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New Compliance articles to help educate, support team on regulatory requirements

03/23/21 03:36:pm

compliance.jpgWelcome to the first-ever Compliance addition to Insight. We hope to use these articles to provide you with education and support for regulatory requirements we have to operate within.

As many of you know, healthcare is one of the most regulated industries in the United States, making healthcare compliance a crucial and growing field within the industry.

What do we do in Regulatory/Compliance? Healthcare compliance professionals are needed to help clinical facilities and organizations address the ever-growing government regulations that set privacy and usage standards for patient information, ensure quality patient care, prevent fraud, and protect healthcare staff.

How extensive are the compliance requirements we must manage? Here’s an overview of some of the major laws, acts, and regulations that Rogers Behavioral Health needs to comply with and are areas we all need to know, especially as federal and state authorities continue to evolve and update these and other standards.

First, we must safeguard our patient’s privacy and ensure the quality-of-care standards are maintained. The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) is the federal wing responsible for these areas. They do this by ensuring organizations like Rogers are compliant with federal healthcare laws and HHS programs. This agency oversees a large portion of what we do here at Rogers. They oversee and enforce The Healthcare Information Portability and Accountability Act (HIPAA), Health Information Technology for Economic and Clinical Health Act (HITECH), Emergency Medical Treatment and Labor Act (EMTALA), and The Affordable Care Act (ACA).

Because of these and other state laws, we have, for many years now, implemented a compliance and ethics program at Rogers. That program continues to evolve and is outlined in several core areas for Rogers to follow when establishing an effective compliance program. Those areas are:

  1. Governance
  2. Administration
  3. Human Resources
  4. Operations
  5. Medical
  6. Clinical

There are several key areas we need everyone’s help with.

First, we must all fight fraud and abuse.

The National Health Care Anti-Fraud Association estimates that roughly 3 to 10% of medical care costs are lost to fraud annually. Many laws, statutes, and even entire state and federal compliance teams exist to combat fraud and waste. For physicians and all Rogers employees, understanding these laws is crucial, as violations can result in criminal charges, fines, and physicians possibly losing their medical license.

We must also ensure to follow the Federal Anti-Kickback Statute: As the name suggests, this statute prohibits healthcare professionals from accepting any kind of “kickback” (i.e., money, contracts, products) as rewards for referrals or provider recommendations to patients on federally covered medical programs, such as Medicare and Medicaid. The statute covers the payers of kickbacks and kickbacks recipients, with those who pay or accept kickbacks facing penalties of up to $50,000 per kickback.

We must also follow the Physician Self-Referral Law, also known as the Stark Law. This law prohibits physicians from referring patients covered by Medicare or Medicaid to treatment or service entities (i.e., care facilities, pharmaceutical drugs, etc.) that the physician has a financial relationship with or stands to profit from.

We must also protect healthcare workers and the public. This requires Rogers to ensure we have compliance protocols under CDC (COVID-19), OSHA, FEMA, and the Department of Health Services to protect all Rogers employees and the public we serve.

Here we want to ensure to protect all employees covering everything from the handling of our equipment, infectious disease protocols, workplace safety standards, and federal and state employment leave programs are just a few of the areas we must protect.

Contacting Regulatory Compliance

If you have any questions or concerns about any of these or other state and federal laws, company policy, or practices, please contact the Regulatory Compliance department any time at 262-646-1303 or Compliance@rogersbh.org. You can and will remain anonymous if so desired.

We also hope to use this column and meet many of you in person to be preventative and perfective related to the ever-evolving regulatory landscape. We are here to assist you before you suspect things have gone wrong. Please reach out at any time with questions. We plan to use this space and other opportunities to interact with you to help everyone navigate the regulatory minefield we all operate in.

We have years of experience in public policy, law, loss prevention, and strategic management, coupled with an agile workstyle and innovative mindset. We want to share these skill sets with you to ensure your success while here at Rogers. Thank you, and we look forward to working with you!

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