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Corporate Compliance for the Health
Care Professional
This section provides an overview of the seven elements of corporate
compliance programs and a glossary of commonly used compliance
acronyms.
Brief overview of health care compliance
The move by many in the health care industry to develop corporate
compliance programs came after passage of the Health Insurance
Portability and Accountability Act of 1996. This Act gives the
Department of Health and Human Services’ Office of Inspector
General and the U. S. Department of Justice more investigational funding
and authority to increase penalties for health care fraud and abuse.
Using these and other enforcement tools the government continues to
investigate health care institutions across the U. S. searching for
violations of the False Claims Act and other federal laws.
To protect their institutions from liability, health care providers
are implementing corporate compliance programs using the seven elements
outlined in the U. S.
Sentencing Guidelines for Organizations and appointing corporate
compliance officers to develop, implement, and manage them.
While law does not require an organization to meet the Guidelines
seven elements of a compliance program, these elements provide the
backbone of a well-designed compliance program. An organization that is
found guilty of violating federal criminal laws and has a compliance
program in accord with the Guidelines, may reduce assessed penalties by
up to 70% against the fines that the law requires.
The U. S. Sentencing Commission was created by Congress in 1984 to
promulgate the U. S. Sentencing Guidelines for Organizations and the U.
S. Sentencing Guidelines for Individuals to increase sentencing
uniformity for those found guilty of violating federal laws. To
encourage good corporate citizenship, the Commission outlined a
punishment structure based on the culpability of the organization and
the seriousness of the crime.
U.S. Sentencing Guidelines Revisions:
Effective Compliance and Ethics Programs
Click here to download the U.S. Sentencing
Guidelines revisions regarding an effective compliance and ethics
program.
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