Patients tend to see physicians only as providers of care — meeting their medical needs. The reality is that a physician’s efforts to stay compliant with regulations and laws may consume as much or more time than actually rendering care. With consequences for regulatory violations ranging from financial to criminal, compliance is a subject of the utmost importance for any physician practice.
The best way to avoid penalties is to have a serious compliance program in place to prevent, detect, and respond to any possible violation. With regulations always changing on both a federal and state level, especially now with the implementation of the Affordable Care Act (ACA), having a compliance program in place is critical. The benefits of creating an effective compliance program range from better sleep, higher ethical standards, satisfying government auditors and regulators’ requirements, and ensuring that business operations align with proper legal protocol. Given all the possible problems that may derive from doing otherwise, the absence of a strong compliance program invites problems.
To create an effective compliance program, physicians must first understand that there is no one-size-fits-all model. Compliance programs must be adaptable to each practice’s unique structure, services, and personnel. An experienced consultant and/or healthcare attorney should be considered to help set up or review the program and minimize particular risks applicable to your specific type of practice. You must also keep in mind that an effective compliance program will require time and resources to set it up properly and to modify it as needed to adapt to changes in our regulatory environment.
Seven Essential Steps to Compliance
In 1998, the Office of the U.S. Inspector General delineated seven steps healthcare providers should utilize to ensure an effective compliance program. These seven elements of a compliance program may help avoid the fines that would normally be faced by a defendant found in violation:
1. Establish clear standards 2. Administered by a designated Compliance Officer 3. Ensure authority is not given to individuals who engage in illegal activities 4. Provide periodic employee training on compliance 5. Provide continuous auditing of business systems 6. Establish enforcement mechanisms to deal with violations of the established standards 7. Provide for effective responses to such violations.
No compliance program is helpful if not followed and periodically updated. While compliance programs are currently voluntary in nature, the type of practice you operate and where you choose to operate it may determine that a compliance program is mandatory in your case. In addition, the Medicare, Medicaid, and CHIP Program Integrity provisions of the ACA establish that all providers must maintain effective compliance programs in order to enroll in these programs. The U.S. Department of Health and Human Services (DHHS) has continually sought public feedback on proposed rules for mandatory compliance programs so it would come as no surprise if the present voluntary nature soon disappears.
*Disclaimer: Thoughts shared here do not constitute legal advice.