DOJ Updates Evaluation of Corporate Compliance Program Guidance

In case you missed it, the US Department of Justice Criminal Division updated their “Evaluation of Corporate Compliance Programs” guidance on April 30th. This document outlines how prosecutors could potentially determine if an organization facing a settlement may receive credit by demonstrating sufficient evidence that they are committed to compliance.

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While having an effective compliance program has always been best practice, it's more important than ever given the updated guidance. Our Key Elements of Physician Contracting Compliance Programs white paper outlines how to construct a complete and efficient contracting compliance program.

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According to the Department of Justice, 3 key factors are being taken into consideration:

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1. Is the corporation’s compliance program well designed?
2. Is the program being applied earnestly and in good faith?. In other words, is the program being implemented effectively?
3. Does the corporation’s compliance program work in practice?

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Additionally, as JDSUPRA wrote on May 29 “The Guidance provides that a well-designed compliance program requires a robust risk assessment process, and appropriate and updated policies and procedures; tailored training and communications; confidential reporting structure and investigation process; and the application of risk-based due diligence to its third-party relationships."

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Given the most recent Guidance from the Department of Justice, it is clear that not only does your hospital or health system needs to have a compliance system in place, you have to also prove that it is effective. If not, you could be on the hook for millions of dollars in a federal investigation. And if you do, you could receive a credit that would reduce the cost of a potential settlement.

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What tools are you using to remain in compliance with Stark and AKS?  Having physician contracting benchmarks such as MD Ranger can go a long way in showing the Department of Justice that you not only have a compliance program in place, but that you are leveraging the best possible data available when determining what you pay your physicians.

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