All compliance programs are a direct result of the Federal government's 1993 challenge to the national health industries professional business practices, which have been intertwined with fraud, waste and abuse. The governments top priority is to reduce all fraud, waste and abuse thus meeting the governmental and regulatory authorities directives at both the Federal and state levels.
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This web-site page is an attempt to, introduce, address these types of questions and become an advocate for your operations compliance program and executive staff as they decide whether they need a compliance program. It is not true that compliance programs have to be elaborate, burdensome, or all encompassing, but your vision, direction and question should be, do you need to enhance or revamp your program as it stands now?
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The best programs are the ones that formalize existing practices, identify areas of weakness, and provide written documentation of the organization's commitment to comply with the law. You can help your operation develop a program, which fits your overall circumstances, addressing the areas of concern for, which your organization needs to focus, and to be based on existing good practices, shoring up weaknesses, and is practical.wOperations who adopt such programs may avoid losses by identifying and preventing criminal and unethical conduct. It is more difficult to embezzle from an organization, which periodically audits their functions. This same watchfulness can reduce exposure to civil damage action against the organization with all the direct and indirect costs. Reduced exposure to investigations by government agencies is also valuable because those procedures take time, money, and patience to work through even when the results is a clean bill of health from the regulators.
wThe regulatory enforcement atmosphere for physicians and other healthcare providers has been steadily increasing. The Health Insurance and Portability and Accountability Act of 1996 introduced a program to fund investigations and coordinate the activities of the OIG, DOJ, and FBI. Between 1993 and 1996 more than 450 FBI agents were assigned to healthcare issues with the number of investigations increasing from under 1000 to 2000. Medicare indicates that its Integrity Program will not be focused of particular provider types and will work closely with OIG, FBI, and DOJ. The dollar risks of repayments, penalties, exclusion, criminal and civil suits, and other outcomes of investigations are well known to those in the healthare industry.w |
