D. Conducting Effective Training and Education

The proper education and training of corporate officers, managers, and health care professionals, and the continual retraining of current personnel at all levels, are critical elements of an effective compliance program. These training programs should include sessions summarizing the organization’s compliance program, fraud and abuse laws, and Federal health care program and private payor requirements. More specific training on issues such as claims development and submission processes, residents’ rights, and marketing practices should be targeted at those employees and contractors whose job requirements make the information relevant.87

The organization must take steps to communicate effectively its standards and procedures to all affected employees, physicians, independent contractors, and other significant agents by requiring participation in such training programs or by other means, such as disseminating publications that explain specific requirements in a practical manner.88

Managers of specific departments or groups can assist in identifying areas that require training and in carrying out such training.89 Training instructors may come from outside or inside the organization, but must be qualified to present the subject matter involved and sufficiently experienced in the issues presented to adequately field questions and coordinate discussions among those being trained.

The nursing facility should train new employees soon after they have started working.90 Appropriate training for temporary employees should be provided by the facility before they are assigned responsibility for resident care. Training programs and materials should be designed to take into account the skills, experience, and knowledge of the individual trainees. The compliance officer should document any formal training undertaken by the nursing facility as part of the compliance program.

A variety of teaching methods, such as interactive training and, where a nursing facility has a culturally diverse staff, training in different languages, should be implemented so that all affected employees (including temporary employees) understand the institution’s standards of conduct and procedures for alerting senior management to problems and concerns.91

In addition to specific training in the risk areas identified in section II.B.2, primary training for appropriate corporate officers, managers, and facility staff should include such topics as:

  • compliance with Medicare participation requirements relevant to their respective duties and responsibilities;
  • appropriate and sufficient documentation;
  • prohibitions on paying or receiving remuneration to induce referrals;
  • proper documentation in clinical or financial records;
  • residents’ rights; and
  • the duty to report misconduct.

The OIG suggests that all relevant personnel participate in the various educational and training programs of the nursing facility.92 Employees should be required to have a minimum number of educational hours per year, as appropriate, as part of their employment responsibilities.93 For example, for certain employees involved in the nursing facility admission functions, periodic training in applicable reimbursement coverage and eligibility requirements should be required. In nursing facilities with high employee turnover, periodic training updates are critical.

The OIG recognizes that the format of the training program will vary depending upon the resources of the nursing facility. For example, a nursing facility with limited resources may want to create a videotape for each type of training session so new employees can receive training in a timely manner. If videos are used for compliance training, the OIG suggests that a nursing facility make a knowledgeable individual available to field questions from video trainees.

The OIG recommends that participation in training programs be made a condition of continued employment and that failure to comply with training requirements should result in disciplinary action, when such failure is serious. Adherence to the training requirements as well as other provisions of the compliance program should be a factor in the annual evaluation of each employee. The nursing facility should retain adequate records of its training of employees, including attendance logs and material distributed at training sessions.


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