Healthcare Compliance Attorneys

Why Should Every Healthcare Provider or Healthcare Entity Have a  Compliance Plan?

In today’s world, having a healthcare compliance program or plan signals to others—including employees and the healthcare community—that you are committed to ethical behaviors. It also indicates your responsibility as a healthcare provider who works to ensure compliance with laws and regulations. When you implement  a comprehensive healthcare compliance plan, you may be able to identify and correct any compliance issues prior to their discovery by the government or by a whistleblower.

These compliance issues could include violations of the Stark Law—a healthcare fraud and abuse law that prohibits doctors from referring patients for specific health services paid for by Medicare to any entity with whom they have a financial relationship. Because the law is broad in scope, it can be far too easy to violate the Stark Law without even being aware of doing so. Those who violate the Stark Law could face penalties up to $15,000 for each billed service, plus three times the amount of the government overpayment.

Perhaps the best reason for ensuring you have a comprehensive healthcare compliance program in place is that the lack of such a program can significantly increase your liability should an instance of healthcare fraud be identified within your practice. U.S. Sentencing Guidelines even provide for potentially reduced criminal penalties and fines for individuals and entities that have a documented healthcare compliance plan in place prior to the alleged offense.

What are the Goals of an Effective Program for Healthcare Compliance?

Your Healthcare Compliance Program or Plan must be living and breathing, meaning that can’t just put in on the shelf and never look at it again.

Being proactive is one of the most effective methods of risk abatement, specifically for healthcare providers who are subject to myriad, complex, and frequently changing compliance requirements. By proactively implementing a thorough healthcare compliance program, your organization may prevent investigations by self-identifying and correcting errors, while continuously monitoring and self-auditing to avoid any suggestion of impropriety. Some of the most important things your healthcare compliance program should address include:

● Developing clear standards of conduct.
● Implementing written policies regarding acceptable conduct.
● Developing self-monitoring plans.
● Developing written policies and procedures for all those involved in the business.
● Developing open lines of communication such that personnel know exactly how to respond and to whom compliance issues must be reported.
● Ensuring initial training and continuing education for all staff and stakeholders, including communication of any change that affects job performance.
● Designating a compliance officer and a compliance committee to continuously monitor and audit compliance.
● Ensuring clear and well-defined disciplinary and corrective actions.
● Implementing a rapid-response protocol for highest-priority issues.
● Responding appropriately to detected offenses.
● Ensuring proper internal controls.

What Should You Consider When Developing Your Plan?

While the specifics of your healthcare compliance program or plan should directly address your organization’s status, experience and goals, you may want to consider the following:

● Concerns regarding the False Claims Act
● Federal and state-specific anti-kickback laws
● Issues regarding controlled substances
● How audits and appeals will be addressed
● Florida’s self-referral laws
● Initiatives on health reform
● Third-party appeals
● CMS appeals
● DEA compliance
● Medicare and Medicaid audits and appeals
● HIPAA laws
● Best practices regarding peer review and credentialing
● Regulatory compliance
● Telemedicine

Does Your Healthcare Entity Have a Governing Board?

If so, is that governing board significantly involved in overseeing your practice? Would board members be able to comprehensively answer questions regarding your compliance-related activities? If your organization accepts reimbursement from government payors, it is even more important to have comprehensive regulatory compliance measures in place that protect the entirety of your organization. All personnel at every level of your healthcare organization must be constantly aware of their role in this continuing commitment to compliance. If your governing board members are inexperienced with the inner workings of your particular practice or entity, they have an even greater obligation to stress compliance at all levels.

How Can Rosenberg Law, P.A. Help with Healthcare Compliance Plans and Programs?

When you choose Rosenberg Law, P.A.’s healthcare compliance attorneys, we will carefully analyze all your current policies and procedures to help you to protect against liability for violations of the Stark Law, the False Claims Act and every other compliance regulation. We will construct your comprehensive healthcare compliance plan such that it will protect your healthcare professionals and the medical practice from administrative, civil, and criminal penalties imposed by the state of Florida or by the federal government. We will help build the plan tailored to your needs, then help you remain compliant with best practices for continuous monitoring and training. Contact Rosenberg Law, P.A. today.