Developing a Patient-Centered Nursing Home Compliance Program that is 3E (Effective, Efficient, and Economical)

Thomas Herrmann | January 2019

As discussed in the last issue, in less than one year (November 2019) all nursing facilities participating in the Medicare and Medicaid programs will be required to develop and implement a Compliance and Ethics Program. The challenge for nursing facilities is to establish a program that is appropriately focused on ensuring compliance with all applicable laws and regulations, as well as:

  • Health and safety of patients;
  • Quality of care;
  • Accuracy and completeness of documentation; and
  • Integrity of bills and claims for payment submitted to federal health care programs (e.g., Medicare and Medicaid), other third-party payers, and patients.

Moreover, in light of  the many requirements imposed on long-term care  (LTC) facilities under the revised conditions of participation (COPs) for Medicare and Medicaid, how can the obligation to implement and maintain a Compliance and Ethics Program be accomplished in a “3E” (i.e., effective, efficient, and economical) manner? The solution lies in aligning and integrating the mandated Compliance and Ethics Program with other key COP requirements related to:

  • Resident rights;
  • Patient “freedom from abuse, neglect, exploitation”
  • Quality of life;
  • Quality of care;
  • Quality Assurance and Performance Improvement; and
  • Training.

Through a centralized, comprehensive, and coordinated process for addressing these regulatory mandates, a nursing facility can develop its Compliance and Ethics Program in a 3E manner.

About the Author

Thomas Herrmann advises health care clients on compliance and regulatory matters, with a focus on development and management of effective health care compliance programs. Mr. Herrmann is a recognized expert on issues related to the federal Anti-Kickback Statute, Stark Law and the False Claims Act.