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CMS Final Rule: Compliance and ethics programs

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Compliance programs in skilled nursing facilities (SNFs) have been around for years. The Health and Human Services (HHS) Office of the Inspector General (OIG) published Compliance Program Guidance for Nursing Facilities in 2000 and its Supplemental Compliance Program Guidance for Nursing Facilities in 2008. The Department of Justice released its Evaluation of Corporate Compliance Programs in February 2017 to provide specific guidance on how to assess the “effectiveness” of compliance programs.

In the past, compliance programs in long-term care have been optional. But Section 6102 of the Affordable Care Act mandated that all nursing facilities must have a compliance and ethics program. The Centers for Medicare and Medicaid Services (CMS) promulgated a new regulation regarding compliance and ethics programs in its Final Rule published in October 2016, making compliance programs a requirement at all CMS-reimbursed facilities.

An effective compliance program not only promotes quality care, but also may prevent enforcement issues based on alleged survey deficiencies and allegations of fraud, which can result in multi-million-dollar jury verdicts and settlements.

Elements of an effective compliance program

The CMS Final Rule requires nursing facilities that participate in Medicare and Medicaid to develop, implement and maintain effective compliance and ethics programs that include—at the very least—the eight discrete elements below:


Alan C. Horowitz

Partner at Arnall Golden Gregory

Alan C. Horowitz

Alan C. Horowitz, Esq., is a partner at...