Blockbuster Compliance Trainings: Reaching Your Audience Without Knocking Them Out Cold

Transcription

1 www. TheNationalCouncil. org Blockbuster Compliance Trainings: Reaching Your Audience Without Knocking Them Out Cold Adam J. Falcone, Esq. Feldesman Tucker Leifer Fidell LLP November 6, 2013

2 Quick Reminders Your Participation Open and hide your control panel Join audio: Choose Mic & Speakers to use VoIP Choose Telephone and dial using the information provided Submit questions and comments via the Questions panel Note: Today s presentation is being recorded and will be provided within 48 hours. 1

3 Asking Questions Your Participation Please continue to submit your text questions and comments using the Questions Panel Please raise your hand to be unmuted for verbal questions. 2

4 Frequently Heard Responses to Audit Findings: FELDESMAN TUCKER LEIFER FIDELL LLP www. TheNationalCouncil. org But I didn t know we were supposed to do it that way!! Nobody told us to do it that way!! But said we could do it that way!! 3

5 Poll Question Can you recall a time in which you ever said, or heard, something similar to I didn t know we were supposed to do it that way? Yes No 4

6 Benefits of Compliance Training www. TheNationalCouncil. org Goal: To prevent and identify non-compliant conduct. Effective compliance training: Uses examples to describe the impact of non-compliance conduct Explains an individual s role in the compliance program Sets forth consequences to individuals for non-compliance. 5

7 Poll Question Do you believe your organization has a compliance program that includes all seven elements recommended by the Office of Inspector (OIG)? Yes No Not sure 6

8 The Seven Elements of Compliance Programs FELDESMAN TUCKER LEIFER FIDELL LLP www. TheNationalCouncil. org 1) Designate a compliance officer 2) Develop written standards and policies to implement the compliance program and govern operations 3) Implement training and education programs 4) Establish effective, clear, open lines of communication 5) Conduct internal monitoring and regular audits 6) Respond to detected issues 7) Publicize and enforce disciplinary standards 7

9 Poll Question Does your organization currently require: (a) new employees to receive compliance training upon hire (b) current employees to receive compliance training on a periodic basis, e.g., annually (c) Both (a) and (b), above

10 Training and Education FELDESMAN TUCKER LEIFER FIDELL LLP www. TheNationalCouncil. org Who? Anyone affiliated with organization (Board members, employees, contractors, agents, volunteers, etc.) What? Why the organization has a compliance program What a compliance program is How a compliance program operates What the individual s role and obligations are in the compliance program That there are sanctions for individuals who do not comply or cooperate with the compliance program When? Part of the orientation for newly affiliating individuals On a regular, periodic (annual) basis thereafter As needed as an element of corrective action to address specific problem areas or vulnerabilities 9

11 Poll Question Does your organization have a systematic, pro-active approach to ensure that employees receive specialized training to perform their job functions? Yes No Not sure

12 Training and Education FELDESMAN TUCKER LEIFER FIDELL LLP www. TheNationalCouncil. org Who? Anyone affiliated with organization (Board members, employees, contractors, agents (as appropriate), volunteers) What? Should address specific compliance risk areas Related to individual s role in organization When? Part of the orientation for newly affiliating individuals On a regular, periodic (annual) basis thereafter As needed as an element of corrective action to address specific problem areas or vulnerabilities 11

13 Participant Question What training methods does your organization currently use? [Type in Response]

14 Training Methods FELDESMAN TUCKER LEIFER FIDELL LLP www. TheNationalCouncil. org Use a variety of cost-effective training methods to reach different types of learners. Conferences, including opportunities for group and interactive learning Webinars E-Learning courses/modules Videos Manuals and guidebooks Published articles, such as those in the National Council s Compliance Watch Consider making attendance and participation in training programs a condition of continued employment or a prerequisite to promotion, job advancement, or receiving a bonus. Document your training and education activities. Demonstrates training and education efforts. Get credit for what you do! 13

15 Questions?? www. TheNationalCouncil. org 14

16 www. TheNationalCouncil. org General Compliance Training Sample Presentation

17 Why Are Compliance Programs Needed? 16

18 Why Are Compliance Programs Needed? 17

19 Why Are Compliance Programs Needed? 18

20 What Is Corporate Compliance? Compliance is a proactive and reactive system of internal controls, operating procedures, and organizational policies to ensure that the rules applicable to your organization are regularly followed.

