By Dan Matas, Founder of OutcomesBase, Inc.
Early on, after already working in the Applied Behavioral Analysis (ABA) industry for many years, I still had very little understanding of what regulatory compliance was and how it impacted me. I understood HIPAA laws, and the protection of Private Health Information, but I really didn’t understand how many aspects of day-to-day operations are tied to regulatory requirements. The regulations impact clients as well as employees, and are vast.
Setting the Stage
Becoming a Compliance Officer and being certified in healthcare compliance was eye-opening for me. Healthcare compliance is only about as old as the ABA industry, and was established to regulate hospitals, skilled nursing facilities, and longterm care facilities. In fact, when I took my certification exam back in 2018, many of the questions were focused on those types of entities. However, the basics are the same, regulatory compliance is focused on ensuring that clients are receiving ethical treatment from providers, and that the government is not being defrauded with false claims.
We have likely all seen some of the fraud, waste, and abuse issues that have taken place in the ABA industry, and the statistics are staggering from a funder’s perspective. ASD diagnoses are on the rise, and have been for years, and the most common treatment (ABA), requires a high frequency of service that can last for a good portion of an individual’s life. This combination is very threatening to funders, and the autism industry is no longer being overlooked by the government, state regulators, and funding sources.
In my own experience, I have seen an uptick in funder and state audits, and also more stringent regulations be regularly updated and imposed upon ABA companies.
Why Should This Matter to Business Owners?
Allegations of wrong doing, or fraud, can be made by anyone at anytime; and often, they can be hard to fully investigate. I have seen several instances where it is one person’s word against the other’s, but if I can’t prove that a provider was in the client’s home for the full duration of the session, then I have no choice but to refund the funding source. Conversely, if a parent tells me that a provider did something to endanger a client in their home, it is usually their word against the provider’s.
The best advice I can give to any business owner is to start somewhere. Having internal controls, effective trainings, and a goal of understanding and implementing regulations, is key to ensuring that you have legs to stand on if CMS, OIG, or state regulators come knocking. It is well known in the compliance community that it is essentially impossible to be in 100% compliance with every regulation at all times. Just think about how often employment law changes, and then multiply that by the number of funding sources you work with, and the number of states you work in, and then add federal requirements to the mix. It can be overwhelming.
Getting it right is monotonous, challenging, and on-going. However, the companies that take compliance seriously and are aware of their deficits, and who have a plan of action, are generally shown more mercy than those who turn a blind eye to compliance. I have seen healthcare companies (ABA included) shut down due to unpaid claims because they were not adhering to regulations, and it’s saddening to think about all of those clients who lost out on services in these cases.
Where to Start?
Start by understanding what compliance means for your company and what regulations apply to you. Then, run a risk assessment for your organization against those regulatory requirements to bring to light any areas that need to be addressed. From there, you can create a compliance work plan with actionable items ranked from highest level of company risk to lowest. I also encourage every company to align with a compliance professional who can ensure you have all of the core elements of a compliance program in place, and can provide support and guidance along the way.
Consequences to Companies
As I mentioned earlier, the government and funding sources, are aware of how big autism services are and by how much they are growing in cost. There are limited healthcare resources, and it is being closely monitored where those dollars are being spent. The focus on ABA is only going to increase in the years to come, and the companies who don’t understand compliance, could be fined heavily or even shut down completely. Additionally, most audits at the state and federal level are public knowledge. Companies, even well-intentioned, could have their name and reputation dragged through the mud if they are found to be out of compliance.
If you would like a free consultation, or need help tackling a regulatory requirement that you are currently facing, OutcomesBase can help. You can reach out to us here.
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