What is a Corporate Integrity Agreement? - A negotiated settlement between an
organization and the government in which the provider accepts no liability but must agree to
implement a strict plan of government-supervised corrective action.
What is the Health Care Fraud and Abuse Control Program?
When was it established?
What law mandated its creation? - It's a program that coordinates federal, state, and
local law enforcement activities to combat fraud and abuse in the healthcare sector.
1997.
HIPAA.
HHS OIG issued "Practical Guidance for Health Care Governing Boards on Compliance Oversight" in
what year?
What law outlined the use of exclusion from federal health programs? - 2015.
Social Security Act.
OIG and HCCA issued "Measuring Compliance Program Effectiveness - A Resource Guide" in what
year? - 2017.
What are the benefits of a compliance program? - * Good corporate conduct and
quality of care.
* Protects patient rights and privacy.
* Detects criminal and unethical conduct.
* Centralized resource for info. on healthcare regulations.
* Encourages reporting w/o retaliation.
* Allows for prompt/thorough investigations.
* Initiates in RCAs and CAPs.
* Reduces exposure to:
-civil damages and penalties
-sanctions
-administrative remedies.
-CIAs and government exclusions
Why are effective compliance programs essential? - 1. Protect the organization's
reputation.
2. "Doing the right thing."
3. Raise awareness - employees can report anonymously.
4. Keeps employees accountable.
5. Detect non-compliance early and reduce risk of fines and penalties.
More reasons to implement a compliance program! - * Demonstrate commitment to
honesty/corporate citizenship.
* Cost-effective.
* Provides procedures to identify and correct misconduct.
* May protect corporate directors from liability.
What are the risks of not having a compliance program? -
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