Harmony Healthcare Blog

Compliance Series - 7 Elements: #7 Enforcement, Discipline and Incentives

Posted by Kris Mastrangelo on Tue, Oct 10, 2017


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


complaincedice.jpgAs a finalization of the 7-Post Blog Series on Compliance, today we will explore #7 Enforcement, Discipline and Incentives.

P-R-E-P-A-R-E

  1. Policies and Procedures
  2. Reporting and Investigating
  3. Education and Training
  4. Prevention and Response
  5. Auditing and Monitoring
  6. Responsibility and Oversight Committee
  7. Enforcement, Discipline and Incentives 

Enforcement, Discipline and Incentives

A fundamental component often overlooked in Compliance Programs is the transparency, communication and enforcement of the disciplinary  guidelines.   An effective compliance program includes disciplinary policies that explain the consequences of violating the organization’s standards of conduct, policies, and procedures. Actions of noncompliance subject the transgressors to punishment. These penalties range from oral warnings to suspension, termination, or even financial penalties.

Likewise, incentives, such as a bonuses or promotions, should align with the organization’s messaging for ethical and proper behavior. Incentives are intended to promote and improve quality care, not undermine the code of ethics.

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Enforcement

In order to implement punishment for “acts of noncompliance”, the organization must define and message the standards of conduct, policies, and procedures. The written standards of conduct should elaborate on the procedures for handling disciplinary problems and those who will be responsible for taking appropriate action. Staff must comply with the law, facility policies, facility procedures, code of conduct and compliance program expectations. All staff have a duty to report suspected violations.

Disciplinary actions are handled by a variety of players (managers, administrators, governmental agencies).  The organization should advise personnel that disciplinary action is applied in a fair and equitable basis. Managers and supervisors are responsible to discipline employees in an appropriate and consistent manner. It is vital to publish and disseminate the range of disciplinary standards for improper conduct and to educate employees regarding these standards. The consequences of noncompliance should be consistently applied and enforced, in order for the disciplinary policy to have the required deterrent effect.

“Managers and supervisors should be disciplined for failing to adequately instruct their subordinates or for failing to detect noncompliance with applicable policies and legal requirements, where reasonable diligence would have led to the discovery of any problems or violations and given the nursing facility the opportunity to correct them earlier. Conversely, those supervisors who have demonstrated leadership in the advancement of the company’s code of conduct and compliance objectives should be singled out for recognition.” 

Discipline

Disciplinary action results when noncompliance is substantiated via an investigative process. The disciplinary action must reflect the severity of the noncompliance (which may include immediate termination). As stated under enforcement, disciplinary action must be consistent:

  • at all levels of the organization
  • within the disciplinary policies and procedures
  • within the documentation of the specific occurrences
  • within the job description and performance criterion. 

All disciplinary actions must be: timely, documented, collaborated with Human Resources and reported to the regulatory body.

Incentives 

Per the Federal Sentencing Guidelines:

“The organization’s compliance and ethics program shall be promoted and enforced consistently throughout the organization through appropriate incentives to perform in accordance with the compliance and ethics program.”

Simply stated, the management performance system should not portray mixed messages to the employee on “what is expected” versus “how the employee is compensated” as this represents a lack of internal controls. Promotions, Bonuses and Assignments must be congruent with the organization’s code of conduct, policies and procedures and  job descriptions.  Misalignment in this area is readily uncovered when under an investigation and results in negative outcomes.   It is common for organizations to seek guidance from external experts to determine if the established performance system is consistent with the compliance expectations.   

Federal Register 

The Federal Government provided Compliance Guidelines to the Skilled Nursing Facility in 1998.  For a download of the Compliance SNF Federal Register March 16, 2000:

OIG Compliance Program Guide

Harmony Healthcare International (HHI) offers a unique approach to Auditing and Monitoring. Our program combines QAPI, Compliance and Medical Record Review into a user-friendly, process refinement methodology.  Please call us to hear more about our monthly service plans (Platinum, Gold and Silver) and knowledge center (HarmonyHelp). 

As always, I hope this helps with your Quest for Compliance!!

CHHi-MDS

Harmony Healthcare International (HHI) is available to provide assistance You can contact us by clicking here. Looking to train your staff?  Join us in person at one of our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


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