First Healthcare Compliance CONNECT- June 2016

When a healthcare entity is the
target of a government investigation
or audit, it is the Compliance
Officer who is responsible for leading
the response to, and coordinating and
tracking all steps and details of the
challenging and unnerving process.
In responding appropriately to such
government requests or contacts, it is
important to not only have a prepared
compliance officer, but also prepared
employees— do you have a clear plan
for employees if an auditor arrives at
your office?
The federal and state governments
have made the investigation and prosecution
of healthcare fraud one of their
highest priorities and have proposed
many new initiatives for identifying
By Julie Sheppard, BSN, JD, CHC
fraudulent and abusive practices. A
number of these initiatives include conducting
audits of healthcare providers.
A healthcare entity’s policy should be
to provide reasonable cooperation to
these government authorities while at
the same time protecting the rights
of the entity and all of its employees.
However, many administrators admit
that they are not well prepared for the
first steps if a government enforcement
agency shows up for an official, unannounced
visit. This is because time and
resources are typically spent training
team members to comply with multiple
rules and regulations regarding privacy,
coding, billing, and documentation. But
careful and advance preparation will
make all the difference when faced
with a government inquiry.
Even for a routine audit, your staff
should be prepared to stop, think, and
follow the plan. It is advisable to contact
an attorney licensed in your state
who specializes in the applicable regulatory
issues.
Read more here!
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