Delaware County Medicine & Health Spring 2017 - 12

FEATURE

Developing, Implementing
and Maintaining An Effective

PROGRAM
T

he development, implementation and ongoing
maintenance of an effective compliance program
("Program") has become a necessity to protect any
organization participating in the healthcare industry, including even the solo physician practice. This article focuses on
providing practical guidance for physician practices of all
shapes and sizes (each a "Medical Practice Organization," or
"MPO"), recognizing that MPOs are often small, privately
owned businesses, with limited resources (i.e., personnel,
capital) to commit to an effective Program.
At its core, the purpose of a Program is to protect an MPO
by detecting and preventing improper conduct and promoting
adherence to the organization's legal and ethical obligations.
By and large, the Federal Sentencing Guidelines ("FSG")
establish the "gold standard" for an effective Program.
The FSG are closely aligned with the principles set forth in
compliance guidance that the Department of Health and
Human Services - Office of Inspector General ("OIG") has
developed over time for specific segments of the healthcare
industry, including MPOs (the "OIG Guidance").
In general, the FSG impose less stringent criminal penalties
on MPOs that have adopted an effective Program. To qualify
for these less stringent penalties, an MPO must demonstrate
that the design, implementation, and enforcement procedures
of its Program promotes an organizational culture that encourages ethical conduct and a commitment to compliance.
An effective Program demonstrates an MPO's good faith

10 DELAWARE COUNTY MEDICINE & HEALTH

spring 2017

effort to comply with applicable statutes, regulations, and other Federal health care program requirements, and may significantly reduce the risk of unlawful conduct and corresponding
sanctions. It is well recognized that there is no single "best"
or "one-size-fits-all" Program for every MPO, and that no
one factor is determinative of Program effectiveness. There
are, however, several key elements that should exist to have
an effective Program in an MPO, irrespective of specialty or
subspecialty.

Elements of an Effective Compliance Plan
Development of Written Policies and Procedures
The FSG and OIG Guidance both recommend that MPOs
adopt clearly written policies and procedures relevant to the
day-to-day responsibilities of their employees. There are
several vendors who offer templates of such written policies
and procedures. An effective Program, however, only begins
with the adoption of the policies and procedures. These
Program policies and procedures need to be made available
to all employees (i.e., via Intranet). In addition, these Program
documents must be re-evaluated on a periodic, regular basis,
with the assistance of qualified legal counsel. Legal counsel
can also be helpful in developing fairly simple risk assessment
tools to monitor employee compliance, as well as in identifying and assessing weakness and risks areas with the operation
on a regular basis.



Table of Contents for the Digital Edition of Delaware County Medicine & Health Spring 2017

Delaware County Medicine & Health Spring 2017 - 1
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http://www.nxtbook.com/hoffmann/delcomed/DelcoMedicalSocietySummer2019
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietySpring2019
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietyWinter2019
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietyFall2018
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietySummer2018
http://www.nxtbook.com/hoffmann/delcomed/DelcoMedicalSocietySpring2018
http://www.nxtbook.com/hoffmann/delcomed/DelcoMedicalSociety
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietyWinter2017
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietyFall2017
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietySpring2017A
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSociety
http://www.nxtbookMEDIA.com