Planning comes before actionThe Office of the Inspector General of the Department of Health and Human Services recently published “Practical Guidance for Health Care Governing Boards on Compliance Oversight,” in collaboration with a number of leading health care organizations.

This post examines health care governing boards and their roles in providing oversight for compliance with state and federal health care regulatory laws by identifying and auditing potential risk areas.

Identifying and Auditing Potential Risk Areas

To maintain compliance as a health care provider, it’s important to identify and audit potential risk areas. As the guidance states, common risk areas include:

  • Referral relationships and arrangements
  • Billing problems
  • Privacy breaches
  • Quality-related events

The guidance advises that boards can identify these risks through internal and external resources, such as professional publications, OIG-issued guidance, consultants, competitors and news media. Boards and management teams can learn from publicity generated by problems in other organizations, using such publicity to take stock of their own processes in place.

On the topic of auditing, the guidance states that risk areas should be routinely audited in conjunction with the development of corrective action plans, and when designing risk assessment plans, Boards should consider recent industry trends. Such trends include an emphasis on quality, industry consolidation and changes in insurance coverage and reimbursement, with the guidance giving a nod to new payment models and Stark and anti-kickback laws.

The guidance also suggests that Boards should use newly available data resulting from the push toward increased transparency in the health care industry to their organization’s benefit. For example, Boards could use the data to compare against peers when assessing their own organizational risk and compliance.

Read the full guidance here. If you have any questions on identifying and auditing potential risk areas in your organization, please give me a call.

Kristin Edgar practices as part of the Health Care and Education Law sections at Caplan and Earnest. She can be reached at 303-443-8010 or [email protected]