With healthcare reform and increased scrutiny of providers and suppliers, voluntary compliance programs are a thing of the past. Now, any provider participating in federal healthcare programs must comply to the standards, which can be tedious to track and manage. By implementing an effective compliance program, a company will not only fulfill its legal duties to provide accurate claims, but it will also benefit the company itself.
Here are just a few of the advantages of an effective healthcare compliance program:
1. Avoid serious sanctions
The OIG is not tolerant of unenforced, “symbolic” compliance programs. To avoid serious sanctions, a facility must actually implement the plan they claim. The new Compliance Counsel (2015) within the Department of Justice Criminal Division will help assess the quality and effectiveness of compliance programs in order to command compliance across all regulated industries.
2. Improve communication among healthcare providers
Many compliance officers may be enforcing effective compliance protocol but have not taken the time to document an outline of the program to show to someone outside of the company. A clear compliance manual and effective database of documents and deadlines helps companies stay organized and prepared at a moment’s notice. It improves communication, cooperation, and collaboration among healthcare providers and those processing the information.
3. Quickly and effectively address compliance concerns
With all data in place, a compliance manager saves time scrambling for answers and accurate documentation when the time arises. An efficient communications system will establish a clear process and structure to address compliance concerns when they arise. It promotes prompt and thorough investigation of possible misconduct to expedite the process.
4. Establish credibility among peers and employees
Dedication to honest and responsible corporate compliance sends the message to employees and peers in the community that the institution is committed to excellence and outstanding performance.
5. Prevent and detect unethical conduct
An effective healthcare compliance program database with appropriate checks can detect unethical conduct; the knowledge that the checks are routinely made will prevent breaches and criminal activity. All early detection and reporting minimizes loss to the government from false claims and thereby reduces exposure to penalties, such as program exclusion.
While a structured compliance management system may not entirely eliminate fraud, abuse and waste, it significantly reduces the risk of unlawful or improper conduct. According to the OIG, a compliance management system is a sound business investment because of the myriad of issues and hurdles it prevents.