OIG
Effective Compliance Program- The Seven Basic Elements
by A. Maureen Hanna
OIG
Effective Compliance Program-
The Seven Basic Elements
by A. Maureen Hanna
Element # 7 - Responding promptly to detected offenses and developing corrective action
Detected but uncorrected misconduct can seriously endanger the mission, reputation, and legal status of the DMEPOS supplier. It is important that the compliance officer or other management officials immediately investigate the conduct in question to determine whether a material violation of applicable law, rules or program instructions or the requirements of the compliance program has occurred, and if so, take decisive steps to correct the problem.
Such steps may include:
Immediate referral
to criminal and/or civil law enforcement authorities,
A corrective action plan
A report to the Government, and
The return of any overpayments.
Where potential fraud or False Claims Act liability is not involved, the OIG recommends that the DMEPOS supplier promptly return overpayments to the affected payor as they are discovered. Depending on the nature of the alleged violations, an internal investigation will probably include interviews and a review of relative documents, such as submitted claims and CMNs. Some DMEPOS suppliers should consider engaging outside auditors of health care experts to assist in an investigation.
Records of the investigation
should include:
Documentation of the
alleged violation,
Description of the investigative
process, (including the objectivity of the investigators and methodologies
utilized),
Copies of interview notes and key documents,
A log of the witnesses
interviewed and the documents reviewed,
The results of the investigation (e.g. any disciplinary action
taken and any corrective action implemented).
If an investigation of an alleged violation is undertaken and the compliance officer believes the integrity of the investigation may be at stake because of the presence of employees under investigation, those subjects should be removed from their current work activity until the investigation is completed. In addition, the compliance officer should take appropriate steps to secure or prevent the destruction of documents or other evidence relevant to the investigation. Disciplinary action should be prompt and imposed in accordance with the DMEPOS supplierís written standards of disciplinary action.
If the Compliance Officer etc. discovers credible evidence of misconduct from any source and, after a reasonable inquiry, has reason to believe that the misconduct may violate criminal, civil or administrative law, then the DMEPOS supplier should promptly report the existence of misconduct to the appropriate Federal and State authorities within a reasonable period (but not more than sixty days). This prompt reporting will demonstrate the DMEPOS supplierís good faith and willingness to work with governmental authorities to correct and remedy the problem.
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