How’s Your Compliance Program Coming Along?

Last week I attended a webinar sponsored by The National Council: Healthcare Reform Expands Compliance Requirements: Prepare Now.  There is a recording of the presentation at the link above.

I attend lots of webinars to try to stay informed about what is happening in our industry. As indicated by the fact that I often write about those webinars, I am often stimulated by them. I am rarely alarmed, but this presentation by attorney Adam Falk was almost frightening. I found myself thinking that, if I were still in private practice of psychology, I would stop accepting Medicare patients. Since I just turned 60 and will become one of those Medicare patients in only five years, that thought was most distressing.

According to Mr. Falk, the Patient Protection and Affordable Care Act of 2010, as part of the attempt to save money by eliminating fraud, has placed new requirements on providers of service large and small, to demonstrate compliance with the law. It is not enough to comply; one must also be able to prove that compliance, hence the need for a formal Compliance Program.

The regulations have not yet been written to determine what must be included in such a Compliance Program, but Mr. Falk strongly suggests the need to be proactive rather than reactive regarding this matter. While compliance programs are to be ‘scalable’ based on the size of the organization and the amount of service provided as part of the Medicare or Medicaid systems, there are certain aspects that are essential.

The biggest danger to provider organizations is that the Affordable Care Act classifies much irregular activity as making a false claim. The penalties for false claims are significant. Fraud is rampant and HHS is tasked with eliminating as much of it as possible to protect the taxpayer’s dollar. The attempts to prevent this fraudulent activity provide the Secretary of HHS with broad authority.

Additionally, providers are required to identify, report and return overpayment by Medicare or Medicaid within 60 days of the provider’s recognition that an overpayment has been received. That recognition applies to the clerk in your accounts receivable department who mentioned the overpayment to a supervisor or to someone in authority. Training staff and providing formal procedures to follow will be an essential part of any compliance program.

I would suggest that you take an hour and listen to Mr. Falk’s webinar. Then start to research what might be required at your organization’s level to comply with the requirements of the law.


I received an email notification today from the Office of Civil Rights indicating that HHS has scheduled a second public discussion on Confidentiality and Privacy Issues Related to Psychological Testing Data. The meeting will be held in Los Angeles on November 18, 2010.

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