The workings of a hospital are complex and varied, and in dealing with serious issues such as health and finances, there is a huge potential for malpractice, fraud or accidental injury, and even death. Oversight and proper procedures are of huge importance in a hospital environment, and you should take all the measures you can to prevent malpractice and avoid the repercussions of investigations and civil or criminal proceedings. Hospitals come under the watchful eye of the OIG, or Office of Inspector General, which conducts investigations into individuals and organizations suspected of not following laws, policies, committing fraud, or committing negligence. If you are working for a hospital, here are some ways your organization can be OIG compliant and reduce the risks of getting in trouble.
What is OIG?
OIG is short for the ‘Office of Inspector General’, it is the oversight division of The US government and works with state agencies to combat unlawful practices. There are 73 offices of the US inspectors general, covering areas such as International Development (AID), Department of Commerce (DOC), Department of Defense (DOD), and The Department of Health and Human Services (HHS). These offices employ agents, investigators, and auditors to follow up on complaints or reports, conduct criminal investigations and compile evidence for cases against organizations suspected of unlawful practices. Adherence to OIG regulations can reduce the risk of investigations and personal injury lawsuits against your hospitals. Hospitals and healthcare businesses must be compliant with The HHS Inspector general and could be prosecuted through this branch of the government.
Compliance Guide
The OIG does provide a guide for healthcare bodies to follow in order to be compliant with the regulations and standards of the HHS and to avoid any investigations. They recommend seven points for organizations to follow to voluntarily work towards compliance.
Clear Set of Standards
They recommend that companies have a strict and clear set of standards that can be printed and distributed throughout the company. Companies can also outline their evaluating standards for managers and employees so that they are aware of the consequences of non-adherence to the companies standards.
Chief Compliance Officer
The hiring of a ‘Chief Compliance Officer’ is a recommended step for any sizable healthcare business, and for a hospital, in particular, they should have a department that is responsible for ensuring that compliance standards are being met by the entire hospital and its staff. This could include different sub-departments for areas such as diagnostics, procedures, facilities, and finance.
Compliance Department and Training
Once a compliance department has been established, they will be able to implement the program and create training programs for different areas of staffing. This can be from simple drills and instructions to more in-depth programs of training that can also result in qualifications for the staff or becoming registered compliant officers within their department.
Feedback And Complaints
Making a convenient method for receiving complaints and feedback is recommended by the HHS. Also, allowing for anonymity in the complaints procedure and offering protection for employees who are whistleblowing on colleagues. Having a safe and secure system for this can allow the standards department to collect information from staff and open their investigations into suspected cases of malpractice.
Investigating Claims
The OIG also recommends developing a system for responding to allegations and complaints and for compiling evidence in any suspected cases. Internal disciplinary actions can be taken against any employees in violation of the company’s standards and policies. If there is a victim in the case, there should be action taken to remedy the situation.
Auditing
Audit controls and evaluations are recommended for all departments involved in finance or acquisition. Preventing fraudulent activity should be a high priority for any hospital, having strong standards and a compliance sub-department for financial transactions is of high importance. Between 3-10% of all healthcare spending is fraudulent and can leave your company vulnerable to investigation or criminal action. A strict overview of your hospital’s accounting and strict measures for action can help prevent fraudulent activity in your hospital.
Termination Of Contracts
Finally, they recommend the implementation of strict policies in regards to the termination of contracts for individuals in violation of your companies standards and compliance. Reporting individuals that are in breach of federal law and taking appropriate action against them. If there are systemic issues, investigation remediation of the issues and disciplinary action against management or department heads should proceed.
Additional Tips
Outside of the recommendations from The OIG, there are other measures you and your hospital can take to be compliant and reduce the risks of getting in trouble. Here are some additional OIG compliance tips your company can implement to stay out of trouble. These include compliance-based promotions, bonuses, and rewards to support a culture of compliance and to give positive reinforcement to your staff. Creating extra benefits for those who show high compliance can encourage you, employees, to make an extra effort to follow the rules and regulations.
Compliance needs analysis is important too, keeping ongoing records of compliance actions and evaluating the results, so you can more efficiently regulate the standards in your hospital, there may be specific needs or unforeseen incidents that require changes to the regulations.
Monitoring OIG fraud alerts can help your hospital continuously undertake compliance measures. The OIG issues fraud alerts to help hospitals and businesses combat fraud. IF your company is not in compliance, you could be facilitating fraud and may be vulnerable to an investigation, and can incur civil or criminal disciplinary measures.
Being OIG complaint not only reduces your risk of being involved in an investigation or lawsuit, but can also help your staff improve and become more compliant in their open practices, can make your hospital a safer and secure environment that supports staff opinion and offers protection to whistleblowers, and, of course, can reduce the likelihood of accidents or practices that can lead to injury, harm or death. Running a hospital requires a huge team of dedicated staff, and thorough practices and oversight. Following the OIG recommendations and following some of these tips will help your hospital with OIG compliance and reduce the risk of getting in trouble.