Yes, compliance is mandatory. But it’s also good for business.
The benefits of effective compliance efforts go far beyond adhering to the government mandate. Your compliance program can bring the following rewards:
The OIG views the existence of an effective compliance program as a mitigating factor in fraud and abuse cases. Plus, under the Affordable Care Act, deficiencies that are self-reported and corrected may receive reduced civil monetary penalties.
Even if the mandate did not exist, compliance programs are crucial to avoid penalties under health care laws. We are in an unprecedented era of enforcement, and regulation of healthcare providers is only increasing. SNFs already struggle to comply with HIPAA (and HITECH); the Anti-Kickback Statute; the Civil Monetary Penalties Law; the False Claims Act; the Stark (physician self-referral) Law; Medicare and Medicaid requirements; and many other laws and regulatory requirements. Recent penalties include:
A compliance program is the best way to prevent, detect, and mitigate penalties.
When an organization treats compliance seriously, employees are more comfortable reporting incidents within the organization rather than to third party enforcers. This allows the organization to address non-compliance as soon as possible – before it reaches the level of a government investigation or whistleblower lawsuit.
Effective compliance programs can detect systemic failures of care that can result in liability for submitting false claims under the False Claims Act and the Civil Monetary Penalties Law. Effectively managed quality assurance programs can reduce the likelihood of quality of care breaches that can lead to costly litigation.
Adherence to standards of quality of care and compliance enforcement increases resident satisfaction, market competitiveness and employee loyalty. Plus, a compliance program provides great PR – put it on your website and promote it in your newsletter. Let the world see that your compliance program makes you a leader in quality and ethics.
A compliance program with an effectively monitored quality assurance program should advance your quality of care, addressing issues immediately, before they become widespread.
Your compliance program’s regular audits of billing and claims documentation and identified billing risk areas will help you identify and correct inaccuracies in the claims submission process.