Regulatory Compliance Project

Scenario

You are a compliance officer at City Hospital, an acute care hospital located in a major metropolitan area. City Hospital has recently opened a new branch and is in the process of onboarding new staff. As a compliance officer, you are responsible for ensuring that new members of City Hospital’s staff understand the role and importance of regulatory compliance in healthcare organizations. For part of this responsibility, you will be designing a presentation to inform new staff about the importance and purpose of regulatory compliance.

Directions  

For this project, you will create a compliance presentation to educate new staff members at City Hospital on compliance programs and compliance audits. Specifically, you will address the purpose of compliance programs, the various roles and organizations that interact with compliance programs, the seven elements of a compliance program, and the ramifications of compliance audits for healthcare organizations.

Specifically, you must address the following:

  • Compliance Fundamentals: To begin your presentation, you have decided to acquaint new staff members with the fundamentals of corporate compliance in healthcare. In describing these fundamentals, be sure to address the following:
    • Identify and define the seven required elements of a healthcare compliance program. In your description, answer the following:
      • What are the seven elements of a compliance program, as listed by the Office of the Inspector General?
      • For each element of the compliance program, briefly describe why it is necessary to a compliance plan.
    • Describe the purpose and importance of a compliance program within a healthcare organization. In describing the purpose of a compliance program, answer the following:
      • What is the role of the Office of the Inspector General for ensuring quality within a healthcare organization?
      • What is a compliance program risk assessment, and why is it critical to the success of a compliance program?
    • Explain the role of a compliance officer within a healthcare organization.
  • Compliance Functions: As a compliance officer, you understand that compliance plans serve several key functions within healthcare organizations. In this part of your presentation, you will specifically address the following functions:
    • Describe the elements of a compliance program that address prevention, detection, and correction of fraud. In describing these elements, answer the following:
      • How do policies and procedures lead to the prevention of fraud, waste, and abuse?
      • How do monitoring and open lines of communication lead to fraud detection?
      • How do corrective action plans and prompt responses lead to correcting fraud?
    • Describe the elements of a compliance program that allow organizations to be proactive versus reactive. In selecting these elements, answer the following:
      • What is the internal audit function of a compliance program?
      • What is a whistleblower policy?
  • Compliance Audits: As your organization will soon be undergoing a compliance audit, your manager has asked you to specifically explain the ramifications of a compliance audit. In describing this audit, be sure to address the following:
    • Explain the purpose of a compliance audit within a healthcare organization.
    • Describe the purpose of coding compliance in healthcare organizations. In your description, answer the following:
      • What are the consequences of noncompliant coding?
      • What is the False Claims Act, and how is it related to coding compliance?
    • Identify how proper documentation supports compliance plans.

What to Submit

Compliance Presentation
Your compliance presentation will describe the fundamental elements of a compliance program and explain the ramifications of audits within your healthcare organization. Your presentation should consist of 8 slides, with accompanying speaker notes.

Sources 

https://www.healthtechs3.com/wp-content/uploads/Field-Guide-to-Healthcare-Compliance-Manual-FINAL-01062016_55pgs.pdf

https://www.natlawreview.com/article/seven-elements-effective-compliance-program

https://www.medpro.com/documents/10502/2837997/Guideline_Developing+an+Effective+Compliance+Program.pdf

KUSSEROW, R. P. (2017). Ineffective Compliance Programs. Journal of Health Care Compliance, 19(1), 47–56.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MedCandDGenCompdownload.pdf

https://oig.hhs.gov/documents/provider-compliance-training/945/Compliance101tips508.pdf

https://www.federalregister.gov/documents/2000/10/05/00-25500/oig-compliance-program-for-individual-and-small-group-physician-practices#print

https://www.ecri.org/components/CCRM/Pages/LegReg6.aspx?PF=1%3Fsource=print

SHEEDER, F. (2018). Define Your Role in Your Organization: Know Who You Are and Develop Attributes that Enhance Your Credibility and Value. Journal of Health Care Compliance, 20(4), 53–68.

Are You Starting Out As A Healthcare Compliance Officer?

https://oig.hhs.gov/documents/provider-compliance-training/942/ListofComplianceResourcesHandoutBR508r1.pdf

https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/index.html

Fleming, C. A., Humm, G., Wild, J. R., Mohan, H. M., Hornby, S. T., Harries, R. L., Fitzgerald, J. E. F., & Beamish, A. J. (2018). Supporting doctors as healthcare quality and safety advocates: Recommendations from the Association of Surgeons in Training (ASiT). International Journal of Surgery, 52, 349–354.  

Kern, S. I. (2010). FCA compliance plan can help protect practice. Medical Economics, 87(7), 31. https://link.gale.com/apps/doc/A227652790/AONE?u=nhc_main&sid=bookmark-AONE&xid=6509e8ee

https://www.whistleblowers.gov/

https://www.dol.gov/general/topics/whistleblower

Romeo, J. (2017). Healthcare Data Compliance: Maintaining Integrity, Privacy and Security. Security: Solutions for Enterprise Security Leaders, 54(3), 34–36.

https://assets.hcca-info.org/Portals/0/PDFs/Resources/ResourceOverview/oig-hcca-roundtable.pdf?ver=2017-03-28-062709-153

O’Donnell, J. (2015). The Role of an Internal Auditor. Journal of Health Care Compliance, 17(6), 11–53.  

KUSSEROW, R. P. (2018). Ongoing Auditing of the Compliance Program: Compliance Officers Should Not Ignore This Standard. Journal of Health Care Compliance, 20(3), 53–56.

Wiedemann, L. A. (2017). Are You Ready for a HIPAA Audit? Journal of AHIMA, 88(4), 26–27.

https://library.ahima.org/doc?oid=58837#.YjjChXrMLMa

https://www.beckershospitalreview.com/finance/3-steps-hospitals-must-take-with-their-coding-compliance-policies.html  https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/smd032207att2.pdf

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