Healthcare Compliance Programs
How Mishandling Overpayments Can Lead to Fraud Investigations
Operating a healthcare entity without an effective compliance program significantly increases your regulatory vulnerability. A comprehensive compliance program functions as preventive medicine for your practice, ensuring operational integrity and adherence to state and federal mandates.
Vitale, Suarez & Associates, P.A. can assist your organization in developing an effective compliance program that enables you to proactively identify and correct structural issues before they become the target of a formal government investigation.
If you or your company become the subject of an investigation, the existence of an active and effective compliance program may help mitigate or eliminate potential administrative sanctions, monetary penalties, and program exclusions from federal healthcare networks.
Maintaining an effective compliance program provides a critical layer of protection; regulatory guidelines and federal sentencing standards demonstrate that organizations with active compliance frameworks often receive substantially more favorable treatment from government prosecutors and enforcement authorities.
Understanding Medicare and Medicaid Overpayments
The U.S. Department of Health and Human Services Office of the Inspector General has a list of seven suggested guidelines that should be followed when creating a compliance program, directed at various segments of the healthcare industry.
- Conduct internal monitoring and auditing
- Implement compliance and practice standards
- Designate a compliance officer or contact
- Conduct appropriate training and education
- Develop open lines of communication with employees
- Enforce disciplinary standards through well-publicized guidelines.
- Respond appropriately to detected offense and develop a corrective action plan.
Our team can help you to identify areas that need attention and help you to put policies and procedures in place. We also can conduct regular audits to ensure that policies are being followed by all personnel, and make updates when changes in the law occur.
Because the healthcare regulatory environment is complex and in constant flux, you need a team of experienced attorneys who stay up to date with the most recent changes. All you need to do is read our blog to realize that there are changes coming down the pike all of the time.