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Physician Compliance Programs

Designing Physician Practice Compliance Programs That You Can Use

Physician compliance ProgramsThere is currently a lot of hype out there about the need for physicians to establish compliance programs.  I agree that each practice should have a compliance program in place.  However, I do not agree that the compliance program necessarily needs to be lengthy or complicated.  In fact, I believe that it is most important to be focused in on the key elements that are applicable to your practice and that can be followed given the resources that are available.  Simply adopting precanned policies will do little more than create a roadmap of items that you cannot possibly achieve.

So what should be included in your compliance program?  Your program should certainly include reference to the seven basic elements that are commonly identified as being required in a compliance program.  You should describe the steps that you will take to assure that each of the seven elements are achieved.  You will also want to prepare a basic code of conduct that reflects your commitment to creating a culture of compliance.

The Office of Inspector General published guidance for physician practice compliance programs in October of 2000.  You should read those guidelines and integrate the aspects of the guidance that applies to your practice.  The OIG guidance also includes a description of the seven basic compliance program elements.  The seven basic elements of a compliance program include:

1.         Internal auditing and monitoring,

2.         Compliance processes and standards,

3.         Appointing a compliance officer or compliance responsible individual,

4.         Providing education and training to your staff,

5.         Responding to compliance issues in an appropriate fashion and taking corrective action,

6.         Creating an open system of communication of compliance issues, and

7.         Taking appropriate disciplinary action with respect to compliance infractions.

You will also want to adopt policies to implement some of these general areas.  For example, it is crucial that your compliance program include a strong anti-retaliation policy and a system that permits employees to register anonymous complaints.  Your compliance policies should also be integrated into your employment and disciplinary procedures so that employees are made aware that non-compliant behavior will not be tolerated.  Your policies need to be uniformly applied, from the top to the bottom of your organization.

Applicable guidelines recognize that your compliance program may be scaled to the size of your organization.  However, scalability does not permit you to ignore or overlook specific areas that present risk to your business.  Your program, regardless of its size or the number of words that are used to convey your standards, must be uniformly and consistently followed and can under no circumstances be left on the shelf collecting dust.

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John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
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