Eli's Hospice Insider
5Ways to Head Off Compliance Problems -- And Lawsuits
How carefully do you listen to your employees' complaints?
False Claims Act lawsuits assault providers on multiple fronts. First,they can carry a big price tag due to the treble damages allowed for in the statute. That can result in whopping settlement amounts.
Second, a qui tam lawsuit settlement announcement can do major damage to a provider's image. It's much better to issue a release saying you found and self-reported a problem instead of that you had to settle a whistleblower suit, notes attorney Robert Markette, Jr. with Gilliland & Markette in Indianapolis. "That'sbad publicity," Markette says.
Local news outlets often comb through every unsubstantiated allegation in the qui tam relators' suits, tarnishing your standing with referrals.
To head off costly and embarrassing whistleblower suits, take these steps:
1. Draw up and institute a sound compliance plan. The HHS Office of Inspector General "tells you to have a compliance plan for a reason,"Markette stresses. "The whole reason for the compliance plan is to avoid this kind of thing."
Resource: The OIG's compliance guidance for hospices, which dates to 1999, is at www.oig.hhs.gov/authorities/docs/hospice.pdf.
2. Encourage a culture of compliance.It's not enough to have a compliance plan sitting on your shelf,notes Washington, D.C.-based attorney Elizabeth Hogue. Make sure all employees know you are committed to doing the right thing and expect them and yourself to live up to the compliance plan.
3. Focus on compliance hot spots. You may need to give extra attention to areas that regulators are targeting. For example, the OIG currently seems very concerned about hospice-nursing home relationships, Markette notes. Be sure your compliance plan adequately addresses this area and then be sure your practices adhere to your plan.
4. Be receptive to employee complaints. Hospices need to have "openness about concerns such as those brought forward by the qui tam relators in this case," Hogue maintains. "Many individuals in the hospice industry want to do the right thing. The right thing is clearly to bring any concerns to management first before staff members go to outside third parties." However, if staff complains and management does not appropriately address their concerns, employees have no choice but to take action outside of the organization.
"Management must work hard to make certain that staff members don't reach a conclusion that the only way to address the problem is to go outside the company," Hogue cautions.
5. Police yourself. Once you have proper compliance procedures and practices in place, you need to do your own checks and audits to make sure you're complying with them,Markette counsels. It's much less costly and embarrassing to fix problems yourself than to have regulators do it for you.
Eli's Hospice Insider
- PAYMENT AND REGULATORY UPDATE:
Hospices Battle Industry Trends as Lawmakers Mull Cuts
CMS also discusses billing changes, new COPs at industry conference. If you're wondering why policy- [...] - PRIVACY:
Are Red Flags for Identity Theft on Your Risk Management Radar Screen?
Find out where these new requirements fit into the bigger picture. If your hospice thinks [...] - Reimbursement:
Higher Hospice Payment Rates Now in Pocket
But cuts are still planned. April brought -- well, not showers of extra money for hospices -- [...] - CLIP AND SAVE:
Check Out the Top 10 Hospice Diagnoses
Most shocking: Non-Alzheimer dementia's dramatic jump in 8 years. - COMPLIANCE TIP:
GiveYour Billing Systems for Hospice-Related Meds a Check-Up
Expect this issue to catch auditors' attention. If nursing homes bill Medicare, Medicaid, or residents [...] - Fraud and Abuse:
Find Out What Else Is Catching the Feds' Eye These Days
If you want to avoid hospice audits from the Centers for Medicare & Medicaid Services, [...] - HOSPICE PAYMENT:
Check Out This Rundown of Reimbursement News
Stay in the know to prevent cash flow woes. Here's what's new in the hospice [...] - COMPLIANCE:
5Ways to Head Off Compliance Problems -- And Lawsuits
How carefully do you listen to your employees' complaints? Whistleblower lawsuits like the recently unsealed [...] - INDUSTRY NOTES:
Doctor-Patient Conversation Can Lower End-of-Life Expenses
Patients who discuss end-of-life preferences have lower rates of intensive care admission. Dying isn't a [...]
