With the passage of the Patient Protection and Affordable Care Act of 2010, as amended by the Health Care Education Reconciliation Act of 2010 (the Healthcare Reform Law), Congress mandated compliance programs in all SNFs by March 23, 2013. The Affordable Care Act also requires compliance programs as a condition of Medicare and Medicaid enrollment. Incorporated in the updated CMS regulations is clarification that an effective compliance program must include measures that prevent, detect, and correct program noncompliance and fraud, waste and abuse.
Potential Risks to Providers:
The Affordable Care Act (Health Care Reform Law) has changed the option for SNF providers from voluntarily participation, now requiring mandatory operational Compliance Programs in a SNF. Programs must be designed that are effective in preventing and detecting civil and criminal violations, preventing administrative violations under Federal Law. Not complying with this new obligation poses greater exposure. The OIG lists several operational categories that present liability risks to the LTC provider.
- Quality of Care addressing
- Sufficient staffing
- Comprehensive resident Care Plans
- Medication Management
- Appropriate use of Psychotropic medications
- Resident Safety: Mistreatment, neglect and abuse
- Billing Integrity
- Anti-kickback regulations
- Medicare and Medicaid payments
The OIG guidance details the potential benefits including demonstrating the facility's commitment to honest corporate conduct, increasing the odds of detecting dishonest and unethical conduct, encouraging all stakeholders to report potential problems to enable investigations and reduce the risk of sanctions, minimizing risk of financial loss and financial penalties, enhancing resident care, and enhancing the facility's reputation.
How can Harmony Healthcare International (HHI) help?
HHI consultants are strong patient advocates facilitating the delivery of quality care. HHI’s expertise with Medicare Regulations coupled with intense medical record reviews assists with Corporate Compliance programs at many levels.
- Corporate Compliance Program overview and evaluation
- Review for compliance in identified areas of concerns
- Assist with Quality Programming