Compliance Program Requirements for Private Practice

The Affordable Care Act (ACA) established in March 2010, requires all healthcare providers to implement a healthcare compliance plan to participate in federal and state Medicare and Medicaid programs. Many private insurers now also require providers to have a compliance plan. For medical practices, not only is a compliance program necessary it can also serve as a first line of defense. Compliance programs enable practices to avoid or mitigate significant penalties associated with violations of healthcare regulations. They also help enforce government rules and regulations, prevent criminal behavior, and protect a medical practice from improper conduct and fraudulent activities.

The Affordable Care Act issued seven fundamental elements required for a comprehensive compliance program. Healthcare providers that do not yet have a compliance plan should utilize this guidance as a foundation for their program.

  1. Establish written policies and procedures and distribute to all employees.
  2. Designate a compliance officer to monitor and enforce practice standards.
  3. Encourage open communication that allows individuals to voice concerns without fear of retribution.
  4. Provide training to all employees annually and within 90 days of hiring.
  5. Conduct ongoing internal audits and review systems to measure the effectiveness of the program and identify deficiencies.
  6. Enforce standards through disciplinary guidelines.
  7. Respond immediately to offenses and take corrective action.

With enforcement initiatives ever increasing, a compliance plan can serve as a valuable tool to help your practice reduce the chances of acquiring penalties from violations of healthcare law. It can also reduce the risk of fraud and abuse while improving quality care for your patients. Medical practices that do not yet have a compliance plan in place, should promptly adopt these criteria.