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Federal Sentencing Commission Guidelines And Compliance And Ethics Initiatives

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In 2013, the Department of Health and Human Services recovered four and a half million dollars from individuals and firms that committed fraud. Healthcare fraud regulations that require care providers to implement compliance and ethics initiatives allow the agency to accomplish this success. The regulations require healthcare organizations to develop programs that actively promote ethical culture and reinforce compliance commitment. By promoting moral behavior with internal and external influences, compliance officers guide staff members in making moral decisions and conforming to the law.

The United States government has contended with fraudulent claims since the Civil War, resulting in President Lincoln endorsing the first antifraud
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Compliance Training and Education

Ongoing training ensures that staff members remain aware of current organizational policies and standards. This includes teaching general compliance guidelines to all staff members, supervisors and managers. Additionally, all new employees must undergo basic training before or beginning their first shift. Compliance officers also host annual training sessions to review policy changes and developments. The annual sessions also reinforce organizational policies among staff members.

Maintaining Organizational Communication

Two-way communication facilitates effective staff member compliance. Employees must feel that supervisors and managers will receive concerns with neutrality. To support this environment, compliance personnel implement formal procedures for voicing concerns. The procedure allows employees to anonymously report issues if desired. While larger enterprises may provide a toll-free hotline for this purpose, smaller firms might implement an open door policy.

Ongoing Monitoring and Auditing

Effective healthcare organizations routinely monitor and audit compliance performance. The processes ensure that the organization complies with regulations and uncovers compliance risks.

Monitoring involves ongoing evaluation as a part of daily operations, while audits involve a formal process, where compliance officers benchmark staff
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