Compliance programs: 'A great way to raise the bar'

Tuesday, June 30, 2009

WASHINGTON - The draft healthcare reform plan recently released by the House of Representatives isn't all bad, industry stakeholders say. To help reduce fraud and abuse, it would require HME providers to have compliance programs.

"This would be a great way to raise the bar for the industry," said Georgie Blackburn, vice president of government relations and legislative affairs for Tarentum, Pa.-based Blackburn's, which implemented a compliance program 10 years ago. "Why would business owners, in this day and age, risk working on the assumption that everyone's doing things compliantly, when they're the ones who are on the hook in an audit?"

The House's plan calls for the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG) to establish the required elements of the compliance programs. They may include written policies and procedures; a designated compliance officer; training and education pertaining to fraud; and disciplinary guidelines.

Implementing compliance programs shouldn't be a stretch for most providers, industry stakeholders say. As part of the accreditation process, providers must have written policies and procedures in place. Also, the OIG published voluntary guidelines for compliance programs for HME providers in 1999.

"We followed those guidelines step by step," Blackburn said. "There's no need to reinvent the wheel."

But, as always, the devil's in the details. Industry stakeholders pointed out that the House's plan would give HHS and CMS the authority to determine whether providers meet the requirement and to fine or dis-enroll them if they don't. If the agencies plan to do this as part of an audit, that's one thing; if they plan to do it just for the sake of doing it, that's another, they say.

"If it doesn't matter whether I've done anything wrong or not--I just don't have a plan that meets the criteria--that's a little scary," said Wayne Stanfield, executive director of NAIMES.

Details aside, if the House moves forward with its draft, providers who don't currently have compliance programs will be happy it gave them a nudge, Blackburn said.

"It's one of those things, like accreditation, that makes you realize how much better you could be doing the things you thought were doing well," she said. "It's a holistic approach to doing the right thing the right way all the time."