Compliance Program Effectiveness Evaluations
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) and other regulatory bodies have made it clear that a compliance program must be demonstrated as being fully effective. A weak program would likely be viewed as a “sham” program, which is worse than no program at all. The OIG has noted that organizations should incorporate independent reviews and compliance program effectiveness evaluations to identify compliance gaps and evince that the compliance program is effective.
OIG guidelines and the general shift towards Board oversight have made executive management and members of the Board increasingly concerned about their investments in the compliance program. They expect Compliance Officers to demonstrate that the compliance program covers all seven elements outlined by the OIG and that key metrics are tracked to prove compliance effectiveness.
To prevent avoidable compliance incidents and provide adequate proof of program effectiveness to both the Board and potential auditors, Compliance Officers should work with an independent organization to conduct independent compliance evaluations. Strategic Management has over 20 years of experience working with healthcare organizations and will work closely with your team to ensure that current compliance strategies are effective and meet the standards outlined by the OIG.
If you are seeking a firm to provide an independent compliance program effectiveness evaluation and would like to speak with a Compliance Consultant, please call (703) 683-9600 or fill out our online contact form. One of the Firm’s highly qualified consultants would be happy to discuss your organization’s needs and unique strategies that may be able to help.
Strategic Management Has Proven Expertise with Corporate Compliance Programs
Strategic Management is highly experienced in designing, implementing, evaluating, and enhancing Compliance Programs for healthcare entities. Under the leadership and direction of its Chief Executive Officer (CEO) and President, Richard P. Kusserow, a former Inspector General, the firm has designed, developed, managed, reviewed, and enhanced Compliance Programs for more than 3000 organizations and entities in the industry over the last twenty years. These were organizations of all sizes and types, including hospitals, managed care organizations, insurance companies, physician practices, SNFs, DME supply companies, and clinical and imaging laboratories. It is, therefore, not surprising that Strategic Management is a leader in providing compliance program evaluations for a variety of healthcare organizations.
Our compliance program assessments include a baseline analysis of your compliance programs to establish their current status and needs. It performs these assessments using its Comprehensive Compliance Program Evaluation Protocols of 160 factors drawn from the Sentencing Commission “Guidelines,” OIG compliance guidance, JCAHO, as well as overlapping requirements from HIPAA. All of these authorities directly impact Compliance Programs and set expectations for organizations. It is important to ensure they have been appropriately integrated and do not conflict with each other.
Strategic Management certifies it conducts its performance and evaluation review in accordance with the independence and objectivity guidelines of the Generally Accepted Government Audit Standards (GAGAS) of the Government Accountability Office (GAO). The results of Strategic Management’s assessment will include a fully certified report of findings, as well as recommendations for needed corrective or remedial action.
Connect with a Compliance Consultant to Learn More About Our Compliance Reviews
The consultants at Strategic Management have years of experience working with both private and public sector healthcare organizations. Contact a consultant today to discuss your organization’s needs and to learn how Strategic Management can help your organization meet or maintain compliance regulations. Call us at (703) 683-9600 or fill out our online contact form today.
Related Resources for Compliance Program Effectiveness Evaluations
The following articles provide additional information regarding health care compliance program effectiveness evaluations:
- Health Care Data Analysis and Analytics — Friend or Foe?
- Taking Control of the CMS Managed Care Audit Process
- New Charging Guidelines Underscore the Importance of Cooperation and Evidencing Program Effectiveness
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