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Tips for an effective voluntary health care compliance program

The government requires medical facilities to follow certain rules and regulations. A failure to do so can result in allegations of wrongdoing. One specific area that can cause great harm to a health care facility are allegations of health care fraud. If substantiated, the allegations can come with crippling financial penalties and potentially result in the inability to continue to bill for services through Medicare and Medicaid.

Facilities can help to better ensure compliance by putting together a voluntary health care compliance program.

How do we put together a health care compliance program?

The United States Department of Health and Human Services Office of the Inspector General put together recommendations to help physicians develop their own compliance program. Helpful tips include:

  • Educate. It is wise to conduct regular sessions to educate all staff about applicable regulations and expectations.
  • Communicate. Have an open line of communication so co-workers can voice frustrations and concerns or provide information about potentially illegal activity within the facility.
  • Audit. The importance of regular internal audits cannot be overstated. These audits provide an opportunity to review the practices within your group and make changes as needed before any potential issues evolve into serious problems.
  • Enforce. Enforce any disciplinary actions as needed if an audit or other information results in the finding of a violation. Have clear and well publicized guidelines so all staff is aware of the ramifications of violations.

These tips will help better ensure those within your practice remain in compliance of applicable health care laws. If under investigation by the government for allegations of health care fraud, it is wise to take the matter seriously. Penalties are serious and can include imprisonment in addition to financial penalties.

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