Home Health & Hospice Week

Question 1: Can you provide a general job description for a compliance officer? Can we outsource that role?

Answer: In general, the designated compliance officer will:

• Coordinate the annual compliance in-service with management.
• Oversee the compliance program, and recommend changes to company policies and procedures as needed.
• Coordinate and participate in education.
• Lead investigations of incident reports.
• Coordinate communication with the billing department or billing service when billing, coding, or compliance problems occur.
• Oversee the internal monitoring process.

The HHS Office of Inspector General indicates that it may be appropriate to outsource compliance officer responsibilities. The outside individual or group must develop and maintain a good working relationship with your agency and stay up to-date with activities and changes. The OIG recommends that you designate an internal employee to be a liaison with the outsourced compliance officer.

Question 2: We bought a compliance plan from a consultant about eight years ago and we have not had a problem since then. This plan should cover us if we ever get audited, right?

Answer: When you say you "bought" the compliance plan, it is assumed that you purchased a pre-written plan and simply filled in your information on the front page, which probably is not enough to protect you if an audit ever occurred. Compliance is a multi-step process that does not stop after you file away your compliance plan.

"A pre-written compliance plan may be a good place to start, but it provides a false sense of security for several reasons," says attorney David Jose with Krieg DeVault in Indianapolis. "First and foremost, a compliance plan needs to be directed at the various regulatory, payment, operational, and legal issues that are most implicated" for your particular organization.

Model compliance plan guidance from the HHS Office of Inspector General states that each organization should look carefully at areas of exposure to make sure that it has adequate systems in place to monitor and correct sources for potential claims and penalties.

"Another reason to not simply buy something 'off the shelf' is that it is less likely to be integrated into ... operations," Jose says. "If it's not been integrated (by means of a thoughtful adoption process that leads to accountable assignments), it's less likely to be effective. It will also make the training process more difficult, and this is an essential component for any effective compliance program."

Keep in mind: Any authority (whether regulatory, accreditation or other) will be skeptical regarding the credibility of this type of compliance program, Jose adds.

Question 3: Our compliance plan does not identify who we should contact if we see compliance violations, but I assume we'd report that to our compliance officer. However, in my case, it's the compliance officer who appears to be causing the violations. In this case, who do I contact?

Answer: Every compliance plan should include information on handling complaints from different sources within and outside the organization, Jose says. "In larger organizations, there will be some protective mechanisms to make sure that the employee can report a concern anonymously, and there are laws that protect against retaliation for the reporting of compliance concerns."

In addition, Jose says, "A compliance plan should have an option for reporting a concern to another party if the reporting individual is concerned that the compliance officer is implicated in the matter, or if the reporting individual fears some form of retaliation."