Compliance is a big issue in the medical field. With state and federal regulations governing virtually all aspects of health care, missteps in this complex area can lead to major consequences. Providers must navigate the murky waters of HIPAA privacy regulations, proper billing and coding procedures, periodic audits, Stark Law and the anti-kickback statute, hospital and emergency department EMTALA obligations, and the ethical demands of their own professional licenses – all while addressing the run-of-the-mill challenges that go along with running a successful business in any industry.

To stay afloat amidst this regulatory mire, health care providers must take compliance seriously. That means being proactive, not reactive.

At Marcilliat & Mills PLLC, we can assist you with this Herculean task. Our lawyers combine in-depth regulatory knowledge with a practical, business-oriented mindset to help clients avoid the regulatory pitfalls that could doom their practice.

Health Care Compliance Review Plans: What Goes Into An Effective Compliance Program?

Formal compliance programs are mandated by law for many Medicare/ Medicaid providers. All providers, however, can benefit from having formal written policies and procedures. These compliance plans should address, at a minimum:

  • Establishment of a compliance officer
  • Education and training
  • Internal reporting and complaint systems
  • Disciplinary and enforcement guidelines
  • Internal investigations, monitoring, and audits
  • Documentation and record-keeping
  • Corrective action for lapses

Additionally, whenever providers are contemplating major transactions or agreements – for example, bringing in new physicians, contracting with a medical supply company, restructuring the organization, or entering an arrangement with another practice – a thorough compliance review is essential to avoid issues such as anti-kickback violations. Our lawyers apply meticulous attention to detail in identifying any red flags.

Risk Assessments

It’s far better for health care providers to uncover regulatory violations internally rather than waiting for auditors or investigators to stumble across them. Our lawyers can help you identify vulnerabilities by conducting thorough risk assessments. We will take a close look at all aspects of your operations to pinpoint weaknesses and provide detailed recommendations to strengthen them.

Partner With Trusted Legal Allies

To discuss how we can help your organization steer clear of compliance snares, contact our firm online or call 919-838-6643. We serve health care organizations and providers across North Carolina.