Understanding Healthcare Compliance
Healthcare compliance is a big deal for providers, as it pertains to many laws surrounding billing and general conduct. These laws apply at local, state, and federal levels and quickly get overwhelming. As a healthcare provider, it is your job to ensure you are on top of all the compliance standards set in place, and failure to meet these standards can result in disastrous problems for your practice.
The compliance process can often become complicated. Thankfully, you do not have to worry about facing compliance on your own. Getting in touch with an established healthcare law attorney can make healthcare compliance less headache.
What Does Compliance Involve?
Many areas fall under healthcare compliance laws that cover patient care and billing practices and more extensive business activities. Compliance laws cover hospitals, single and multi-specialty physician groups, dental clinics, medical labs, pharmacies, and EMR developers.
- Federal Laws: Regulations around Medicare and Medicaid are mainly of compliance standards. Stark Laws, Anti-Kickback laws, the False Claims Act, and the Emergency Medical Treatment and Active Labor Act are included.
- State Licenses: Any state licenses or certificates for your practice must also be up to date for compliance to be reached.
- Patient Care and Privacy: Patient data and privacy also fall under compliance. This includes HIPAA regulations, the storage and transfer of medical records, electronic payment systems and records, and potential data breaches.
- Mergers and Acquisitions: All mergers and acquisitions are subject to compliance laws. The same goes for any investments, joint ventures, or even if you plan on retiring and selling your practice.
- Audits: Audits, whether internal or external, can be triggered as a part of a potential compliance protocol violation. Audits serve as a way for the government to enforce healthcare compliance.
Healthcare compliance laws are always changing, which is why you need to be aware of them, but older rules that have not changed are easy to forget about. An excellent way to avoid compliance complications is to brush up on some of the regulations you may not be familiar with.
The Benefits of Implementing a Compliance Plan
An essential step to meet compliance standards is creating a healthcare compliance plan. This allows you to handle any issues in your practice in a systematic way. Strategies can help you determine what actions to take in the event of non-compliance. This includes who to contact, what government entities may get involved, and which documents to keep on hand.
Another reason these plans need to be in place is that they can protect you from prosecution in the event of compliance failure. A good compliance program indicates that you had procedures in place to deal with issues. This, in turn, shows government regulators that mistakes happened by accident and not through ill intent.
One of the biggest reasons to have adequate compliance protocols in place is that the cost of non-compliance can be very high. Several federal and state authorities are involved in sniffing out fraud, waste, and abuse in healthcare. The federal government’s crackdown on fraud has only grown more prominent in recent years, with many agencies getting involved. Agencies like the Department of Health and Human Services (HHS), the FBI, the Justice Department, and the Centers for Medicare & Medicaid Services (CMS) are involved in anti-fraud investigations.
If any of these agencies investigate your practice due to non-compliance, there can be severe penalties. These could include criminal charges, hefty civil fines, the loss of your medical license, and being barred from Medicare and Medicaid reimbursements. Compliance plans are essential to show that you have done your due diligence in the event of a government investigation.
How Healthcare Attorneys Fit Into the Compliance Picture
The laws around healthcare compliance are often exhaustive and subject to change. You should contact a healthcare law attorney to help you navigate the often confusing laws. They can help you establish a compliance plan from the ground up and help with any business decisions that would otherwise trigger compliance regulations.
Waiting for a non-compliance issue to come up before reaching out to a lawyer is never a good idea. It helps to be proactive and establish a relationship with a firm before your practice comes under investigation. At the Norman Spencer Law Group, our healthcare attorneys are familiar with every aspect of the industry, including healthcare compliance. Our team can help you with all of your compliance needs or defend your practice in the event of non-compliance. Do not wait to call us to set up a free consultation over the phone, email, ZOOM, or in person.