16 Questions to Assess a Hospital's Legal Compliance

A hospital's leadership team helps set the tone when it comes to the organization's legal and regulatory compliance. To get an idea of how robustly a hospital approaches its compliance plan and creates a culture that mitigates risk, it helps to ask a few questions.

Here are 16 considerations for hospital boards and executive leaders as they gauge their organization's compliance. Questions are from Ernst & Young's Health Care Industry Report 2013.

1. Is everyone at the organization challenged to do the right thing for compliance? Does the board hold everyone accountable for conforming to the organization's compliance policies and procedures?

2. Are performance incentives tied to satisfying compliance goals?

3. Does the chief compliance officer report directly to the CEO and a compliance committee of the board? Are the CCO and CEO reporting periodically to the board on compliance efforts, findings and issue resolution?

4. Is the CCO at the table when business decisions are made?

5. Does the organization have clear procedures in place so employees can safely report concerns of potential fraud and abuse? Does the organization ensure any reported issues are promptly and effectively investigated?

6. Are there appropriate procedures in place to ensure self-reported items follow Office of Inspector General and CMS protocols?

7. Are there designated individuals responsible for following legislative and regulatory updates, both state and federal, to ensure the hospital is kept compliant? Do these individuals follow pending legislation to help the organization proactively plan for changes?

8. Is the hospital effective in coordinating compliance and quality assurance functions to keep pace with the linking of reimbursement to patient outcomes?

9. Does the CCO or staff monitor the OIG semiannual report to Congress and the annual Health Care Fraud and Abuse Control Program report from the Department of Justice and OIG?

10. Does the CCO review the OIG Work Plan each year?

11. Does the hospital review the requirements of recent corporate integrity agreements to understand the OIG's current expectations of compliance programs from similar organizations?

12. Does the hospital conduct a robust self-assessment at least once per year to evaluate billing, coding and documentation efforts?

13. Does the hospital have an established process where any noted billing errors, problematic contractual issues or other potential violations are promptly reported to an internal team?

14. Does the hospital's compliance department and legal counsel preview any proposed contractual agreements to consider potential violations of the Stark Law or federal anti-kickback law?

15. If the hospital has acquired physician practices, has the organization provided educational programs to ensure employed physicians understand and embrace the protection of personal health information, privacy requirements and other aspects of practice that may be somewhat different as an employee?

16. Does the hospital use innovative data analytics to identify areas of potential fraud for internal investigation?

More Articles on Compliance:

Stark Law, False Claims and HIPAA: Key Risk Areas for Hospitals
Updated Fraud Self-Disclosure Protocol: 5 Considerations for Healthcare Providers
Emerging Trends in Stark, False Claims and Anti-Kickback Cases for Health Systems

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