Is your health care entity at risk?
The health care industry is heavily regulated and the compliance landscape is continually growing and evolving. Material noncompliance with state and federal health care rules and regulations can present substantial risks to health care organizations. At Sumner Schick, we understand that it is critical to keep our clients abreast and compliant with the latest health care rules and regulations. We will conduct a risk assessment to identify any vulnerabilities, establish a remediation plan, and implement a comprehensive compliance program and maintain its operation after installation. Maintaining an ongoing compliance effort will operate to safeguard your organization from liability which may include but is not limited to state and federal fines and harsh penalties, Whistleblower/Qui Tam civil lawsuits, and potential criminal exposure.
Who Is Responsible?
All health care providers – from hospitals, physicians’ groups, and individual practitioners – must remain in compliance with the rules and regulations set forth by both federal and state government entities that include, but are not limited to:
- Centers for Medicare and Medicaid Services (CMS) requirements
- State specific Medicaid regulations
- Health Insurance Portability Accountability Act (HIPAA)
- OSHA record-keeping privacy
- FDA Compliance Programs
- Stark Law
- Anti-Kickback Regulations
Medicare, Medicaid, HMOs, private insurance companies, and State licensing agencies conduct routine compliance audits. Practitioners must adhere to all compliance rules and regulations to be prepared for compliance reviews.
Maintaining compliance with health care rules and regulations is of utmost importance to ensure that practitioners:
- Retain their billing privileges for insurers and government payors
- Remain in compliance with standards for specific provider types
Comply with health care data protection rules and regulations
Risks Of Not Following Health Care Compliance
Failure of an organization or individual practitioner to comply with health care rules and regulations could result in:
- Loss of billing privileges
- Temporary or permanent unenrollment from participation in federal and/or state programs such as Medicare and Medicaid
- Monetary fines
- Criminal prosecution
Aforementioned above, Sumner Schick will conduct a three-pronged approach in an effort to shield your organization from civil and potential criminal liability. We will 1. Conduct a risk assessment, 2. Identify a remediation plan, and 3. Develop and implement a compliance program and maintain it after installation. An effective compliance program is invaluable for your organization’s peace of mind if and when a government investigator, civil attorney, or the Department of Justice comes knocking on your organization’s door to investigate.
If your organization has recently undergone a health care audit, Sumner Schick’s attorneys can help you address and implement steps to ensure errors are not repeated in the future. Implementation of a corrective action plan will help mitigate penalties and convey to auditors that measures are in place to prevent errors in the future.
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