A critical element of an effective compliance program is training the facility’s employees and contractors on the compliance program. This should include training on both the company’s compliance program itself (i.e., how the program operates, who is the compliance officer, etc.) and on the applicable laws and company policies that make up the compliance program.
Training Employees on the Employee Standards and Code of Conduct. The Employee Standards and Code of Conduct should be provided to and discussed with all new employees, regardless of their role in the company, in a language they can read and understand. When a new employee is hired, the employee’s immediate supervisor or other designated person (such as human resources personnel) should review with the employee the Employee Standards and Code of Conduct and ensure that its provisions are understood. The employee then should sign and date the Employee Affirmation Statement or Supervisor Affirmation Statement, as applicable. Samples of these affirmation statements are provided later in this compliance guidance.
An information and education program should be utilized to assist employees in understanding the compliance program and the Employee Standards and Code of Conduct. Furthermore, all employees should be apprised of applicable federal and state laws, regulations, standards of ethical conduct, and the consequences that will follow for any violation of those rules or violation of the facility’s compliance program.
Training should be conducted upon adoption of a compliance program and/or immediately upon hiring a new employee. Training should be repeated frequently, and at least annually, thereafter to make sure employees remain mindful of their compliance obligations and to capture changes in applicable law or facility compliance policy. New employees should be scheduled for compliance program training no more than 30 days after beginning employment. For employees with certain responsibilities, such as patient care or patient billing, training should be provided before employees are allowed to assume those rules, as applicable.
The OIG has indicated in its Compliance Guidance for Nursing Facilities that the following are important elements of effective employee training and education:
Training should include summaries of the provider’s compliance program, fraud and abuse laws, Federal health care program requirements and other issues unique to an employee’s job duties;
Training should be tailored to an employee’s job responsibilities. For example, special training on billing requirements should be provided to billing office employees; special training on quality of care obligations should be provided to direct care staff, etc.;
Training should be provided to employees and to physicians, independent contractors and other agents of the facility, and they should be required to reasonably participate in compliance training and education as part of their employment or contractual arrangement with the facility;
Training should be provided in a practical way. This may be live in-person training for some employees, videos for other, and/or publications for others. Whatever method is used, it should fit the employee’s needs and should always include an opportunity for the employee or contractor to ask follow up questions about the compliance program and applicable law or facility policy;
Training can be provided for the facility by company employees, consultants, attorneys, or outside experts such as billing consultants, as appropriate, based upon the topic being taught and the level of expertise needed;
Training materials and methods should take into account the skills, experience and knowledge of individual trainees;
The facility should document all compliance training provided, including the date of the training, a summary of the material covered, who attended (with signatures documenting their attendance) and the name and qualifications of the trainer(s);
Training should include the various risk areas identified by the OIG in its Compliance Guidance for Nursing Facilities, as well as other risk areas identified by the facility based upon its own experience and internal audits and monitoring of operations. We will discuss the risk areas that should be discussed as a part of a provider’s compliance program in later sections of this compliance guidance;
Participation in compliance training should be a condition of employment or a continuing or initial contract relationship (for physicians, vendors or others whose relationship with the facility is by virtue of contract) and serious failures to participate in such training should be disciplined in keeping with facility policies (up to and including termination of employment or of existing contracts); and
Federal and state compliance investigators expect all employees to be familiar with the information contained in the Employee Standards and Code of Conduct. Thus, this information should be the subject of ongoing, periodic training for all employees. To facilitate employee understanding of these principles, some providers provide employees with “wallet cards” containing the Employee Standards and Code of Conduct.
Here is some sample language on employee education and training that can be used to develop an education training policy as part of your overall compliance program and policies.