Healthcare Compliance
Your medical practice is subject to countless rules, laws, and regulations. Keeping track of the ones that apply to your practice can be an overwhelming task. But putting healthcare compliance on the back burner isn’t an option. Failing to comply can lead to costly civil and criminal penalties, including jail time.
Unfortunately, noncompliance happens all too often. And most medical practices don’t even realize they’ve committed it…until it’s too late.
This is where I can help. Part of my duty as a healthcare-focused CPA and Certified Healthcare Business Consultant is to make sure your practice complies with all applicable rules, laws, and regulations.
Healthcare compliance challenges
Compliance in healthcare can cover a wide variety of practices and involve observing both internal and external rules. In addition to the notoriously complicated HIPAA requirements, medical practices must follow laws such as the Stark Law, Anti-Kickback Statute, Civil Monetary Penalties Law (CMPL), and the False Claims Act. Medical practices must also comply with Federal Trade Commission (FTC) and Federal Drug Administration (FDA) rules, to name a few.
The most common healthcare compliance issues relate to the following:
- Billing compliance
- Fraud compliance
- Human resources compliance
- Compensation compliance (including anti-kickback)
- HIPAA
- OSHA
The consequences of non-compliance
It’s easy to overlook healthcare compliance. This is especially true for busy physicians and office managers as well as for practices with inexperienced staff members. Most assume their practice is complying when it’s not, or they simply don’t understand compliance requirements. (I see this regularly in HIPAA compliance.) Pleading ignorance, of course, is no excuse if the auditors come knocking.
How a compliance program can help your practice
The list of federal and state regulations that apply to medical practices is lengthy, to say the least. It’s nearly impossible to comply with all without a compliance program to follow. Not only does a compliance program give you a plan; it also serves as proof you’re making a good-faith effort to comply.
Part of the complete service package I offer includes developing a healthcare compliance program for your practice. Think of me as the outside eyes looking into your practice. In this position, I can help you proactively manage your practice’s compliance before it becomes an issue.
These three pillars serve as the basis for compliance program development:
- Prevent
- Detect
- Correct
First, I prevent a non-compliance issue from raising its head by assessing your practice’s risk areas. If a compliance issue arises, I detect it through constant monitoring of your practice’s activities. If I do find a problem, we work together to correct it immediately.
Make healthcare compliance a non-issue for your practice
When you’re caring for patients and managing a practice, it can be hard to worry about staying in compliance, too. To find out how working with a healthcare compliance expert can benefit you and your patients, contact me today.
Medical practices often encounter several key compliance issues, including:
- Compensation Compliance (including Anti-Kickback):Ensuring that compensation arrangements comply with the Anti-Kickback Statute and other related laws.
- HIPAA Compliance: Protecting patient privacy and securing health information as mandated by HIPAA.
- OSHA Compliance: Maintaining a safe working environment for employees in accordance with OSHA standards.
Non-compliance in these areas can lead to severe penalties, making it crucial for practices to stay informed and proactive about compliance requirements.
Failing to comply with healthcare regulations can have severe repercussions, including:
- Civil and Criminal Penalties: Non-compliance can result in hefty fines and, in severe cases, criminal charges that may include jail time.
- Legal Liability: Practices may face lawsuits and legal challenges, increasing the risk of financial losses and long-term operational impacts.
Therefore, staying compliant is not only a legal requirement but also essential for maintaining a practice’s integrity and operational efficiency.
A compliance program offers several benefits for medical practices, including:
- Risk Prevention: Identifies and mitigates potential compliance risks before they become problematic.
- Corrective Actions: Facilitates immediate corrective measures when compliance issues are detected, minimizing potential damage.
Implementing a comprehensive compliance program ensures that your practice remains in good standing with regulatory bodies and reduces the risk of facing severe penalties.
If you have questions about healthcare compliance, contact me at 281-379-5988, submit a form online, or email me directly at reedt@rtacpa.com.