The fourth essential element of an effective Compliance and Ethics Program is communication, education and training on compliance issues. The program cannot be effective if staff are not aware of the compliance issues that are vital to the organization. This means developing comprehensive and formalized plans for training and communication to employees throughout the organization in conjunction with the compliance committee and others.

A compliance training plan should start with providing the code of conduct and compliance and ethics education to all employees at the time of hire, as well as to physicians, volunteers, vendors, and contractors as services commence and on an ongoing basis. Training for Board members and senior leaders should include compliance issues related to their specific obligations and responsibilities. Compliance training should occur at least annually and be embedded within other education provided throughout the organization.

The third essential element of an effective Compliance and Ethics Program is the screening and evaluation of employees, physicians, vendors and other agents. The purpose of this is to ensure that a health care organization does not hire a person or entity that has committed a violation against a federally funded health care program.

Hiring someone with a documented violation would, of course, put the organization at risk and increase the likelihood of serious penalties if violations should occur resulting from this oversight. The Office of Inspector General (OIG) issues guidance and updates to organizations regarding the expectations related to screenings and other compliance issues.

The OIG was established in the U.S. Department of Health and Human Services to identify and eliminate fraud, waste and abuse in its programs and to promote efficiency. Through a nationwide program of audits, inspections, and investigations, the OIG has the authority to sanction persons or entities who have engaged in fraud or abuse by excluding them from participation in Medicare, Medicaid and other Federal health care programs. To determine whether a person or entity has been sanctioned in this manner, health care organizations must perform screening through the OIG and the System for Award Management (SAM), a comprehensive database that is part of the General Service Administration (GSA) of the federal government. Health care organizations who participate in Medicaid must also do sanction screening through their state’s Medicaid Exclusion lists.

The second essential element of an an effective compliance and ethics program is the Compliance Officer and Compliance Committee. The designation of a Compliance Officer serves as a focal point for compliance activities, and ensuring that this person has appropriate authority is critical to the success of the compliance program.

“Is the (compliance) program adequately resourced and empowered to function effectively?”