How To Create an Effective Compliance Program

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.

For more information, download our white paper, The 7 Keys to Healthcare Compliance, and learn how to create a simple compliance plan that is in accordance with the seven elements recommended by the OIG.

From early 2011 to early 2014, the Federal government has recovered $8.10 for every dollar it spent on healthcare-related FWA investigations. The Department of Health and Human Services recovered:

  • $4.2 billion in 2012
  • $4.3 billion in 2013
  • Expects $4.9 billion for fiscal year 2014

In addition to being forced to return overpayments, providers may face severe civil, criminal, and financial penalties. Penalties can total three times the amount of the claim, in addition to fines reaching $11,000, per claim, under the False Claims Act.

Three recent settlements under the FCA include:

  • $15.75 million settlement against a chain of addiction treatment clinics and a clinical laboratory in Kentucky
  • $3.3 million settlement against a Baltimore billing company
  • $1 million dollar settlement against Duke University Health System

An effective compliance program is essential for every healthcare organization. Compliance programs not only meet legal requirements but also help your organization to run efficiently and securely.

You can protect your organization by creating a solid compliance program. For it to be complete, it needs to include appropriate submissions of healthcare claims, workplace safety, fair labor practices, and the protection of patient health information among other important items. Organization may also be required to implement specific compliance safeguards.

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