is a year we will likely never forget, it is time to look forward to a new year and a fresh start. There is no better time to review and refresh your organization’s compliance and ethics training. Below are a few tips to start the year off on the right foot...

  10. Self-monitoring

    Compliance Today - January 2021  | Author: John Falcetano  | January 2021 

    One thing many compliance professionals never think of monitoring is themselves. Since my first compliance conference more than 20 years ago, I have had the pleasure to interact with thousands of compliance professionals. One common trait compliance professionals seem to have is that they are constantly working, even when off the clock. Compliance professionals constantly worry about potential compliance concerns, employee complaints, hotline calls, compliance audit findings, pressure to perform, and a never-ending workload. Today, COVID-19 has been added to the list, and working remotely has become the new normal...

  11. I am Batman

    Compliance Today - January 2021  | Author: Kelly M. Willenberg  | January 2021 

    Effectively communicating with your connections is an important part of engaging team members and customers. Finding the best way to show emotion is a universal challenge for all of us right now, as we are working via technology or with a mask on. Some of these challenges of communicating emotion with a face mask on were described in The New York Times in June.[1] Those interviewed for the article lamented about how face masks make the ability to convey facial expressions problematic, prompting one to find alternate ways to communicate positively. Nonverbal cues, such as using eye contact or body...

  12. Planning and preparing to conduct the investigation

    Compliance Today - January 2021  | Author: Mike D. Sandulak  | January 2021 

    Based on my experiences as an investigator working in both the public and private sectors, one key takeaway I learned was that there is no way to conduct the perfect investigation. You can spend countless hours working on a case, but regardless of your good efforts, mistakes can be made. However, with the proper planning and preparation, the likelihood of these mistakes and their potential risks to your organization can be significantly reduced...

  13. Driving compliance efficiency through enterprise cyber risk management

    Compliance Today - January 2021  | Author: Bob Chaput  | January 2021 

    The business case for cyber risk management is clear. A cyber incident can lead to consequences that threaten the care and safety of patients. Cyber incidents can also result in financial, reputational, compliance, and legal consequences that threaten the viability of an organization. Healthcare organizations have begun to understand that cyber risk management is a critical part of overall enterprise risk management. That is why many healthcare organizations are establishing enterprise cyber risk management (ECRM) programs...

  14. Understanding the power of habits and how it may drive noncompliant behavior 

    Compliance Today - January 2021  | Author: William E. Lucas  | January 2021 

    Do you consistently find reoccurring compliance deficiencies in your organization? Have you ever considered staff habits as the reason you may continue to see repeated noncompliant behavior?...

  15. Emerging ERM lessons from COVID-19: Considerations for compliance officers and managers of risk

    Compliance Today - January 2021  | Authors: Jeffrey Driver, Sarah Couture  | January 2021 

    For months, our world, our country, our healthcare systems, and our lives have been drastically altered by the COVID-19 pandemic. It has been impossible to hide from the realities of the pandemic as news, social media, and conversations with friends and colleagues have frequently centered on the continuously developing COVID-19 stories. At the same time, our healthcare systems have not been able to hide or be sheltered from the course-altering effects of the pandemic. Healthcare providers around the country have been rocked in multiple ways, including their financial health, their ability to take care of patients, and the new normal...

  16. HHS guidelines address racial disparities in COVID-19 testing and treatment

    Compliance Today - January 2021  | Authors: Jeremy P. Burnette, Sidney S. Welch  | January 2021 

    The year 2020 will certainly be remembered for at least two events: the COVID-19 pandemic and the far-reaching and sustained movement against racial inequality in America. These two events metaphorically intersect in guidance from the U.S. Department of Health & Human Services (HHS) Office for Civil Rights (OCR) designed to help providers ensure that their COVID-19 testing and treatment services do not discriminate on the basis of race, color, or national origin...

  17. A proactive and targeted approach to billing audits

    Compliance Today - January 2021  | Authors: Sheva Sanders, Jessica Wheeler, Habib Ilahi  | January 2021 

    Incorrect billing to government programs, such as Medicare and Medicaid, can result in substantial liability under the federal False Claims Act (FCA).[1] Any person found to violate the FCA is liable for treble damages plus a civil penalty between $5,000 and $10,000, adjusted for inflation, per claim, and each line item submitted to the government may constitute a separate claim. Appropriate use of billing audits can help you avoid the submission—or allow the timely correction—of incorrect and, at least potentially, false claims. However, in our experience, many companies conduct billing audits only as a response to a crisis. A more...

  18. Physician sentenced to prison for fraud that led to deaths

    Compliance Today - January 2021  | Author: Sascha Matuszak  | January 2021 

    A Houston-area physician was sentenced to seven years in prison for healthcare fraud that resulted in the deaths of multiple patients due to opioid overdoses, as well as the death of an entire family in a car accident involving one of the patients...

  19. Citigroup pays $400 million and must overhaul internal controls

    Compliance Today - January 2021  | Author: Sascha Matuszak  | January 2021 

    Just a few months before Jane Fraser takes over as chief executive officer—the first woman to run a major Wall Street bank[1] —Citigroup agreed to pay $400 million to settle an Office of the Comptroller of the Currency (OCC) investigation of its risk management and internal controls processes...

  20. HHS enforces patients' right to access medical records

    Compliance Today - January 2021  | Author: Sascha Matuszak  | January 2021 

    The Office for Civil Rights (OCR) at the U.S. Department of Health & Human Services (HHS) has been vigorously enforcing patients’ right to access their medical records under the Health Insurance Portability and Accountability Act (HIPAA).[1] According to an October 9 notice, the OCR has settled nine such investigations in its HIPAA Right of Access Initiative.[2]...

  21. Cybersecurity agency issues alert for healthcare facilities

    Compliance Today - January 2021  | Author: Sascha Matuszak  | January 2021 

    The newly created Cybersecurity and Infrastructure Security Agency issued a joint alert with the Federal Bureau of Investigation and the U.S. Department of Health & Human Services regarding “an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers.”[1]...

  22. 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?...

  23. 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...

  24. 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...

  25. 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...