Members of healthcare governing boards now have direction from the OIG as to what is expected of them as they oversee the regulatory compliance of their organizations. And the good news is that the board members don’t have to leaf through 200 pages of regulations in the Federal Register to find the answer. The new guidance, published on April 20, 2015, is a 15-page document that gives board members the basic information they need. The guidance comes at a time when the OIG is beginning to scrutinize boards and their members who are not taking an active role in identifying compliance issues, or who are not actively evaluating the effectiveness of the organization’s compliance program and the people involved.
For compliance professionals, there’s nothing new here. The guidance identifies the usual primary areas of concern: appropriate billing, evaluating referral relationships, determining whether the organization is billing for medically unnecessary services or services not provided at all, and privacy concerns. It reminds boards that analyzing compliance concerns and evaluating the company’s compliance program is a function to be performed regularly, not just when there’s a problem. Boards are responsible for assuring that staff within the organization or outside compliance consultants are staying abreast of changes in reimbursement and licensing requirements, and communicating those requirements throughout the organization.
The OIG guide recognizes that compliance programs are not a “one size fits all” product, and that programs will vary based on the size, complexity, and resources of an organization. The guidance does emphasize the role of the board in establishing a culture of compliance.