Business
Anyone involved in healthcare financial
issues should be clear about the risks of not having an effective
compliance program in place. The Office of Inspector General's
website is an excellent source of information. Its Electronic
Reading Room may be found at http://www.hhs.gove/progorg/oig/
on the internet.
At the same time, are our vendors ready
for compliance? Reducing costs has supplanted increased reimbursement.
Outsourcing is often a reasonable way to lower costs and still
maintain quality services. Outsourcing, however, does not relieve
our organizations from compliance responsibilities even when contractors
provide the function/role/service on our behalf.
The independent agent has liabilities,
but our organization's liabilities remain, too. Federal sentencing
guidelines are sobering.
They define "agent" as any individual,
including a director, an officer, an employee or an independent
contractor, authorized to act on behalf of the organization. Many
of our vendors are exposed to compliance issues. Due diligence
involves asking these kinds of questions about the outsourcing
businesses we use: Is there a valid, functioning compliance program?
Are any employees barred from the Medicare program? Has the company
or employees engaged in illegal activities?
Below are 11 points to think about when
contracting with outsourcing agents:
1) The hospital's policy should make
its compliance program applicable to the outsource contractors
insofar as is practical.
2) The hospital's contractual requirements
should include that the contractors' employees read the hospital's
basic compliance standards and procedures annually.
3) The hospital should maintain a high
level of oversight with contractors to assure adherence to the
hospital's compliance policy. This includes reporting the oversight
results to the compliance committee on a regular basis. Also,
monitor and audit the performance of the contractors' work for
the hospital.
4) In most cases, contractors' compensation
should not be on a contingency basis.
5) Contractors should contractually
agree to establish an effective compliance program within their
organization in a reasonable time period.
6) The hospital should determine that
contractors have adequate staff training on compliance issues.
7) The hospital policy should include
a statement that the hospital will not knowingly contract with
any agent convicted of a healthcare related criminal offense.
8) The hospital should have the right
to terminate contracts where an agent has been convicted of
a criminal offense related to healthcare or has been listed
by a federal agency as debarred, excluded, etc. Such occurrences
should be identified in the contract as material breach and
grounds for immediate termination.
9) In exercising due diligence, the
hospital should document inquiries that validate the agent is
not on the DHHS/OIG Cumulative Sanction Report.
10) The contractor should be obligated
contractually to report promptly all adverse findings of the
contractor's own monitoring of work for the hospital regarding
compliance issues.
11) The hospital should have a policy
to follow up immediately and investigate any adverse findings
discovered by the contractor's compliance program.
The points made here are only for discussion
purposes and not intended as legal opinion. Consult with your
legal counsel to determine the best policies and procedures for
your organization.
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