Protecting Your Practice with a Compliance Program

Corporate Compliance Programs are being required for more and more provider types, and the healthcare provider that does not have a required active corporate compliance program may be out of compliance for participation.    Kennedy’s attorneys understand that a manual on a shelf does not qualify as a corporate compliance program in the eyes of governing authorities.  Therefore, Kennedy attorneys recommend an active and continuously circulating program that will keep a provider in compliance with the rules and regulation of the programs it participates in, thereby avoiding heightened scrutiny by a regulatory contractor for having a program that is not being properly utilized.  Kennedy attorneys can create a corporate compliance program for your business, or maintain its operation after the initial installation of the program.  Keeping the program active is the only way to truly meet the requirements for a Corporate Compliance Program.

hhs oig - Corporate Compliance ProgramWhy You Should Consider a Corporate Compliance Program.

The healthcare industry operates in a heavily regulated environment with a variety of identifiable risk areas. An effective compliance program helps mitigate those risks. Because federal and state-sponsored healthcare programs play such a significant role in paying for health care, material non-compliance with these rules can present substantial risks to the healthcare provider. In addition to recoupment of improper payments, the Medicare, Medicaid and other government healthcare programs can impose a range of sanctions against healthcare businesses that engage in fraudulent practices. The authorities of the OIG provide for mandatory exclusion for a minimum of five years for a conviction with respect to the delivery of a healthcare item or service. The presence of aggravating circumstances in a case can lead to a lengthier period of exclusion. Of perhaps equal concern to board members, the OIG also has the discretion to exclude providers for certain conduct even absent a criminal conviction. Such conduct includes participation in a fraud scheme, the payment or receipt of kickbacks, and failing to provide services of a quality that meets professionally recognized standards. In lieu of imposing exclusion in these instances, the OIG may require an organization to implement a comprehensive compliance program, requiring independent audits, OIG oversight and annual reporting requirements, commonly referred to as a Corporate Integrity Agreement.

Source: U.S. Department of Health and Human Services Office of the Inspector General