It seems every year new regulations and standards are put out by the federal government with higher penalties, and this year 2018 is no exception. If your practice compliance plan is not up to date, you could be putting an unnecessary criminal, civil, and financial risk on the practice and providers. For the most part, larger integrated health practices have compliance plans and compliance officers to ensure they are not at risk. I am talking to the small to large independent practices that have 1-50 providers in their practices.
What I have found in my experience is that the small to large independent practices have either outdated or none existing compliance plans, this is where you are at risk. Every year it is imperative that the practice administrator and providers review the compliance plan and ensure they are updated and are followed. Where most practices fail is in the follow through, they may have a plan, but don’t enforce the plan thus resulting in a possible review of the OIG. I understand it is not the pretty side of healthcare management however if neglected it could have significant ramifications. I read an article from KraftCPA, PLLC regarding “The Cost of Noncompliance” which outlined the 2018 increases in the penalty for the different compliance areas such as Stark Law, False Claims Act, Anti-Kickback, HIPPA, EMTALA. It is an excellent article and should light a fire in all practices to ensure your compliance plans are in place. Just know that the OIG doesn’t listen to you if you say “I didn’t know”! It is your responsibility as an administrator, provider, practice team member to understand the rules and regulations regarding the compliance in the practice.
December 2017 the OIG released a video talking about the successes they had in recouping monies as well as legal ramifications related to compliance penalties. In 2017 they had 881 Criminal actions, 826 Civil Actions and +4 Billion in expected recoveries. You can review the video on YouTube – Eye On Oversight 2017 Year in Review. In my opinion, every one of these situations is preventable. It is not a guessing game as to if you are following the compliance rules and regulations. It is unbelievable that we still have these types of recoveries from OIG when we have so many resources and individuals who can help our small to large practices with compliance plans. As far as I know, there is not a practice (small-large) that could withstand a compliance error resulting in the criminal actions, civil actions, and recoveries that the OIG will assess on practice, individuals in the practice, and providers if they find fault.
So, what do you need to do, it is so simple!
Set up a compliance plan and make sure that the plan is enforced by the practice with repercussions if not followed! The compliance plan includes everyone from the team members, administrators, and providers no one is exempt. If anyone (team member to management to a provider) in your practice decides not to follow the compliance rules and regulations, it should be addressed immediately. I realize this is harsh to say, and some individuals would even say they can’t address the issue because of the political ramifications. I will say to you, Are you willing to put your practice at risk and yourself at risk because you're afraid to resolve the situation because it is political? I understand the pressures that come with political situations in a practice. However, there are ways to hold individuals accountable without causing a negative backlash, and as administrators and providers, it is our ethical responsibility to ensure our practices are meeting compliance plans. Because once the OIG starts their review, it is too late to try to fix the issue.
If you're unsure of how to create or put in place a compliance plan for your practice we at Revitalize Healthcare Solutions would be happy to assist you.
Cissy Mangrum, MBA, CMPE, CPC
Revitalize Healthcare Solutions
CEO/Principle Consultant
Phone: 615-397-5042
Email: Cissy.Mangrum@cmhealthconsulting.net
References
Office of Inspector General, Department of Health and Human Services. “Eye on Oversight - 2017 Year in Review.” Https://Youtu.be/X_LSRl5onPw, Office of Inspector General | U.S. Department of Health and Human Services, 20 Dec. 2017, oig.hhs.gov/.
KraftCPA. “The cost of noncompliance | Kraft Healthcare Consulting | Nashville, TN.” KraftCPA PLLC, KraftCPAs, 26 Jan. 2018, www.kraftcpas.com/articles/the-cost-of-noncompliance/#.Wm9pdIu4RRc.linkedin.
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