By using guidelines in CIAs for other healthcare entities similar to yours, you can mimic compliant program requirements.
Create a compliance committee.
A compliance committee should be an integral part of any health care organization, providing a front line of defense to ensure an adequate compliance program that is properly administered and monitored. The committee should advise the compliance officer as well as assist in compliance program implementation. Members of the compliance committee should be well informed about the regulations, legal requirements, and potential risks that may impact the organization. The compliance committee should assess current policies and procedures, develop appropriate new policies and procedures, and monitor performance.
Use the guidelines outlined in CIAs for other healthcare entities similar to yours to structure your physician contracting program.
By using the OIG’s requirements, your organization should be well positioned if it’s ever under federal scrutiny.
Physician contracting is an area where healthcare organizations are especially vulnerable to government intervention given Stark and Anti-Kickback statutes. While CIAs vary slightly from case to case, generally they require:
- A contract management system
- Tracking of payments and up-to-date time logs for physician services
- A written review process for all arrangements to ensure they are not violating Stark or AKS. The process should require that each arrangement has documented the following:
- A review by an attorney with Stark and AKS knowledge
- Demonstration of a business need for the arrangement
- Documentation that agreements meet FMV for all payments
- Annual reviews of all arrangements to be completed by the Compliance Officer and submitted for review by the compliance committee
- Training for everyone who is involved with arrangements surrounding the contract management system, internal review and approval process, and the tracking of payments corresponding to the arrangements
Evaluate stipulations of CIAs that might pose a problem for your organization.
While you are reviewing other CIAs, think about requirements that could pose an issue if they were placed upon your organization. Some aspects of a CIA are non-negotiable, but you may be able to create alternate policies that are acceptable to both your organization and the Feds. Your in-house and external counsel are key people in negotiating the terms of a CIA, but it is important for everyone to think about the reasonableness and timing of the requirements. For example, if you have an existing personnel training program that covers the requirements outlined in the CIA but requires fewer hours, your lawyers may be able to negotiate an acceptable compromise. For more on CIA negotiations, this article is a great resource.
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