As all in the long term care industry are very aware, the Affordable Care Act mandates compliance programs in all nursing homes by March 23, 2013 -- a date that is now behind us.
What does this mean for providers?
It means compliance programs are now mandatory.
What we don't know is when, or how, this will be enforced. What we do know is that nursing homes without a compliance program are in violation of the law. And, as has been the case for years, providers without compliance programs miss an opportunity to have criminal penalties mitigated.
The Affordable Care Act required the government to issue regulations providing guidance to providers for implementing the compliance program mandate. These regulations have not been issued yet-and we don't know when they are coming. Some have speculated that enforcement might be delayed until these regulations are issued. However, the government has not officially indicated that enforcement will be delayed-and providers should be prepared for enforcement.
We also know that, under the Affordable Care Act, compliance programs will soon be a condition of participation in Medicare and Medicaid. The Affordable Care Act does not specify when this condition will be implemented-but when it is, providers without compliance programs could lose the ability to bill Medicare and Medicaid. This provides an additional incentive to advance compliance efforts now.
Finally, even without these mandates, an effective compliance effort is crucial to providers' survival. Government enforcement of compliance-related laws such as the False Claims Act, the Anti-Kickback Statute, and HIPAA are at an all time high. Health care enforcement, settlements and penalties are a lucrative business for the federal government. For example, for every $1 spent by the federal government on health care-related fraud and abuse investigations in the last three years, it recovered $7.90. The spotlight continues to shine on long-term care: the OIG increasingly targets this industry with its investigations and enforcement activity.
An effective compliance program is essential for any provider seeking to stay on the right side of this government enforcement trend.