ComplianceHotline

“Simplifying Compliance….. Once Incident at a Time”

ComplianceHotline provides independent, third-party report line services for health care providers, suppliers, and their vendors around the country.

Our confidential report line system provides a cost-effective report line alternative to the often impersonal, expensive, commercial report line systems now marketing their systems to health care providers and suppliers. Unlike a number of the companies now servicing the industry, ComplianceHotline was designed by former Federal prosecutors with extensive compliance experience. Moreover, the day-to-day operations of ComplianceHotline are managed by a Certified Medical Compliance Officer.

Our service provides several ways for employees, contractors, vendors, patients and their families to report potential violations of an organization’s ethical, regulatory, or legal obligations. These reports are confidential and reporting individuals may choose to identify themselves or remain anonymous. Once a report is made, it is forwarded to the appropriate compliance professional designated by a sponsoring health care provider or supplier organization. Options for making a report include:

  1. Web-based reporting option: An individual can conveniently file a report directly from our simple to use web based reporting application. Individuals filing a web-based report may identify themselves or may make an anonymous report.
  2. Fax-based reporting option: A ComplianceHotline incident report form is included on our website and may be printed for completion at a later time.
  3. Mail-based reporting option: Our incident report form may be sent by a concerned party directly to ComplianceHotline by mail.
  4. E-Mail-based reporting option: Incident details may be sent by a concerned party directly to ComplianceHotline by e-mail.
  5. Toll-free telephone report line option: ComplianceHotline maintains and operates a live, compliance hotline reporting service. Unlike many of our competitors, we do not subcontract this aspect of our hotline services to a commercial answering services operating out of a foreign country. Our hotline calls are answered by trained compliance personnel in Washington, DC.

[accordion-item title=”What types of messages are typically reported through the Compliance Hotline?”]

Reports of potential improper coding or billing practices by employees, patients, and their families.

Reports of harassment, bullying, or other improper conduct by both supervisory and staff personnel.

Reports of vendor misconduct by employees or by an outside third-party.

Reports of possible patient abuse by employees, patients and their families.

Anonymous reports by concerned employees or potential whistleblowers who may be concerned about possible retaliation.

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[accordion-item title=”What Makes Our Compliance Service Different?”]

Our hotline services are affordable and effective.
Health care providers and suppliers are required to comply with ever-increasing regulatory obligations, despite the fact that reimbursements from both governmental and private payors are continuing to fall. We have designed ComplianceHotline to provide an inexpensive yet effective way to learn of and address an employee concern as soon as possible, thereby reducing the likelihood of a whistleblower suit under the False Claims Act. Similarly, ComplianceHotline can provide an avenue of communication for patient concerns directly with your organization, rather than channel a dissatisfied patient to file a complaint with your state’s medical board or with federal and state law enforcement.

Convenient access and low cost are only part of the solution. Our staff has expertise in compliance.
All hotline reporting systems have one or more ways to file a report 24 hours a day, 7 days a week —
only ComplianceHotline is manned by Certified Medical Compliance Officers. Calls and e-mails are handled by compliance professionals, not call center operators with little or no knowledge of this specialized regulatory area.

Cookie-cutter approaches to a compliance hotline don’t work. We understand compliance and we recognize that your organization is unique.
Working with your compliance staff, we will assemble questionnaires to be used when calls regarding your facility are received.

We recognize the importance of quality patient care.
Any reports received by
ComplianceHotline which raise patient care concerns are reported to you by phone as soon as possible. A standard written report will then follow by e-mail to your designated compliance professional.

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[accordion-item title=”Why is it important to implement a confidential compliance hotline?”]

The Department of Health and Human Services, Office of Inspector General (HHS-OIG) has long encouraged health care providers and suppliers to develop and implement an effective compliance plan and an overall compliance program. A compliance plan is generally comprised of seven critical components. One of these components includes:

Developing Open Lines of Communication.”

As HHS-OIG notes, in order to prevent problems from occurring in the first place, and to foster an open and frank discussion of potential business problems and concerns, health care providers and suppliers need to develop and maintain open lines of communication. HHS-OIG further recommends that health care providers set up several methods of communication for the reporting of an ethical, regulatory or legal violation by members of a provider’s staff, contractors, patients, vendors or other outside parties. Our team of compliance professionals at ComplianceHotline® have carefully reviewed HHS-OIG’s guidance in this regard, noting the agency’s concerns and incorporating its recommendations into our confidential report line system.

