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.
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:
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.
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.