Mandatory Compliance

It looks like the days of “voluntary” compliance programs are coming to a close. As we discussed in a recent blog, the health care reform bill contained provisions mandating compliance programs. New York providers receiving Medicaid funds have already experienced mandatory compliance obligations as a result of the New York Office of Medicaid Inspector General regulations that went into effect last year. Although the implementing regulations have yet to be issued, providers are well advised to have a renewed focus on compliance activities. For those smaller health care providers who never formally implemented compliance, the time has come to make compliance a top priority! With the increased health care enforcement environment and ramping up of audit activity, including from the Medicare Recovery Audit Contractors (RACs), The HLP attorneys have seen extensive auditing and investigations of health care providers and significant overpayment demands being requested of providers. We encourage health care providers to take the topic of compliance seriously and take a critical look at their documentation and billing practices, as it is more cost-efficient to be proactive in developing an effective compliance program than responding to a compliance request without having adequate compliance processes in place. It is likely just a matter of time before a Medicare or Medicaid contractor (e.g., PSCs, ZPICs, RACs, MICs) or even a third party auditor hired by another payor does.

For more information on Medicare and Medicaid compliance, please contact Abby Pendleton, Esq. at (248) 996-8510, or visit the HLP website.