As January gets underway, it is common to reflect back on the prior year and set expectations for the upcoming months. Whether it is losing weight or maintaining better relationships with loved ones, New Year's resolutions are abundant. Your physician practice group should also set a New Year's resolution: updating your corporate compliance plan or, if you do not already have one, creating and implementing such a plan. Compliance plans are written strategies, adopted by a practice, to assist in compliance with applicable laws and business policies. They can be of great benefit to practice groups. Not only can they detect under-coding, thereby increasing collections and minimizing billing mistakes, but they can also help mitigate against prosecution and reduce sanctions. Many healthcare laws have an intent requirement for violations. An effective corporate compliance plan can be used to demonstrate that violations of such laws are simply inadvertent mistakes without the necessary intent for prosecution. In fact, the Department of Justice has advised prosecutors that the existence of a corporate compliance plan should be considered in determining whether or not to prosecute. The Office of Inspector General (OIG) has published guidance on compliance programs for small group physician practices. The OIG allows flexibility in developing a plan, but there are some general elements that should be included in most plans: implementing compliance and practice standards, appointment of a compliance officer, effective employee training and education, audit and monitoring processes, effective communication, internal investigations and enforcement, and responding to offenses and applying corrective action. However, to be effective and beneficial to a physician practice, all compliance plans should periodically be revised and updated. This will ensure that the plan complies with healthcare laws and that employees are actually following a working plan on a daily basis. As you revise your corporate compliance plan or implement one for the first time, the following is a list of questions to ask yourself. · Are your employees adequately informed of the practice's commitment to following the compliance plan and are they properly trained regarding the plan's procedures and policies? Following the plan must be a condition for continued employment. Further, routine training regarding the plan's policies and procedures is a requirement. Training can take place in a variety of forms, whether it is Web-based tutorials, attendance at seminars, or self-study. As you revise your plan, inform and train your employees on the revisions and update them on those polices and procedures already in place. · Have you reviewed the changes in healthcare laws since the implementation or last revision of your compliance plan? To be effective, plans should address relevant issues in the healthcare industry and should reflect recent changes. Each year the OIG issues a work plan in which it sets forth the main issues it intends to investigate over the upcoming year. This work plan provides a physician practice with a great tool for identifying relevant issues that should be addressed in a compliance plan. (The 2007 OIG Work Plan is available at http://oig.hhs.gov/publications/docs/workplan/2007/Work%20Plan%202007.pdf.) · Are all your policies, standards, and procedures written to address your particular risks? It is important to document in written form how you have addressed the risks and possible types of misconduct within your particular practice. Although there are several risk areas that are common to most practices, such as coding and billing, reasonable and necessary services, documentation, and avoiding improper inducements, kickbacks and self-referrals, every practice is different. Therefore, during the revision process, conduct an internal review to access your specific risk areas. · Is your compliance officer still the appropriate person for the job? The compliance officer oversees the compliance plan and its implementation. He or she is the person responsible for auditing and documenting the results of the plan, training employees, responding to concerns or questions, conducting internal investigations, and carrying out disciplinary actions. Therefore, the compliance officer should be trustworthy, effective at communication, able to handle large amounts of authority and responsibility, and able to influence organizational practices and behavior. · Have you properly and timely addressed identified problems since the last revision? It is important that when a problem or violation arises, it gets addressed. This may include repaying Medicare or third-party payors when necessary, reporting violations to the government, or referring problems to law enforcement officials. Further, after addressing the problem, you need to ensure that it does not arise again. This may include disciplinary action or revising the ineffective portions of your compliance plan. These questions should provide initial guidance in updating your compliance plan, for an ineffective compliance plan carries the same effect as having no compliance plan at all. Although you may waiver on your other New Year's resolutions and eat that extra piece of cake, this is one resolution that should be, and can be, kept. Kelli Carpenter is an associate at Burr & Forman LLP and practices exclusively within the firm's Health Care Practice Group. January 2007