AHCA Compliance Webinar: Session 4 Communication and Training

1. AHCA Compliance Webinar: Session 4Communication and Training Employee Standards & Codes of Conduct; Employee Education and Training; Developing Effective Lines of Communication; and Creation and Retention of Records These materials have been prepared by Poyner Spruill LLP for informational purposes only and are not legal advice. This information is not intended to create, and receipt of it does not constitute, a lawyer-client relationship.

2. AHCA Webinar Series: Where We’ve Been • In October 2008, Session 1, we began with: • What is a compliance program • Elements of an effective program • Corporate philosophy statements • Role of Board of Directors/Owners • Examining “mechanics” or “structure” of compliance programs first, then moving into “substance” or laws making up the program • We’ll be doing this monthly through November 2009 • Prior webinars, materials and updates to the 2000 AHCA compliance manual are posted on AHCA website (www.ahca.org)

3. Session Two, November 2008 • We covered: • Compliance officers and compliance committees • How they work, what are their responsibilities • Who should be on them • Their role in “structure” of compliance program operation • Discussion with actual providers (large/small) were shared • What works and maybe what doesn’t • Challenges they’ve faced with officers & committees • Successes they recommend to other providers

4. Session 3, Last Month: Excluded Individuals/Entities • The process of checking the exclusion status of potential and current employees and contractors • And the risks of failing to do so for providers • Check AHCA website if you’ve missed these sessions

5. This Month’s Topics • Employee Standards and Codes of Conduct • Employee Education and Training • Developing Effective Lines of Communication • Creation and Retention of Records

6. A Word About Structure • We’ve been looking so far at the mechanics of compliance programs: • The processes that make the program work • In our “house” analogy, the physical framework that holds the home’s interior • Compliance officers and committees, the role of the Board or owners, & other process and structural items for the program • All geared towards the “furniture” or content of the program • The laws we must “comply” with and the company policies that implement its compliance expectations and parameters • We will get to the furniture in a couple of months • OIG calls these “risk areas” • Summary of law and company’s compliance policy/procedure

7. Employee Standards & Codes of Conduct • A “Readers’ Digest” of all the many complex laws, and related company policies/procedures your employees & contractors need to understand and comply with (later) • Examples: False Claims Act, Anti-Kickback Statute, Billing laws, OBRA quality requirements, including the new or enhanced risk areas identified by OIG in 2009 Supplemental Compliance Guidance for Nursing Facilities (Quality, Quality, Quality) • Why have one? Complexity of laws we have to address • Employees cannot retain all the detail • So we give them a list of “do’s” and “don’ts”, with examples, of things to avoid, to report, to question if they encounter them

8. Employee Standards & Codes of Conduct • Should be short, simple and easy to understand • Many providers = 2 or 3 pages • Perhaps on a wallet card, poster, or other approach • And include who to report to / ask questions of re compliance issues • May be the only document employees receive • We’ll come back to this once we reach the “risk areas” in a month or two • And give you a sample of this tool, updated from original AHCA manual to address 2009 supplemental guidance • For today, we mention it because of our first topic, Employee Education and Training

9. Employee Standards & Codes of Conduct • “We’ll come back to this once we reach the “risk areas” in a month or two” • In the meantime ... • Consider bi-lingual editions • Design and frame attractive posters that administrators are willing to display • Family/Resident Versions for Public Areas • Employee Versions for Break Rooms • Distribute with Employee Handbook at hire, and obtain same written acknowledgement • The Code of Conduct should provide the framework for training modules, so keep that in mind when preparing the Code

10. Employee Education & Training • Critical element of effective compliance programs per OIG • Train who? • Employees, independent contractors (MDs; vendors, consultants, billing companies, etc), volunteers, & Board / owners • On what? • The compliance program mechanics • The processes, who is the compliance officer and committee • How to report or ask questions • To whom they report (next topic) • How their reports are handled & confidentiality issues • And the substantive laws/policies we comply with • Summaries of law (risk areas) and company compliance policies

11. Employee Education & Training • Cannot over-emphasize • Assurance of confidentiality • Assurance of non-retaliation • Caution that abusing the process can lead to disciplinary action • Who does the training? • Train-the-Trainer • Presentations • FAQs • Attendance Logs • Coaching and Mentoring

12. Employee Education & Training • Begins with Employee Standards & Codes of Conduct • Distributed and explained to all new employees/contractors • Soon after hiring (30 days recommended) • Sooner for some employees like direct care staff, billing office, etc. • Post-testing recommended by OIG • Explain there’s a larger compliance program and give access to it • And includes the “process” issues • How the program works, role of compliance officer/committee and the Board/owners • What to report, how to report, when to report • Anonymity issues and non-retaliation policy • Employee & supervisor affirmation statements (samples)