21 What is a Compliance Program? 1) Designate a compliance officer 2) Develop written standards and policies to implement the compliance program and govern operations 3) Establish effective, clear, open lines of communication (internal reporting) 4) Conduct internal monitoring and regular audits 5) Implement training and education programs 6) Respond to detected issues 7) Publicize and enforce disciplinary standards 20

22 What are the rules? Government laws and regulations Medicaid/Medicare billing rules (Federal) HIPAA Privacy (Federal) Practitioner licensing rules (State) Grant program requirements Operational and service obligations (Federal, State or Other) Administrative and financial record-keeping (Federal or State) Organizational policies and procedures Timesheets, clocking in/out (Internal) Purchase of office supplies (internal)

23 What are the benefits of a Compliance Program? Compliance with the law! Minimize payment recoupments and financial penalties Avoid loss of grant funding Protect patient privacy and quality health care. Preserve access to behavioral health and other services.

24 Health Care Fraud Developments New compliance requirements such as establishing a compliance program as a condition of enrollment for all providers in Medicare, Medicaid, and CHIP Increased funding of program integrity activities Higher risk of False Claims Act liability Financial penalties for broader scope of conduct Mandatory return and reporting of overpayments

25 What is Health Care Fraud? In the context of knowingly submitting false statements or claims under the Federal Civil False Claims Act, knowingly means: Actual knowledge of truth or falsity of statements or claims. Deliberate ignorance of truth or falsity of statements or claims. Reckless indifference of truth or falsity of statements or claims. Applies to any health care program paid for in whole or part with federal funds, including: Medicare Medicaid and CHP Exchange-based health plans HHS grant funded programs

26 What are the possible consequences for an employee who does not follow the rules? Warning and/or probation of employee Termination of employee Exclusion or debarment of individual or organization from federal or state health care programs Loss of license to furnish health care services Recoupments of federal or state funding Financial penalties Referral for criminal prosecution

27 Our Compliance Program Designated a Compliance Officer and a Compliance Committee Implemented Compliance Program policies and procedures and a Standards of Conduct Conducts compliance audits Conducts training (Welcome!) Offers multiple channels for reporting of compliance questions and concerns and does not retaliate for reporting Investigates compliance issues promptly and, if a problem is confirmed, takes appropriate corrective action Takes disciplinary action where appropriate 26

28 Your Role is Crucial! Identify and prevent noncompliance Demonstrate your organization s commitment to honest and responsible corporate conduct Reduce penalties if non-compliance occurs Maintain eligibility to receive governmental funding Protect your organization s reputation Improves quality, efficiency, effectiveness of patient care and operational activities.

29 Your Role in the Compliance Program Managing the Compliance Program not maintaining the organization s compliance is the responsibility of the Compliance Officer Maintaining compliance and cooperating with our Compliance Program is An essential element of every Board member s, manager s, employee s, contractor s, agent s, volunteer s position description A requirement of continued employment 28

30 Duty to Report Our reporting policy requires: Everyone to report any potential compliance violation This is not about snitching on each other Reporting must be done in good faith Managers are responsible for the compliance of their departments / staff and for reporting any questions or concerns to the Compliance Officer Everyone is encouraged to self-report about potential violations Failure to report may subject an individual to disciplinary action If you do not report an issue, how would management know to address it? 29

31 Non-Retaliation Policy We will not retaliate against individuals who report compliance issues in good faith We will take disciplinary action against individuals who retaliate against others who report compliance issues in good faith A person who self-reports is protected from retaliation for reporting, but is subject to disciplinary action for the underlying non-compliant conduct 30

32 How to Report Compliance Issues Reports should be made to your supervisor If you are not comfortable with reporting to your supervisor or your supervisor is not taking appropriate action, then report to the Compliance Officer: [Insert Here] Telephone number: [Insert Here] Reports may be made anonymously, but remember: Identifying yourself makes resolving the issue much easier 31

33 Reporting Compliance Issues What might be a potential compliance violation? Intentional or unintentional Action or failure to act That a reasonable person would believe is a: Violation of corporate policies and procedures Violation of the law, regulations, agency guidance, billing rules, etc. 32

34 Potential Compliance Issues Violation of Policy and Procedure or Standards of Conduct Failure to maintain accurate charts Improper coding or billing Improper expenditure of Federal funds Offering/paying or soliciting/receiving kickbacks from referral sources Violation of patient privacy Failure to ask questions if uncertain or to report any of the above 33

35 Reporting Non-Compliance Issues What is NOT a potential compliance violation? Employee grievances Patient grievances We have a separate process for addressing such matters Human Resources Department/Director [Insert Name and Contact Information] 34

36 Disciplinary Policy Disciplinary action may include, but is not limited to: Reprimand Demotion Suspension and/or Termination 35

37 Three Rules to Remember 1. Comply with the organization s policies and procedures, including the Standards of Conduct Seek additional guidance if unsure of where to look for guidance or how guidance applies to particular facts and circumstances 2. Comply with applicable laws, regulations, or other legal and contractual requirements 3. Report suspected or potential non-compliance You have a duty to report actual and suspected compliance issues Know the compliance reporting procedure Remember the non-retaliation policy

