Components of an Effective Healthcare Compliance Program

Compliance Officers are often the firefighters in healthcare organizations. Their value comes from their ability to predict and quell internal issues that have a multitude of ramifications (HR, Revenue Cycle Management, Compensation Structures, Licensing, Vendor Partners, Internal Audit).

Compliance Officers' responsibilities permeate the organization from the Board of Directors to front-line employees. In order for them to be effective they must be able to off-load work that involves:

– Complex, unique and time-consuming document drafting,

– Redundant and repetitive document drafting,

– Independent Reviews involving Code of Conduct, Reports and Disclosures,

– Tackle Conflicts i.e. investigations and sometimes litigation continuing in the outside world.

These are highly time-consuming tasks, that Compliance Officers do not have time for while they are steering a ship. This is where Healthcare Law Partners can be most helpful, and earn your business.

As a Compliance Officer, you may have a desire to:

  1. Update or Improve your Standards, Policies and Procedures and document review processes;
  2. Identify high-risk and low-risk areas of compliance; implement internal audit findings to be compliant with Stark Laws, Anti-Kickback Rules, and HIPAA, HITECH, OSHA, EEOC; 
  3. Critically evaluate particular arrangements, transactions or activities, and related disclosures.  

The healthcare triangle is tricky to navigate and ever-changing. Outside counsel can help you deliver what you promised the operations team.

The Essential Components of a Healthcare Compliance Program are:
1) Standards and Procedures
2) Oversight and Accountability
3) Education and Training
4) Monitoring and Auditing
5) Reporting
6) Enforcement and Discipline
7) Response and Prevention

Contracts and issues requiring independent critical compliance review often include:

  • Physician Employment Agreements
  • Management Services Organization Agreement
  • Accountable Care Organization Agreement
  • Provider-Related Party Employment or Vendor Agreements
  • Use of Non-Competition Covenants in Physician Employment Agreements
  • Hospital Joint Ventures and Co-Management Arrangements Stark Law and Stark Law Exceptions
  • Personal Services Arrangements
  • Code of Conduct
  • Standards and Procedures
  • Compliance Audit and Review Procedures
  • Fair Market Value Reports for Services Rendered
  • Rental of Office Space and Equipment, Timeshares and Leases
  • Medicare Shared Savings Programs – ACO's and ACO Waivers
  • Self-Referral Disclosure Protocol
  • Anti-Kickback Statutes and Safe Harbors
  • Civil Monetary Penalties
  • HIPAA and Privacy Rules and Regulations
  • Telemedicine
  • Mergers and Acquisitions – Partnership Buy-In and Buy-Out
  • Sale and Purchase of Medical Practice
  • Tax Implications in M&A Activities, and in selection of an Entity
  • Practice Breakups and Physician Departures
  • Reimbursement of Physician Services
  • Physician-Hospital Relationships – Medical Staff
  • Hospital Privileges and Disciplinary Actions
  • Professional Liability Insurance and Risk Management
  • Physician Joint Ventures and Co-Management Arrangements
  • Use of Non-Competition Covenants in Physician Employment Agreements
  • Physician Recruiting Agreements
  • Hospital Ancillary Services
  • In-office/Hospital Dispensing of Drugs
  • Concierge Care

The effectiveness of a Compliance Program begins with its stewardship, and the Compliance Officers lead the charge.

To find out more on how you can put Ben's team to work for you, click call/ text at 954-634-2370.