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Simplifying a Hospice Compliance Program


Having a Hospice Compliance Program isn’t as daunting as it may seem. The OIG has recommended seven elements to guide agencies in the development of their program, knowing that one model isn’t suitable to every hospice. The elements can be tailored to fit your agency. Following the seven elements, I have provided practical, operational activities that will help you begin developing your program. Seven Elements 1. Development and distribution of written standards of conduct, as well as written policies and procedures, which promote the hospice’s commitment to compliance and address specific areas of potential fraud, such as Medicare hospice eligibility and admission, improper financial relationships with nursing facilities and other healthcare professionals and entities, and improper billing practices. 2. The designation of a compliance officer and other appropriate bodies, e.g., a corporate compliance committee, charged with the responsibility for operating and monitoring the compliance program, and who report directly to the CEO and the governing body; 3. The development and implementation of regular, effective education and training programs in compliance for all affected employees; 4. The creation and maintenance of a process, such as a hotline or other reporting system, to receive complaints and ensure effective lines of communication between the compliance officer and all employees and the adoption of procedures to protect the anonymity of complainants and to protect whistleblowers from retaliation; 5. The use of audits and/or other evaluation techniques to monitor compliance, identify problem areas and assist in the reduction of identified problem areas; 6. The development of appropriate disciplinary mechanisms to enforce standards and the development of policies to address (i) employees who have violated internal compliance policies, applicable statutes, regulations or federal healthcare program requirements and (ii) the employment of sanctioned and other specified individuals; and 7. The development of policies that direct prompt and proper responses to detected offenses, including the initiation of appropriate corrective action and preventive measures. Compliance Program in Real Time Operation 1. Ensure that there are policies in place regarding fraud, eligibility, admission and discharge criteria, billing practice, administrative structure, standards of conduct, conflict of interest, employee disciplinary actions and grievance processes. 2. Provide inservices to your staff, contractors and volunteers regarding your Compliance Program and policies. Include topics such as remuneration, altering medical records and duty to report misconduct. 3. Ensure that contracts address your expectation that contractors will maintain the level of compliance with regulation that you expect internally. 4. Designate a Compliance Officer. Inform employees, volunteers and patients how to reach the Compliance Officer. Create a way for all employees to reach the Compliance Officer, anonymously if necessary, to report concerns. 5. Provide education to new employees and at regular intervals (at least annually) regarding your Compliance Program. 6. Conduct internal monitoring. Consider external audits through outside consultants such as Hospice Advantage Solutions. 7. When compliance is not achieved, apply corrective actions, learn, teach and monitor. Develop new policies if necessary. 8. Provide an annual summary to the Board of Directors. Reference: https://oig.hhs.gov/authorities/docs/hospicx.pdf

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