38 Reporting Compliance Issues Name and contact information for Compliance Officer Reports by are discouraged Intranet reporting preferable Telephone number of compliance hotline Location of compliance drop-box

39 Where to Find Additional Information Website or address to obtain additional information or key compliance program documents: Standards of Conduct Conflict of Interest Policy Internal reporting procedure Non-retaliation policy

40 Questions?? www. TheNationalCouncil. org 39

41 www. TheNationalCouncil. org Adult Learning

42 Audience Participation What are some reasons that a training session or program has not met your expectations or goals as a learner?

43 How Adults Learn The key to designing a successful training program for adults is to recognize that adults learn differently from children. In Understanding and Facilitating Adult Learning (1986), Stephen Brookfield stated that successful adult learning involves creating an environment in which exchange and dialogue must take place between trainers and learners. 42

44 How Adults Learn, cont. Adult learning principles emphasize interaction between trainers and learners, rather than relying on a didactic approach (involving experts who present materials using visual aids and handouts) This interactive approach utilizes the six core principles for adult learning first described by Malcolm Knowles in 1975 in Self-Directed Learning: A Guide for Learners and Teachers. 43

45 Knowles Core Learning Principles for Adults The need to know The learner s self-concept The role of the learner s experiences Readiness to learn Orientation to learning Motivation 44

46 Key Components of a Learning Program Analysis Design Development Implementation Evaluation Rosenberg, Marc J. (1982, Sept.) The ABC s of ISD (Instructional Systems Design). Training and Development Journal,

47 Analysis What is the subject matter? Why is it important? Who are the learners? How many people? Who are they? What are their ages and backgrounds? What do they do? What do they already know about this topic? What do they need to know at the end of the learning experience? Why do they need to know? Design the program Identify learning objectives or goals (what do you hope to accomplish?) Develop a strategy to achieve them (what approach(s) will you take?) 46

48 Analysis, cont. Are there barriers to learning that must be overcome? What is the learning timetable? How much time can be devoted to training? What is your organization s attitude toward learning activities? What type of technology does your organization have? Are you limited to use of existing technology or can you experiment? 47

49 Design Begin with a clear purpose and specific goals What do I hope to accomplish? How can I motivate participants to learn? Think in terms of behavior and skills what do you want people to do differently? Include learners in designing the program Build on learner s current knowledge and attitudes Identify and understand obstacles to learning (e.g., subject matter, characteristics of learners, physical barriers) 48

50 Design, cont. Recognize that a single method of teaching adults is not possible Be flexible Vary activities and exercises Use technology when appropriate to enhance learning Make sure you have broad agreement about approach, goals, structure and content 49

51 Development Create a strategy that uses a variety of approaches to achieve learning goals, for instance: Lecture Demonstration Interaction Shared learning Problem solving Case study Team work Role playing Simulation Games 50

52 Poll Question Would participating in a game as a part of a training make you more or less likely to find the training effective?? (A) More effective helps reinforce material, etc. (B) Less effective waste of my time, etc.

53 Choose a category. You will be given the answer. You must give the correct question. Click to begin. (c) Feldesman Tucker Leifer Fidell LLP

54 Development, cont. Ground exercises in real life issues and examples Focus on what s essential: do not try to cover too much too quickly Create visuals and handouts that reinforce learning objectives and the emphasize practical application of subject matter Use technology if it enhances learning 53

55 Implementation Create an environment for learning Physical set up of room Room temperature/lighting/noise Anticipate special needs of learners, especially those with disabilities Minimize obvious obstacles to learning Timing and length of training session Reduce distractions (cell phones, PDAs) 54

56 Evaluation How to measure what was learned? Feedback Transference (can learners apply what they learned to their jobs?) How to measure benefits to the organization? What s the organization s ROI? Be sure to communicate to learners the organization s expectations for follow up/next steps Actually follow through on next steps 55

57 Bottom Line Develop consensus around the need for and approach to training Plan your program carefully: recognize the needs and capabilities of your audience and potential barriers to learning involve learners in designing the program Be sure that the physical setting for your program is not itself an obstacle to learning 56

58 Bottom Line, cont. Learning! Design simple, practical programs that use techniques that reflect adult learning principles and varied approaches to learning Enhance motivation to learn by emphasizing personal and organizational benefits Spend time in the planning process designing evaluation and follow up activities 57

59 Questions? Adam J. Falcone, Esq. FELDESMAN TUCKER LEIFER FIDELL LLP Feldesman Tucker Leifer Fidell LLP th Street, NW 4th Floor Washington, DC (202)