OIG & Regulatory Compliance

With the passage of the Patient Protection and Affordable Care Act of 2010, physicians who treat Medicare and Medicaid beneficiaries will be required to establish a compliance program. A regulatory compliance program keeps your practice updated on constant regulatory changes through various processes and policies. An effective program helps you maintain medical compliance and experience benefits such as:

• Concretely demonstrate to employees and the community at large the organization’s strong commitment to honest and responsible provider and corporate conduct.
• Provide a more accurate view of employee and contractor behavior relating to fraud and abuse
• Identify and prevent criminal and unethical conduct.
• Tailor a compliance program to an organization’s specific needs
• Improve the quality of patient care
• Create a centralized source for distributing information on health care statutes, regulations and other program directives related to fraud and abuse and related issues
• Develop a methodology that encourages employees to report potential problems

The goal of a compliance program should be to build out your compliance framework so it can easily adapt to regulatory changes. As your organization maintains compliance, you can limit government scrutiny, mitigate financial risks, and offer patients the best quality of care.

To help hospitals, physicians and other healthcare providers develop comprehensive compliance programs that comply with relevant federal health care laws and regulations, OIG offers compliance resources. These resources include:

• Advisory bulletins
• Brochures
• Articles and papers
• Podcasts
• Videos

The OIG also provides other applicable guidance on compliance with federal health care program standards, and they give their opinions regarding federal anti-kickback statutes and other fraud and abuse authorities. OIG resources are often tailored to providers, enabling organizations to find the educational resources they need to understand their regulatory requirements. With an understanding of federal rules and regulations, healthcare practices can form comprehensive programs that enable them to maintain compliance in healthcare.