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Compliance: Why you should care, now

Posted by Margaret Scavotto, JD, CHC on 2/10/12, 3:56 PM

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Currently, SNFs are not required to have compliance programs. That's about to change. On March 23, 2013, the Patient Protection and Affordable Care Act (also known as the health reform law) takes the government's compliance recommendation and makes it mandatory. SNFs without compliance programs will soon be unable to participate in Medicare and Medicaid.

Even before these deadlines are implemented, a SNF without an effective compliance program has a greater likelihood of violating laws such as the False Claims Act and the Anti-Kickback Statute. These violations can be penalized with exclusion from Medicare and Medicaid, thousands of dollars in fines, and prison time-not to mention the bad publicity and damage to your reputation.

Mandatory compliance will be here sooner than you think.

The OIG recommends making compliance a priority now-and they're right: it can take a year to implement an effective compliance program. MPA has put together some tips to help you use 2012 to prepare for the impending compliance deadline:

  • Take initiative-more offense means less defense.When the OIG shows up at your door to investigate, it's too late. Defending an OIG investigation or lawsuit can be an enormous expense. SNFs with effective compliance programs are far less likely to face an investigation. And, if an SNF is found guilty of violating a federal health care law, the penalties are significantly reduced-if an effective compliance program is in place. By implementing a compliance program now, SNFs can save valuable resources later.
  • Identify YOUR risks. All compliance programs should follow the OIG Compliance Guidance posted on the OIG website. But don't forget to evaluate your facility and identify compliance vulnerabilities in your specific environment. A good compliance program must target and address your specific compliance risks.
  • Perform regular "check-ups" to keep your compliance program effective. A compliance program that sits in a binder gathering dust on a shelf will not do much to keep you out of trouble. Regular audits should be a part of your compliance effort. Each compliance risk should be audited periodically to measure performance and make any necessary improvements to keep your program on track.

 compliance risk assessment annual review

Topics: Compliance Basics, Penalties and Enforcement, Affordable Care Act

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