In an attempt to minimize fraud, there are high compliance standards which are required from organizations within the health industry. The standards are especially strict for those who administer federal healthcare programs like Medicare and Medicaid.
Upholding these compliance standards is a must. Violators can face severe sanctions from the Office of Inspector General (OIG) or even legal action the Department of Justice. However, compliance isn’t all about escaping action from external sources. The compliance standards actually establish internal controls which minimize the likelihood of fraud occurring.
Essentially, compliance makes an organization more effective at preventing fraud. As such, it is imperative for every healthcare service provider to implement the compliance standards set by agencies like the Centers for Medicare & Medicaid Services (CMS) and OIG.
The only challenge with compliance is in setting up an effective program. It is quite simple to set up a generic program. However setting up a program which meets the unique nature of a health provider’s business can be quite difficult.
Fortunately, the OIG has provided a simple way through which different players in the healthcare industry can set up compliance programs. This is through detailed guidelines which can be used as a template for creating the programs.
The guidelines are specifically created for different kinds of healthcare service providers. Examples include hospitals, nursing homes, ambulance suppliers, medical equipment suppliers, individual physician practices, Hospices, Medicare+Choice organisations, clinical laboratories and even pharmaceutical manufacturers.
The guidelines are organized into Compliance Program Guidances which are tailored towards the specific needs of each service provider. For instance, the Compliance Program Guidance for ambulance suppliers provides a detailed approach which an ambulance supplier can use for establishing a compliance program.
Each Guidance begins by describing the compliance requirements for the given health service provider. It then outlines the different components of an effective compliance program. It then gives details on how to implement each component. It ends with practical tips on how to assess the effectiveness of a compliance program.
The most interesting aspect about the Guidances is the approach they take towards compliance program development. Rather than providing a single template for each service provider, each Guidance provides a set of guidelines which can be adapted to the unique circumstances of a specific provider.
In fact, the Guidances encourage each provider to create a compliance program which best suits their unique organizational realities. Such realities include nature of leadership, corporate culture, level of technological adoption and internal processes/procedures. The goal is for each organization to create a compliance program which is both effective and non-disruptive.
Ultimately, the OIG’s Compliance Guidance is perfect for any health service provider in need of setting up a compliance program. It offers such a service provider an effective set of guidelines from which they can set up a program.
The Guidance can also be effective for a service provider who already has a compliance program. It can provide a standard through which such a service provider can evaluate their compliance programs.
Therefore, any health service provider who is serious about compliance needs to check out OIG’s Compliance Guidance. The Guidances are available in pdf format, and can thus be read online, downloaded, printed or even shared electronically. Whoever desires to acquire a copy can visit the OIG’s Compliance Guidance webpage, http://oig.hhs.gov/compliance/compliance-guidance/index.asp.