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Compliance and Ethics: How Effective Is Your Compliance Program?

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By Beth Lori, Compliance Director/Corporate Compliance Officer at Life Care Services

Compliance and regulations. There are so many to follow it can make your head spin. Here are 3 that have widespread impact on senior living communities, along with keys to compliance success from the Life Care Services Compliance team.

3 Hot-Topic Compliance and Federal Regulation Issues:

  1. Yates Memorandum from the Department of Justice. It indicates a willingness to focus criminal investigations on individual executives. The goal is to stop corporate wrongdoing by making individuals accountable and deterring misconduct.

What it means for senior living. Senior living leaders or board members could be personally liable for misconduct, and face civil and criminal penalties.

How to prepare. It is imperative to have a corporate compliance program. You must also have education and training measures in place to ensure your staff is following necessary procedures.

  1. Corporate Compliance and Ethics Program from the Centers for Medicare and Medicaid Services (CMS). Implementation of a compliance and ethics program is mandatory. This is one component of major changes to rules governing long-term care facilities issued by the CMS this fall. They are the most comprehensive rule revisions since 1991.

What it means for senior living. Skilled nursing and nursing facilities (SNF/NF) at communities must develop a compliance and ethics program that includes written standards, policies and procedures. It also calls for a high-level executive at the community to oversee the program.

How to prepare. Read and understand the complete CMS final rule, and begin implementing a compliance and ethics program. At Life Care Services, we created a manual based on guidelines from the Office of Inspector General (OIG) that closely align with the CMS compliance and ethics program. We expect an easy transition from using our LCS OIG Manual to our developing LCS CMS Manual.

Tip – Partner with a management company that brings wisdom and a measured approach. At Life Care Services, we know how to develop and implement a compliance and ethics program.

CMS is mandating a 3-year phased implementation of the new regulations. Phase 1 takes effect by the end of November 2016, phase 2 on November 28, 2017, and phase 3 on November 28, 2019.

  1. Breaches of Health Information. Hacking of health and medical records has skyrocketed. Beyond stealing personal information that could be used to apply for credit cards or other fraudulent activity, reports are surfacing that hackers are also starting to blackmail companies and individuals to keep stolen records private.

What it means for senior living. This goes beyond just health centers at senior living communities and HIPAA violations. It also has implications for residential and assisted living, as state privacy laws pertaining to personal information can apply.

How to prepare. Make sure you have an IT department that conducts audits and has strong security programs in place. At Life Care Services, our integrated IT software package and teams provide the tools to help bolster cybersecurity and avoid breaches.

Other Compliance Keys … by the Numbers

$1.9 Billion

The amount of money the federal government won or negotiated in health care fraud cases and proceedings in 2015. We expect the federal government to continue with its aggressive approach to recovering large settlement amounts and awards.

983

The number of new criminal health care fraud investigations the Department of Justice opened in 2015. It also opened 808 new civil health care fraud investigations. We anticipate the federal government will continue its aggressive approach to investigating and prosecuting health care fraud.

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Steps we recommend you follow for compliance success:

  1. Install a high-level compliance officer who reports directly to the governing body.
  2. Implement policies and procedures designed to reduce violations and promote quality of care.
  3. Educate and train staff on why compliance is needed.
  4. Provide an anonymous reporting system free from retaliation.
  5. Use audit and monitoring systems.
  6. Investigate potential violations and take corrective action, if needed.
  7. Stay proactive and monitor changes in federal legislation.lcs-24298-9-2_tweet-quote

Parting Thoughts

To achieve performance excellence, you can’t be static. It’s crucial to learn, seek continuous improvement and work with experienced partners. At Life Care Services, we also value working with senior living trade organizations to collaborate on doing what’s best for seniors and aging services providers.

Put our management experience and resources to work for you.

Read what others have to say about working with senior living management companies.

About Beth Lori:

Beth joined Life Care Services in 2013, providing leadership and guidance across the company’s portfolio to ensure compliance with federal, state, and local laws and regulations. As a licensed attorney, she previously served as assistant general counsel for a system of Life Plan Communities throughout the West Coast and Midwest. She also has government experience serving as an assistant county counsel and prosecutor. Beth brings expertise in complex legal and administrative law, health care and regulatory compliance, in addition to HIPAA training and policy reviews. Beth earned her Juris Doctor from Suffolk Law School, and a B.A. in political science from the University of Michigan.

Disclaimer: This communication has been prepared for general information purposes only to permit you to learn more about Life Care Services. The information presented is not legal advice, is not to be acted on as such, and is subject to change without notice. You should not act upon the information without first seeking qualified professional counselor.