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Compliance

Compliance

Health care is one of the most highly regulated industries in the United States. There is no area of the health care practice that doesn’t fall under the scrutiny of a regulatory body. Having a compliance plan can mitigate your risk.

A compliance program, which is recommended for all medical practices and clinical labs, is a comprehensive program to prevent and detect violations of law or policy. It comprises a number of important functions including:

  • Defines expectation for employees for ethical and proper behaviors when conducting business
  • Demonstrates the organization’s commitment to “doing the right thing”
  • Encourages problems to be reported
  • Provides a mechanism for constant monitoring

The Office of Inspector General (OIG) has substantial guidance on the implementation of a compliance program. The OIG website has other resources, including opinion letters, fraud alerts and open letters from the OIG to the health care industry.

Questions? Contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Resources

OIG compliance resource guide

 

The Office of Inspector General recently released Measuring Compliance Program Effectiveness: A Resource Guide, a new resource to assist organizations with their compliance efforts. The guide provides organizations with a host of ideas as to what and how to measure the effectiveness of all seven elements of a compliance plan. The guide allows providers to select the ideas that work best for their program. The OIG cautioned that the guide is not intended to be applied as a template.

The OIG has long encouraged physicians to implement compliance programs, consisting of seven specific elements, and to measure the effectiveness of these programs. The guide comes on the heels of the Department of Justice release of “Evaluation of Corporate Compliance Programs,” which is a long list of questions that prosecutors will ask when deciding whether to file fraud charges against corporations and/or individuals and what kind of charges to bring.

The OIG also has a Compliance Program for Individual and Small Group Physician Practices and may be found here. If you have questions or concerns developing or maintaining your compliance plan, contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance.

 

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