13. Employee Education & Training • Repeat training frequently because: • New employees • People need refreshers • Laws & policies change frequently or new examples surface • We recommend role playing exercises including both what to spot and how to respond (i.e., reporting mechanism) • Heavy on examples • They don’t have to recite statutory language but should understand practices that should raise concern & lead to questions/reports • Don’t forget independent contractors—same rules • Their participation should be a contract requirement

14. Employee Education & Training • Example: Anti-Kickback Statute • No item of value may be given in exchange for any item or service paid for, in whole or in part, by an Federal Health Care program • Will your staff have a clue what this means? • But, they do understand: • You can’t take extra pay from families for our care • You can’t take a beach weekend for suggesting vendor products • If you learn the MDS consultant is taking the DON to Vegas in return for renewing his contract, you must report this • If you learn a vendor is giving a cut on Part A patients in exchange for Part B business, you report that

15. Employee Education & Training • If Part B vendors ship “free” supplies • If non-Medical Director physician-admitters are given “a job” in return for fees paid by the facility • If SNF staff supplements hospital discharge coordinator responsibilities to ease workload and steer discharges • Be sure to cover Deficit Reduction Act requirements • Explain what a “whistleblower” is • Advise whistleblowers may participate in fines/settlement amounts on those matters the government chooses to pursue • Describe how and where to file whistleblower claims • Assure non-retaliation

16. Employee Education & Training • Use in-person trainers, videos, publications but always include chance for follow up questions • Tailor training to the employee’s or contractor’s job responsibilities • Some general issues apply to all, some unique to certain jobs • Can train with employees, managers, outside experts like billing experts, attorneys, clinicians • Includes the Board / owners, especially on quality issues • A MAJOR focus of the original and supplemental OIG guidance • Materials are tailored to the educational level and language of the trainees (secondary language issues)

17. Employee Education & Training • Document all training • Who taught & their qualifications, who attended, summary of contents (detailed), dates of training and signed affirmation of attendance & any post-testing, if used • Failure to participate = basis for employee discipline and contract remedies for contractors up to and including termination in serious or repeat cases • Our materials contain these principles and some sample policy language you can use to develop your own for inclusion in your written compliance program • This aspect has not changed from OIG 2000 Compliance Guidance except for inclusion of additional risk areas (later)

18. Developing Effective Lines of Communication • Effective communication goes in 2 directions: • Training from management to employees (last section) • And information from employees back to management or compliance officer/committee • This section looks at the latter – empowering employees and educating them to question & report • This section also has not changed since OIG’s 2000 compliance guidance (except risk areas) • Communicate what: • Suspected violations, known violations • Or question about risk areas / company / vendor practices

19. Developing Effective Lines of Communication • Train Officers and Directors and/or Governing Body • Maintain a record • Periodic reporting • Complaint volume by category • Trends year-over-year • Violations and resolution of violations • Initiatives

20. Developing Effective Lines of Communication • Supervisors normally first line of communication for these • Unless they are unresponsive or involved in the issue • Then, follow company policy but usually approach their supervisor or the compliance officer • Supervisors must report up the chain, per your policy • Develop policy on confidentiality, anonymity & non-retaliation against those who report or raise questions • But warn that identify may have to be revealed in some instances but we’ll try our best to keep their identify confidential • Teach employees how to access compliance officer, full compliance program • Document reports/questions and responses (Susan)

21. Developing Effective Lines of Communication • OIG recommends “hotlines” • Either operated in-house • Or outsourced to professional companies set up for this • Widely publicize the hotline number if you use this approach • Log of incoming calls and company responses • OIG: also publicize the OIG’s fraud reporting number • May use email system, drop-box or other reporting system • OIG: use newsletters, pay check inserts, posters, suggestion boxes to encourage reports, questions, or suggestions about the compliance program

22. Developing Effective Lines of Communication • Bottom line – develop an effective method of getting compliance information to employees and contractors and method for them to feed information or questions back to management and compliance officer • Use whatever works for your company • Based on size, resources, sophistication • But describe your system in written compliance program and document that you use it and the results of it in terms of training and information/responses flowing back to you • Susan will talk to us now about creating/maintaining a records and documentation system for compliance

23. Creation and Retention of Records • Centralization • All records maintained by Compliance Department • Complaints, investigations, data, training logs • Disciplinary actions • De-Centralization • Records somewhat disbursed • Human Resources • Third-party hotline vendor • Legal Department • Outside Counsel • Retention Period • Storage Method