Healthcare Compliance Forms and Tools

Auditing

• Sample Compliance Program Audit Plan
• Sample Internal Audit Plan

Board and Committee Documents

• Sample Compliance Committee Charter
• Sample Compliance Committee Meeting Agenda
• Sample Compliance Committee Meeting Minutes
• Sample Compliance Committee Work Plan
• Sample Corporate Compliance Report
• Sample Governance, Compliance, and Ethics Committee Charter
• Sample Quality Committee Charter
• Sample Board Report 1: Audit Status Update
• Sample Board Report 2: Quarterly Report
• Sample Board Report 3: Compliance Work Plan
• Sample Board Report 4: Annual Compliance Risk Assessment

Clinical Research

• Sample Deferral Checklist
• Sample Exempt Research Guidance Summary
• Sample Flexible Guidance Summary
• Sample Institutional Research Policy
• Sample IRB Review Worksheet/Checklist
• Sample Limited IRB Review Guidance Summary
• Sample Minimal Risk Research Guidance Summary
• Sample Project Transition Form
• Sample Request to Conduct Research Form
• Sample Research Compliance Assessment Form
• Sample Single IRB Review Guidance Summary

CMS Conditions of Participation

• Sample Customer Grievances Policies and Procedures

Communication and Education

• Designing Your Annual Compliance Education
• Sample Compliance Communications Plan

Conflicts of Interest

• Conflict Management Plan

Employee Evaluation

• Sample Manager Evaluation Checklist
• Sample Employee Integrity Recognition Letter

Enterprise Risk Management

• Ten Examples of Risk Appetite Statements
• Example Questions for Department-Specific Risk Identification

General Compliance Program

• Code of Ethics for Healthcare Compliance Professionals
• Compliance Calendar
• Compliance Work Plan
• Job Description, Compliance Officer
• Job Description, Vice President of Corporate Compliance
• Sample Code of Conduct Attestation Form
• Sample Corporate Compliance Helpline Policy
• Sample Compliance Program Policy
• Model Anti-Retaliation Policy
• Sample Non-Retaliation Policy
• Sample Policy Against Retaliation
• Sample Policy Template
• Sample Policy Implementation Master Tracker
• Sample Written Standards Matrix

Internal Investigations

• Sample Internal Investigation Checklist
• Sample Interview Notes Template
• Sample Interview Tips
• Checklist for Interviewing a Reporter, Complainant, or Witness
• Checklist for Interviewing a Person Accused of Wrongdoing
• Sources of Potential Information in an Investigation
• Sample Investigation Checklist
• Sample Checklist for Assessing Investigation Capabilities
• Sample Internal Investigations Policy
• Sample Upjohn Warning
• Sample Evidence Collection Worksheet
• Sample Investigator Script
• Sample Key Allegations Worksheet
• Sample Key Facts Worksheet
• Sample Investigation Report Form 1
• Sample Investigation Report Form 2
• Sample Privacy Incident Questionnaire
• Excluded Individual Investigation Worksheet

Key Laws in Healthcare Compliance

• Sample Stark Law Compliance Checklist for Commercial Reasonableness Review
• Sample Stark Law Compliance Checklist for Employee Arrangement Exception
• Sample Stark Law Compliance Checklist for Fair Market Value Arrangement Exception
• Sample Stark Law Compliance Checklist for Personal Services Arrangement Exception

Measuring Program Effectiveness

• Compliance Program Evaluation OIG Tool
• Sample Compliance Elements Measurement Chart
• Sample Evaluation of Corporate Compliance Program Checklist

Monitoring

• Common Monitoring Examples for a Hospital
• Sample Compliance Monitoring Plan

Patient Privacy and Security

• Business Associate Agreement Checklist and Considerations
• Sample Temporary Work from Home Agreement

Post-Acute Care

• Rehabilitation Documentation Checklist

Provider-Based Rules and Regulations

• Sample Provider-Based Requirements Compliance Assessment Tool
• Provider-Based Compliance Audit Checklist

Risk Assessment

• Compliance Program Structural Risk Assessment
• Sample Compliance Risk Assessment Questionnaire
• Sample Heat Map
• Sample Risk Assessment Policy and Process
• Sample Risk Assessment Summary
• Sample Risk Assessment Template
• Sample Risk Committee Charter
• Sample Risk Rating Survey
• Privacy, Risk, and Discipline Assessment

Vendor Management

Contract Approval Checklist