Health care fraud is now the second most important priority in law enforcement
in the United States. The number of fraud and abuse cases investigated
by the government rises each year. Now the private sector has joined
the enforcement game as a result of the Health Insurance Portability
and Accountability Act. At one time, in order for a health care provider
to be guilty of fraud, the element of “intent” had to be
present. In many instances, the intent requirement has been reduced
or eliminated. As a result, even health care providers with the best
intentions can find themselves on the wrong side of the law.
Medical compliance is only a part of the issue. Consider OSHA, ADA,
HHS, and DOJ-acronyms that, together, spell “trouble.” As
if you didn’t have enough to think about already, you’ve
also got to consider all the state and federal regulations that effect
small businesses-regulations about topics like discrimination, sexual
harassment, accessibility and worker safety. One of the easiest ways
to protect yourself and your livelihood is by adopting and implementing
a comprehensive corporate compliance program. Think
of it as “preventative medicine.”
There are many advantages to implementing a compliance program.
By far the most important benefit is the protection from prosecution
. Even if an investigator discovers a violation, if demonstrate that
you’ve made a good-faith effort to carry out a compliance program,
criminal charges may be dropped and civil penalties minimized. By implementing
a compliance program, you reduce the likelihood of a whistle-blower
lawsuit, because your employees who observe a questionable practice
occurring are more inclined to report it to management.
Compliance plans are good business. A compliance program can help ensure
that you bill for all of the services rendered. It can reduce reimbursement
time by ensuring correct coding and sufficient documentation to prove
medical necessity. A compliance can enable you to respond in a timely
and appropriate manner to investigation. Remember, a compliance program
puts your employees on notice that you expect the highest
standards of the behavior from them. And, Lastly, it announces
to the community that yours your is a practice that takes ethics and
integrity seriously.
Odyssey takes a very comprehensive approach to compliance. We examine
all aspects of your organization’s day-to-day operations and identify
any potential areas of exposure. Based on our findings, we help you
develop and implement a corporate compliance program that meets the
requirements expected of you and your staff by the federal and state
regulatory agencies.
