What is Healthcare Compliance?
Healthcare compliance is the practice of developing proactive strategies to prevent fraud, waste, and abuse within a healthcare entity. Essentially, it’s the process of following federal healthcare laws and regulations. The aim of compliance laws is to protect patients and their sensitive information.
A compliance program is an active process that ensures that legal, ethical, and professional standards are being met throughout the healthcare organization. Noncompliance can result in legal action, and poses serious risks to patients.
Florida Healthcare Compliance Laws
The U.S. Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG) is the system of government responsible for ensuring healthcare entities are compliant with federal healthcare laws and regulations. The healthcare industry is regulated by various laws and regulations, some of the most important include the following:
- The Healthcare Information Portability and Accountability Act (HIPAA): Passed in 1996 and established in 2003, HIPAA outlines how medical professionals can use and store confidential patient healthcare information and the punishments for violations.
- The Health Information Technology for Economic and Clinical Health Act (HITECH): Promotes standardized electronic health records to strengthen HIPAA’s protection information rules (EHR).
- The Emergency Medical Treatment and Labor Act (EMTALA): The act ensures public access to emergency services regardless of a patient’s insurance coverage or ability to pay.
- Anti-Kickback Statute: Prevents healthcare professionals from accepting any kind of “kickback” ( i.e.money) in exchange for referrals of patients receiving treatment paid for by government healthcare programs.
- False Claims Act (FCA): Outlines liability to any person who knowingly submits a false claim to the federal government for payment.
Importance of a Compliance Plan
Compliance plans have become an important and integral tool in ensuring compliance in the healthcare industry. Under the Affordable Care Act, compliance plans have become mandated for many Medicare providers. Even for those Medicare provider types for which CMS has not yet issued rules implementing a requirement for a plan, it is clearly a “best practice” to have a meaningful compliance plan in place.
In addition to government requirements for compliance plans, many commercial insurance plans require enrolled providers to have a compliance plan as a condition of enrollment. The absence of a compliance plan can, therefore, provide a separate basis to terminate a provider if a dispute arises with a commercial payer.
Regardless of the motivation for instituting a compliance plan, having a properly tailored and effective plan is essential. There is no “one size fits all” compliance plan, as each provider is unique in their composition, compliance issues, and compliance needs. The attorneys at Nicholson & Eastin, LLP assist our clients in evaluating their compliance needs and in developing an appropriate compliance plan. For those clients with a plan already in place, we can assist with an effectiveness review.
Seek the Advice of Nicholson & Eastin, LLC for Healthcare Compliance Services
Please do not hesitate to contact us to discuss your compliance plan needs. A properly implemented compliance plan provides valuable compliance insurance that is well worth the investment. At Nicholson & Eastin, our health care compliance consulting lawyers can advise your practice on how to stay in compliance with state and federal healthcare regulations and the best practices to follow.