Best Practices for An Effective Healthcare Compliance Program

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Best Practices for An Effective Healthcare
Compliance Program
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Healthcare, in todays world, has become much
more complex that it was ever before. And this
could be atleast one key reason why frauds have
been ever-increasing in the healthcare industry.
The financial losses to healthcare frauds run in
billions of dollars each year. Such a high rate
of frauds in the healthcare industry is further
fomenting a surge in governmental audits,
inquiries and Medicaid investigations. Rapid
changes in the healthcare system has forced
everyone involved to place more emphasis on
detecting and preventing violations of the
federal and state healthcare laws. Thereby, a
well-planned and effective healthcare compliance
plan is the best defense that anyone has against
medical frauds and it could aid in various
investigations, in case it should occur.
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• The Affordable Care Act (ACA) recommends that
  health care providers implement a well-planned
  healthcare compliance program, if they have not
  done it yet. The compliance program must include
  the following core elements as its foundation
• Establish and adopt sets of written procedures
  and policies to promote the healthcare providers
  commitment to the healthcare compliance
  program. The healthcare compliance plan must
  include sanction screenings as an integral part
  of it. Make sure that there is a routine process
  implemented to keep monitoring potential issues
  regarding compliance.
• 2. Identify and thereby appoint an individual who
  would serve as the healthcare compliance officer
  and it would be this persons responsibility to
  monitor compliance efforts as well as enforce
  practicing standards as per the plan.
• 3. Establish reporting systems through which
  individuals would be able to report or submit
  complaints regarding compliance items without any
  fear of retaliation. Many healthcare providers
  have reported it to be really helpful to setup
  anonymous hotline numbers.
• 4. Make commitment to offering training programs
  and formal education at each level of employment.
  Make this an integral part of the orientation
  process of employee.

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5. Continually audit as well as monitor systems
in order to make sure that they are effective and
also to head off all potential problems in
advance. 6. Develop effective policies that can
be used to enforce high standards of conduct as
well as to establish disciplinary measures at
place for employees who fail to comply with
compliance requirements. 7. Take necessary
corrective actions whenever vulnerabilities are
identified. Apart from these recommendations,
there are many other measures that providers can
take to ensure compliance and also to prevent
medical fraud
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For instance, one can start with assembling a
healthcare compliance committee, suggests
the healthcare lawyer Las Vegas, that would
include cross-section of the employees. Here, it
is essentially everyones responsibility to
uphold and implement compliance. A team approach
could be a really effective way of extending
approach to healthcare compliance beyond just the
designated compliance officer. This compliance
committee would then setup a group charter and it
could eve include case managers, C-suite members,
IT, and other representatives of employees. In
order to be more effective, this group
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