Health care providers have historically been encouraged by the OIG—but not required—to have compliance programs.
The Affordable Care Act (a/k/a/ the Health Care Reform Law) made these recommended compliance programs mandatory on March 23, 2013.
Section 6102 of the Affordable Care Act requires all nursing facilities to have compliance and ethics programs in place. CMS issued a final regulation implementing this requirement on October 4, 2016, and plans to begin enforcing the requirement on November 28, 2019.
The CMS regulation requires nursing homes to have a compliance and ethics program with the following elements:
Nursing home organizations with 5+ facilities must also include the following in their compliance programs:
Even if the compliance program mandate didn’t exist, a compliance program is still essential to avoid penalties under the heavily enforced health care laws. The government may mitigate penalties if you have an effective compliance program in place, and you are much more likely to prevent violations of health care laws if you have a robust compliance program.
The Affordable Care Act also requires all providers to have compliance programs as a condition of enrollment in Medicare or Medicaid.