Implementing your compliance program

It's hard work, but not impossible

Cathy Bellehumeur, JD, senior vice president and general counsel for OptionCare of Bannockburn, IL, says every company should consider doing what OptionCare did in 1995: The company created its own corporate compliance program.

"It's better if this is a self-driven effort because the company knows best what its areas of vulnerability are and what its resources are," she notes. "The most effective training a company can provide employees is the use of hypothetical situations that mirror a situation the company or the industry has encountered. The employee then gets a better grasp of what they are to do and not to do."

Creating a compliance program may also be the only option for small home infusion providers. Bellehumeur notes that consultants charge anywhere from $275,000 to $500,000 to implement a corporate compliance program. Unless you have that kind of money available, you're looking at a do-it-yourself project.

The good news is, it's not impossible. Bellehumeur should know, as she spearheaded the implementation of OptionCare's current corporate compliance program. Here are her recommendations on creating an effective program yourself.

1. Attend a workshop.

If you're going it alone, try to attend a corporate compliance workshop. This will help get you started in the right direction.

"It is an overwhelming task to sit down and pull together resources without hearing other people's views on the subject, finding out what the laws and regulations are, and finding out some of the opinions of what an effective program would be," says Bellehumeur. "If you're able to afford it, you can hire a consultant or attorney to help you. If not, then get somebody else's basic plan and alter it so it is specific to your particular business."

Make the program fit your company

Such alterations will undoubtedly be necessary. If you're a small, local home infusion provider, your corporate compliance program will be much simpler than a large, regional company's.

"A small company may have only one line of business and require, for instance, an `IV only' audit program," notes Bellehumeur. "And it makes little sense for a small company to have a dedicated compliance officer or a hotline."

2. Conduct research.

An experienced health care attorney will likely be able to provide some help, but you can limit billable hours by tracking down some of the information yourself. For example, Bellehumeur says a search on the Internet will provide plenty of information on laws, regulations, and statutes specific to your agency. You may also want to use your local law school library, and don't forget the Office of Inspector General (OIG) and the Health Care Financing Administration.

OIG spokesman Ben St. John says the OIG Web site contains a model compliance plan for hospitals that can get you started until the home care model is available. (Editor's note: The OIG model can be accessed at modcomp/modcomp. html.)

St. John says the seven areas that must be included in an effective corporate compliance program are:

· designation of a compliance officer and committee;

· conducting effective training and education;

· developing effective lines of communication;

· enforcing standards through well-publicized disciplinary guidelines;

· auditing and monitoring;

· responding to detected offenses;

· developing corrective action initiatives.

3. Solicit management backing.

Getting agency management to back the plan - from internal staff to your board of directors - is the most important element of any plan, according to Bellehumeur.

"The plan has to become part of your corporate culture or you might as well not have it," she says. "A lot of people buy canned programs, put them on a shelf, and think that's a corporate compliance program, but it is unlikely to be deemed effective. Management has to be very involved in the formation of the plan, as well as being involved on an ongoing basis."

4. Put it to good use.

A corporate compliance program is not meant to sit in a folder until HCFA comes knocking. In fact, putting it to use can help prevent such an investigation.

Prospective audits catch errors in-house

"With a compliance program, hopefully you will detect if you are not acting in accordance with the law before it turns into a large issue," Bellehumeur says. "If you are doing prospective auditing before things go out the door, you're going to catch errors before you file the claim with the federal government."

This provides you with an opportunity to retrain your staff and to correct the process internally.

"An error in-house is not an error, it is an education opportunity," notes Bellehumeur. "Once the bill goes out to a third party, it becomes an error. And the goal of the program is to try and prevent the risk."

Once your program is up and running, don't be afraid to show it off.

"Our compliance program has helped us get managed care contracts," says Bellehumeur. "It tells people we have the intent of abiding by the law, and we've had some HMOs ask us for this, so it's a growing area."