Ask The Legal Expert about ... compliance programs
John Durso, Esq. Nixon Peabody LLP
What's needed for a vibrant compliance program in today's increasingly scrutinized legal climate?
Depending on state licensure and the services provided, compliance programs may need to address the following:
• Self-referral, fraud and abuse: Compliance programs should outline how to structure operations in compliance with the False Claims Act, the Stark Law, the Anti-Kickback Statute (AKS) and any comparable state laws.
• Facilities subject to state licensure should address regulatory issues such as resident rights and reporting of suspected abuse.
• Accredited facilities should address any applicable accreditation standards in compliance plans.
• Organizations that are exempt from federal income tax should ensure that compliance programs address issues that may threaten such exemption, including the need for negotiating agreements at arms' length and for fair market value compensation.
• Compliance programs should address federal and state privacy and security regulations applicable to the organizations.
• Applicable organizations should detail compliance with the laws and regulations designed to prevent discrimination in housing.
• Compliance plans for facilities that bill commercial or governmental payors should address issues such as preventing upcoding or billing for items included in per diem payments.
In addition to the content, long-term care facilities should ensure that their compliance plans are written and that the organization designates a compliance officer or committee.
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