DOES YOUR PRACTICE HAVE A FRAUD & ABUSE COMPLIANCE PLAN?
Fraud & Abuse Compliance Plan
The government is attempting to reign in healthcare fraud & abuse like never before. Not only are CMS and OIG performing audits and investigations but they have contracted multiple private organizations to assist them, such as Recover Audit Contractors (RAC), Zone Program Integrity Contractors (ZPIC), Medicaid Integrity Contractors (MIC), and many others.
Most experts in healthcare compliance believe it is not a matter of if your practice will be audited but when. When your practice is audited, it is vital to be able to demonstrate that your intentions are to always comply with current healthcare laws and regulations. The best way to achieve this is by having an active, robust fraud and abuse compliance plan. The Office of Inspector General (OIG) has published in the Federal Register seven key elements to a successful compliance plan for medical practices. The recently passed Affordable Care Act made it mandatory for all providers enrolled in the Medicare program to have a compliance plan by 2014.
To understand what a plan should consist of, refer to this PDF from the Office of Inspector General’s (OIG) final “Compliance Program Guidance for Individual and Small Group Physician Practices,” which was published on Sept. 25, 2000. It was issued to assist physicians in developing compliance programs for their practices to prevent fraud and abuse against government health care programs. Another, more basic, reference is available from the Centers for Medicare and Medicaid Services – Avoiding Medicare Fraud and Abuse. This publication covers fraud and abuse laws; your relationship with payers, fellow providers and vendors; ands direction on where to go if you think you have a problem.
If you have questions about this topic or any other issues around the business of medicine, contact us via email or call us at 800-635-4040.