Too often, home medical equipment (HME) companies focus on compliance once a year, via an all-staff, all-day meeting in the conference room.

But is highlighting compliance in that limited way truly enough, given its importance?

Noel Neil, the chief compliance officer at ACU-Serve, doesn’t think that approach delivers the best outcomes. He discussed his experiences at the August FUTURE conference hosted by HME Business in Nashville, Tennessee, where Neil advocated for an active, vigorous approach to compliance — and shared three key takeaways for HME business leaders.

1. Compliance should be a priority for HME professionals

Neil pointed out that compliance is becoming a more significant topic for many HME companies.

“A lot of HME providers are seeing the importance of compliance,” he acknowledged. “There have been a lot of cases where the government has come in and caused serious financial harm to providers for not following the rules and regulations.

“One of the hot topics is waivers of copays, members’ responsibilities, and not collecting from patients in a timely way. So a lot of HME providers are now making a point of emphasis to actually have an effective compliance program. They’re having well-documented policies and procedures. They’re having timely and routine audits, just to make sure that their team is doing what they’re supposed to do.”

Creating a strong compliance program, Neil added, is a proactive way for providers to protect themselves and their businesses.

“There’s just been a lot of government enforcement, and some of this has led to huge fines in the millions due to lack of compliance,” he said. “So HME providers are becoming more sensitive to this fact. It’s always been a requirement by law for them to have a compliance program, but it’s been one of those things that folks have just never paid a lot of attention to, until now. The government is putting additional scrutiny there, so there’s been a renewed focus towards having a compliance program.”

2. Identify your company’s risk areas

While every HME provider is unique — considering its size, number of offices, patient demographics, equipment and services offered, etc. — Neil did identify areas that are generally at high risk in the industry.

“One of the biggest risk areas that we hear about is the waiver of co-pays,” Neil said. “It is a violation of the anti-kickback statute, the beneficiary inducement act and the false claims act if a provider does not make a reasonable attempt to collect the member’s responsibility.”

While providers may be under the impression that they “could just mail three statements, then write off the balance,” Neil said that isn’t accurate.

“You have to make a reasonable attempt to collect that balance,” he said. “Just recently, we talked about some cases where the government has recouped millions of dollars, and folks are actually threatened with jail time.”

Another scenario to be aware of is referral inducement.

“People just thought that the anti-kickback statute only applies to getting money, to paying doctors for referrals,” Neil said. “But there have been some cases that talk about cash in kind: You can’t go and wash Dr. Smith’s car every Sunday so that he sends you all his CPAP referrals. That also violates the law.”

Neil added that some providers “have been tightening up their requirements” regarding, as an example, manufacturers providing free sleep apnea masks.

“Providers have been sensitive to this, and these are areas that they’ve worked on to mitigate internal risk within their organization,” he said. “There have been some cases about oxygen, some cases about Complex Rehab.”

3. Make compliance an everyday strategy

Neil also advocated for HME providers making compliance an integral part of their everyday business processes, rather than relegating compliance to very occasional meetings.

“As it relates to a culture of compliance, compliance should not just be a check box,” Neil said. “It should not be just something that you do once a year. Compliance has that negative connotation associated with it. But what we try to do within ACU-Serve, and for the clients that we work with, is to help folks to understand that compliance is a source of knowledge.

“If you’re in doubt about whether or not you can do something, ask compliance. We’re not monsters; we try to make ourselves very accessible to our staff. If you’re in doubt, just ask us.”

Neil recommended open communication with plenty of room for compliance-related questions.

“If you just tell someone not to do something and if they have an inquisitive mind, they’re going to ask why or why not,” Neil said.

By encouraging regular conversations about compliance, providers can also begin to reshape how their teams perceive it.

“There’s this joke amongst sales teams that compliance is the revenue-prevention department, because compliance tells you what you can and cannot do,” Neil said. “But I always chuckle in response and say, ‘Well, compliance is the revenue retention department, right?’ Because there’s no point in you getting that money if, when the government comes knocking, you cannot keep it. So it’s important for you to do the right thing and make sure that when the money is collected, it stays in the bank.”