OIG's Compliance Program Guidance (now mandatory for all nursing homes) repeatedly emphasizes the importance of written policies, procedures, and standards of conduct. Yesterday, we discussed the need for a written Code of Conduct. Other written policies and procedures are mandated as well.
Fraud and Abuse
OIG stated that its principal goal in drafting the CPG was to: "provide a mechanism that brings the public and private sectors together to reach mutual goals of reducing fraud and abuse, enhancing operational functions, improving the quality of health care services, and decreasing the cost of health care." 65 Fed Reg. 14290
Institutions that go astray of OIG's goal of eliminating fraud and abuse may be excluded from Federal health care programs. That exclusion may result in civil money penalties, along with treble damages. These financial costs merely underline the importance of complying with all relevant laws regarding fraud and abuse.
Appropriate Care of Residents
OIG's insistence on written policies and procedures is not merely to enforce regulatory burdens. Rather, OIG believes that its requirements will result in measurably better care for residents of nursing homes.
It is important for all managers and employees of nursing facilities to understand the consequences of noncompliance with federal, state, and local law. Appropriate policies will detail such consequences, along with procedures to report non-compliance, and procedures to rectify non-compliance.
The complicated federal, state, and local regulatory landscape is frequently modified, resulting in the need to modify compliance programs. Therefore, OIG recommends that all nursing facilities conduct a baseline assessment of risk areas, followed by regular re-evaluations. We will devote the next several days' posts to outlining those specific risk areas.
We have extensive experience helping nursing facilities comply with the CPG. We can help your organization develop written materials, including policies, procedures, and standards of conduct, to make sure that you remain on the right side of the law. We look forward to helping you best protect your interests amid this tangle of now-mandatory regulations.