Sample Language

The compliance officer shall:

• Be appointed by the [Board of Directors or Owner(s)] of [PROVIDER;]
• Be [PROVIDER’s]  [Administrator, Assistant Administrator, Owner(s), legal counsel, others selected by PROVIDER];
• Receive periodic training in compliance procedures;
• Have direct access to [Board of Directors, Owners(s), management]; and
• Have access to necessary records and documentation, including residents records, billing records, and marketing agreements and records.

It shall be the responsibility of the compliance officer to ensure that:

• The Employee Standards and Code of Conduct is distributed to all employees;
• The compliance manual and the Employee Standards and Code of Conduct are revised as needed to reflect changes in state or federal law, private payor requirements, or changes in [PROVIDER’s] operations;
• A background check is conducted for all prospective employees, including a criminal background check where applicable, and a determination made of whether the prospective employee is subject to sanctions under or exclusion from the Medicare and/or Medicaid programs;
• Employees are given appropriate compliance program training, including information regarding the duty to report suspected violations or questionable conduct and the mechanism for such reporting;
• Hotline calls, correspondence, and other reports of suspected violations or questionable conduct are treated confidentially (unless circumstances dictate to the contrary);
• An appropriate inquiry or investigation is initiated with respect to any report of a suspected violation or questionable conduct, and corrective and/or disciplinary action is taken, where appropriate;
• Reports are periodically filled with the [Board of Directors, Owner(s)] regarding material matters involving suspected violations or questionable conduct, and on as needed basis;
• Periodic reviews of vulnerable areas are conducted and the findings reported to the [Board of Directors, Owner(s)];
• A report at least annually regarding the operation of the compliance is provided to the [Board of Directors, Owner(s)];
• A compliance filing system is maintained, including a log of all compliance issues raised, the resolution of such issues, and action taken in response, if any;
• Specific compliance issues are assigned to individuals outside the organization for review, as appropriate, such as legal counsel, accountants, quality consultants, etc. the compliance officer should be given the authority and responsibility to authorize such reviews;
• Activities of the compliance committee, if in existence, are coordinated to assure that all duties are fully performed; and
• [PROVIDER’s] compliance program is explained to [PROVIDER’s] vendors, suppliers, and other contractors.