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[accordion-item title=”Is a health care provider required by law to have a compliance hotline?”]

On March 23, 2010, the Affordable Care Act (ACA) was signed in to law. Among its provisions, the ACA includes a provision which authorizes the Secretary, HHS to mandate that health care providers and suppliers establish a compliance program as a condition of their enrollment in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).  As the statute provides:

‘‘(7) COMPLIANCE PROGRAMS.—‘‘(A) IN GENERAL.On or after the date of implementation, as determined by the Secretary under subparagraph (C), a provider of medical or other items or services or supplier within a particular industry sector or category shall, as a condition of enrollment in the program under this title, title XIX, or title XXI, establish a compliance program that contains the core elements established under subparagraph (B) with respect to that provider or supplier and industry or category.”

In September 2010, CMS solicited comments from members of the health care community asking how to best implement these new mandatory compliance program requirements. Several months later, in February 2011, CMS published the related final rule. At that time, CMS indicated that it intended to issue proposed regulations on the mandatory compliance program provisions of the ACA at a “later date.” No additional proposed or final regulations on the deadline to meet the mandatory compliance requirements has been forthcoming.

Why do we believe that having an effective compliance program is already a necessity?  There are several reasons why we believe an effective compliance program is already an obligation for most health care providers and suppliers. First, it is important to keep in mind that if your practice or other health care organization is a participating provider and accepts Medicare Managed Care, you are already required to have implemented an effective compliance program.  Pursuant to 42 C.F.R. §§ 422.503(b)(4)(vi), 423.504(b)(4)(vi), and as incorporated into Chapter 21, Section 30 of the “Medicare Managed Care Manual,” participating providers are required to adopt and implement an effective compliance program which includes “measures to detect and correct Part C or D program noncompliance.” The compliance program must, at a minimum, include seven core requirements. These seven elements are functionally equivalent to the seven components of an effective compliance plan identified by HHS-OIG in its various publications outlining compliance program guidance for physician practices, hospitals, home health agencies, durable medical equipment (DME) companies, and a host of other provider specialty areas. As a result, all providers and suppliers accepting Medicare Managed Care are currently obligated to have implemented an effective compliance program.  

In addition to Medicare Managed Care, many of the health care providers and suppliers now participating in a state Medicaid program are also required to have an effective compliance program in place. Long before the passage of the ACA, the federal Deficit Reduction Act of 2005 (signed into law February 8, 2006), included a provision mandating that all Medicaid providers receiving more than $5 million each year have various policies and procedures that address prevention of fraud, waste and abuse. These policies and procedures essentially amount to a compliance program.

Since that time, a number of states have modified their Medicaid participation agreement to include a requirement that all participating health care providers and suppliers certify that they have an effective compliance program in place. As a final point in this regard, we are now starting to see private payors incorporating a requirement that providers and suppliers implement a plan in order to participate in their program.

In consideration of the above, most of our clients currently fall into one or more the above categories and are therefore obligated to develop and implement an effective compliance program / compliance plan. While the Secretary, HHS, has yet to announce when the remaining participating providers must comply with the mandatory compliance provisions set out under the ACA, that announcement could be issued any day now.

What do each of the legal obligations discussed above have in common? They all require that participating health care providers and suppliers establish “open lines of communication” as a primary element or component of their compliance program.

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[accordion-item title=”Why does ComplianceHotline operate a “hotline” rather than a “helpline” or similar service?”] A number of other report line companies have opted to refer to their services as a “helpline” or something similar in the belief that the more user-friendly a report line, the more likely it will be that it is utilized by employees, patients and other third parties. We respectfully disagree with their approach. ComplianceHotline is not intended to serve as a “catch-all” report line for everything from minor employee complaints to patient questions over insurance coverage. An effective report line is not intended to serve a substitute for the day-to-day exchange of information and concerns between an employee and his / her supervisor. Nor is it intended to serve as a clearinghouse for patient questions regarding everything from parking to hours of operation. A compliance hotline is just that – a hotline for the reporting of significant concerns and problems. ComplianceHotline is intended to supplement your ongoing compliance efforts, not stand in their way.

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