Healthicity Blog

As a Compliance Officer, you’re charged with the complicated task of creating and maintaining compliance. You manage a thousand moving parts, often while fighting a constant, uphill battle to prove the legitimacy of your relatively new, though crucial, position.

Recently, federal auditors reported that the University of Minnesota Medical Center needs to refund more than $3.2 million in estimated overpayments for services that were allegedly billed incorrectly to the Medicare program.

It’s crucial to perform a medical records audit to effectively maintain your auditing plan. Reporting results to the overseeing physicians, committee, or board is the next step to improving organizational compliance.

"A Code of Conduct is fundamental to a successful compliance program because it articulates the organization’s commitment to ethical behavior.”

Organizations that fail to report overpayments within 60 days can be liable under the False Claims Act and may be subject to civil/criminal liabilities.

Tuomey, a community-based hospital in South Carolina, and the US government, recently resolved a False Claims Act judgement that resulted in a whopping $72 million dollar settlement.

It all started in 2005 when a physician at Tuomey decided to blow the whistle.

Having an effective compliance program is absolutely crucial but measuring the success of any compliance program can be difficult. Available measures of success are not always industry-specific.