Welcome to the New in 2011 Archive!

Back to New in Compliance and Ethics World

  • December 14, 2011 - CMS announced its proposed rule implementing the transparency requirements of the Affordable Care Act which will, eventually, require public reporting of payments to physicians and teaching hospitals by various manufacturers and group purchasing organizations.

  • December 5, 2011 - The DHHS OIG began posting a series of Compliance Training videos on its website with an associated "widget".

  • November 2, 2011 - In commentary on its final rule requiring a compliance plan for those forming an Accountable Care Organization the Centers for Medicare and Medicaid Services (CMS) stoutly defended the value of such efforts, saying in part "compliance programs increase the likelihood of identifying and preventing unlawful and unethical conduct; provide a centralized source for distributing information on health care statutes, regulations, and other program directives related to fraud and abuse; and create an environment that encourages employees and others to anonymously report potential problems, among other benefits.” Other highlights: mandatory training for providers / suppliers, mandatory reporting of "probable" violations of the law and separation of the Compliance Officer role and legal counsel - one individual cannot be both.

  • November 1, 2011 - In recognition of the 20th "anniversary" of the Federal Sentencing Guidelines provisions relating to organizations the nonprofit Ethics Resource Center has compiled an extensive commentary on them with recommendations for improvement. It's also made that draft available for public comment until November 30.

  • October 18, 2011 Hospital Conditions of Participation - proposed revisions- With claims of "$1.1 Billion" in associated savings, the Health and Human Services Secretary unveiled changes to the governing body, medical staff, infection control, nursing, transplant and patient rights COPs. Still no condition requiring a compliance and ethics program. Comments may be submitted at www.regulations.gov, ID number CMS-9070-P or CMS-3244-P.

  • October 9, 2011 Governor Brown of California vetoed SB 442, a bill that would have imposed substantial new requirements relating to language assistance. His veto message makes interesting reading.

  • October 5, 2011 DHHS OIG's Annual Workplan - 2012 - This year's plan is of particular interest because it lists a focused review of inpatient and outpatient Medicare claims in order to profile the submitting hospitals as “most risky” to “least risky across compliance areas”. Follow-up reviews at those in the “most” part of the spectrum will include review of “compliance practices” and interviews with both leadership and compliance officers. Also planned - review of skilled nursing facilities for adequacy of their compliance plans once they become mandatory in 2013; identification of providers with "questionable" evaluation and management (E&M) billing, and a study of physician ordering "patterns" for laboratory tests.

  • September 23, 2011 Hill-Rom, agrees to a five year Corporate Integrity Agreement that requires its Chief Compliance Officer (CCO) to become a member of the Company's Senior Management, participation of a non-employee Board member on the committee supporting the CCO, annual resolutions by the Board describing its oversight of compliance with federal healthcare requirements, incorporation of the Company's Code of Conduct in performance evaluations, specific training (time, frequency, content, format, position) requirements, and exclusion checking every 120 days. All this is in addition to the $42M settlement payment, of course.

  • July 2011 Effective Training? The DHHS OIG reviewed participating Medicare Part D sponsors for their compliance with the requirement, since 2009, of providing "effective" training about fraud waste and abuse to their contractors. The results - although 87% of the contractors reported completing training, 30% were not required by their sponsor to submit proof of that completion. On the effectiveness of the training the OIG concluded "most sponsors could not determine the extent to which the training was effective."