Caution: Match discipline to responsibility
Caution: Match discipline to responsibility
No matter how tight your billing or coding procedures are, sooner or later someone will violate them. And whether and how you discipline the culprits is something that could determine just how harshly the government treats you.
A provider that doesn't enforce its compliance plan "leaves itself vulnerable to government and other actions," says the OIG's model compliance plan for hospitals. Employees should be aware of disciplinary guidelines, and those guidelines should specify a range of sanctions — from warnings to termination — as well as an assurance that everyone will be treated equally.
Unfortunately, achieving equality is the tricky part, says attorney Bob Wolin of Baker Hostetler in Houston. Managers naturally tend to get more slack than lower-level employees. "The problem isn't setting a policy," Wolin adds. "The problem is implementation." He cites a case where the CEO of a large health provider bought his secretary a car and put the expense in the organization's cost reports. When the provider ended up settling with the Justice Department, the local U.S. Attorney was incensed to discover the executive had been treated leniently by the organization.
The key here is to peg disciplinary action to the degree of authority that a manager or employee has over areas such as coding and billing, says Wolin. By virtue of their positions, top executives can be assumed to have power over reimbursement. But so does a lower-level billing manager. In effect, a good compliance plan will contain a multiplier that increases the consequences for those who abused — or have the potential to abuse — reimbursement.
Another solution: Keep a log handy of all disciplinary actions taken, says Alice Guttler, compliance officer for Centrastate Healthcare System in Freehold, NJ. Try to base sanctions on comparable situations in the past.
Yet it's also important to leave yourself some flexibility in applying sanctions. "If you have a good employee who’s made one mistake after 20 years, then you might be able to transfer him or her to another position that doesn't have any responsibility for billing," says Wolin.
The easiest approach is to rely on the normal disciplinary procedures used by the human resources department, says Guttler. Her compliance plan merely says that violations will be handled according to the HR disciplinary process. The HR policy lists general sanctions, but doesn't mandate special measures for compliance offenses.
Listing specific offenses means an employee could claim that his or her actions were not improper because they weren’t specifically barred by the policy. "You could never draft an HR policy that covers everything," Guttler adds. So far, Guttler has had to handle just one compliance matter through the disciplinary process. An employee had used the nonprofit hospital’s tax ID number to get hardware at a discount for his own use.
Not only was the employee dismissed, but because the incident could have jeopardized the hospital’s nonprofit status, a record of the disciplinary procedure is kept in the compliance log.
Caution: Be careful that your disciplinary scheme doesn’t conflict with any union contracts, Wolin warns. Those contracts might specify a particular process for punishing union workers. The safest course is to devise your compliance plan first, and then negotiate a contract with language that allows workers to be disciplined in accordance with the compliance plan.
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