Having an effective compliance program is absolutely crucial but measuring the success of any compliance program can be difficult. Available measures of success are not always industry-specific. However, in the absence of a specific publication for your specific needs, you may be able to adapt some of the following tools and resources to assess your compliance program’s effectiveness.
1. Medicare Advantage and Prescription Drug Compliance Program Effectiveness Self-Assessment Questionnaire
In this self-assessment questionnaire you’ll find 26 pages of specific questions relating to the various elements of an effective compliance program. For example, for Element II (Compliance Officer, Compliance Committee, Governing Body), it asks: Does your compliance officer have express authority (oral or written, preferably written) to make in-person reports to your CEO and Board of Directors in the compliance officer’s sole discretion?
This question is probably applicable to any compliance program, regardless of the subsection of the healthcare industry, or any industry for that matter. On the contrary, one of the many questions under Element VI (Effective System for Routing Monitoring, Auditing, and Identification of Compliance Risks) is: Do you have a monitoring and auditing work plan that addresses risks associated with Medicare Parts C and D?
Though this question is very specific to Medicare Parts C and D, one could easily substitute a different segment of the healthcare industry here to assess effectiveness.
2. OIG Supplemental Compliance Program Guidance for Hospitals
Most compliance professionals are familiar with the various OIG Compliance Program Guidance (CPG) documents for different segments of the healthcare industry. The complete list can be found on the OIG website. One of the more recent CPG’s is the Supplemental Compliance Program Guidance for Hospitals. Section III of this CPG (page 4874) is titled Hospital Compliance Program Effectiveness.
This section takes a similar approach to the Medicare Advantage questionnaire. Various questions are asked as they relate to the seven components of an effective compliance program. You’ll also find a frequency for such assessments for example: Hospitals should regularly review the implementation and execution of their compliance program elements. This review should be conducted at least annually and should include an assessment of each of the basic elements individually, as well as the overall success of the program. Again, some of the questions are specific to a hospital, but could easily be adapted to other provider or organization types.
3. New York Office of the Medicaid Inspector General Compliance Program Self-Assessment Form
New York law requires specific Medicaid providers to annually certify their compliance program. A self-assessment form is provided to aid providers in ensuring that their compliance program meets requirements. The form asks questions relating to the various elements of a compliance program under New York law. The law requires eight elements of a compliance program. The eighth element specifically calls for a policy of non-intimidation and non-retaliation.
The self-assessment question associated with this element: Is there a policy of non-intimidation and non-retaliation for good faith participation in the compliance program, including but not limited to reporting potential issues, investigating issues, self-evaluations, audits and remedial actions, and reporting to appropriate officials as provided in Sections 740 and 741 of the New York State Labor Law?
In summary, though there might not yet be a widely-accepted formulaic solution to quantitatively score the effectiveness of a compliance program, there are some tools out there to give compliance professionals a starting point as they strive to determine the effectiveness of their compliance program.
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