The U.S. Department of Health and Human Services, Office of Inspector General’s (OIG) Compliance Program Guideline’s identify multiple elements that should be included in an effective Compliance Program to reasonably ensure that the claims submitted to CMS and other federal health care programs are valid and accurate. Healthcare providers who cannot prove that they have taken affirmative and consistent action to eliminate billing errors and to avoid other fraud and abuse complications can be found to have engaged in criminal conduct through deliberate ignorance.
The Health Insurance Portability and Accountability Act of 1996 defines required policies, procedures and guidelines for maintaining the privacy and security of individually identifiable health information as well as outlining numerous offenses and criminal penalties for violations. The HITECH provisions of the Economic Stimulus Act of 2009 significantly expanded the scope of HIPAA requirements including additional patient rights, heightened enforcements and increased penalties. Enforcement actions and penalties have been becoming more common and are occurring regardless of the size of the covered entity.
The Stark law is a limitation on certain physician referrals. It prohibits physician referrals of designated health services ("DHS") for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity.
The anti-kickback statute makes it illegal for providers (including physicians) to knowingly and willfully accept bribes or other forms of remuneration in return for generating Medicare, Medicaid or other federal health care program business.
Using the embedded social collaboration platform, your organization can communicate in numerous new ways allowing teams to instantly share data, engage an expert to provide insight, and immediately relay that expert insight to a person or group for decision making.
Managing an organization’s compliance program requires tracking information at multiple levels and within various business processes. Compliatric’s suite of utilities allows this tracking to occur in a seamless way across the suite of modules