Compliance Programs Mandatory in all States by March 2013
The comprehensive health care compliance programs created and implemented by the legal team at the Law Offices Of David S. Barmak, LLC, are designed to address health care providers' need to prevent and detect fraud and abuse and to demonstrate their commitment to conducting their affairs in an honest, ethical and responsible manner.
Health Care Compliance Attorneys Serving Princeton, Newark and Trenton, as well as Cities in New York, Connecticut and Pennsylvania
According to the Office of Inspector General (OIG) compliance program guidelines, (for your convenience, you will find a complete listing of the OIG guidelines at the bottom of this page) measures must be put into place that will encourage employees to anonymously report potential problems and ensure that the health care provider will conduct an internal investigation and make any necessary changes.
To assist our clients, we maintain an anonymous hot line that can be used by any employee who wishes to report a possible incident involving fraud or abuse or any other noncompliant concern. We immediately follow up on all reports by alerting our clients to the call and if an incident is verified, we work with our client to create and enforce a plan of corrective action.
On-Site Quality of Care and Compliance Training
Our customized compliance programs can address any of your specific needs, as well as standard matters such as billing, payment, medical necessity, quality of care, governance, credentialing and other risk areas.
Our lawyers make recommendations and train all relevant staff members regarding the best practices that will help them avoid fraud and abuse problems and identify and resolve any incidents that occur.
Although many health care providers and suppliers prefer to keep our law office on retainer, we always provide our clients with the tools and knowledge needed to proceed independently, training their staff and monitoring their compliance with the procedures and best practices we put into place.
Contact our legal team, so we can evaluate your situation and develop health care compliance programs that are customized to provide you with the protection and direction you need. We are available weekdays, evenings and weekends for appointments.
Our attorneys are licensed in New Jersey, New York, Connecticut and Pennsylvania and we network with other health care law firms around the country.
We create effective and cost-efficient New York, Connecticut, Pennsylvania and New Jersey health care compliance programs.
An effective compliance program addresses the healthcare provider's/supplier's need to prevent fraud and abuse and carries the added benefit of improving the provision of quality health care at lower costs. A successful compliance program also openly demonstrates, to the government, employees and the public, the provider's/supplier's commitment to conducting its affairs honestly and responsibly.
Compliance programs encourage employees to report potential problems and permit the provider/supplier to conduct an internal investigation and take corrective action. An effective compliance program should increase the likelihood of preventing, identifying, and correcting unlawful, abusive or wasteful conduct at an early stage, minimizing financial loss to the government, to taxpayers, and to the provider/supplier.
Compliance programs must encompass billings, payments, medical necessity, quality of care, governance, credentialing and other risk areas that a provider/supplier, with due diligence, identifies.
According to the OIG, an effective compliance plan should include the following elements:
1. Designation of a compliance officer responsible for the day-to-day operation of the compliance program; this employee should report directly to the provider's/supplier's chief executive and periodically report to the governing body (Board of Directors or Board of Trustees) on the activities of the compliance program.
2. Training and education of all affected employees and persons associated with the provider/supplier, including executives and governing body members, on compliance issues, expectations, and the operation of the compliance program; such training should occur periodically and should be made a part of the orientation of new employees and governing body members.
3. A communication process, such as a hotline, accessible to all employees, outside vendors, governing body members, patients or other users of the provider's/supplier's services, for the reporting of compliance issues. The lines of communication should allow for anonymous and good faith reporting of potential compliance issues as they are identified.
4. Disciplinary policies and standards that are distributed to all employees, which are fairly, evenly, and firmly applied, and encourage good faith participation in the compliance process, including policies that articulate expectations for reporting compliance issues and assist in their resolution and outline sanctions for:
a. failing to report suspected problems
b. engaging in non-compliant behavior
c. encouraging, directing, facilitating or permitting either actively or passively non-compliant behavior.
5. A system for routine identification of compliance risk areas specific to the particular provider/supplier, for self-evaluation of such risks areas, including but not limited to internal audits and as appropriate, external audits, and for evaluation of potential or actual non-compliance as a result of such self-evaluations and audits, credentialing of providers/suppliers and persons associated with providers/suppliers, reporting, governance, and quality of care to patients.
6. A system for responding to compliance issues as they are raised; for investigating potential compliance problems, responding to compliance problems as identified in the course of self-evaluations, external evaluations and audits, correcting such problems promptly and thoroughly and implementing procedures, policies and systems as necessary to reduce the potential for recurrence, identifying and reporting compliance issues to federal and state officials (Office of Inspector General, Medicaid Fraud Units, etc.) and refunding overpayments.
