All covered healthcare entities are required to develop and implement a compliance program as a condition of enrollment in Medicare, Medicaid, and the Children’s Health Insurance Program. Additionally, the Office of Inspector General (OIG), Department of Justice, and other federal and state agencies see a compliance program as the minimum standard a healthcare entity should maintain.
Key components of a high-quality compliance program include detection and prevention of inappropriate conduct, as well as commitment to the organization’s legal and ethical values. These components are detailed in the Federal Sentencing Guidelines’ Seven Elements of an Effective Compliance Program.
A successful compliance program is the result of a combination of clinical and regulatory expertise. PYA offers a number of services that help organizations identify and prioritize compliance risks:
Compliance Program Assessment, Risk Assessment, and Advisory
- Assesses policies, procedures, and responsive measures to determine opportunities for improvement
- Assists in implementation of risk assessment process to stratify risk based on impact and likelihood of occurrence
- Provides compliance program advisory and compliance work plan supplementation
Compliance Program Work Plan Development, Project Management, and Implementation
Assists with work plan development according to identified risk areas
Compliance Education, Boot Camp Services, and Support
- Conducts two-day healthcare compliance “boot camp” sessions, structured according to HHS and OIG guidance
- Offers a “compliance officer track” to develop future compliance professionals
- Conducts service line leader training (one-day or multi-day modular program) that covers: communication of pertinent legal, regulatory, and compliance requirements; updates to department staff; and reinforcement of organizational training
Virtual Compliance Program Assistance
Provides virtual compliance officers to assist with compliance program effectiveness, risk assessment, work plan development, reporting to board of trustees, program implementation assistance, and training
PYA’s compliance expertise addresses the wide-ranging scope of regulation requirements: