Establishing and following a compliance program will help health care providers, government or insurance billers, and physicians avoid allegations of fraudulent
activities and ensure that they are submitting true and accurate claims. Insurance companies and government programs have become more aggressive in pursuing billing fraud allegations.
The following seven components provide a solid basis upon which a business can create a voluntary compliance program:
1. Conduct internal monitoring and auditing.
2. Implement compliance and practice standards.
3. Designate a compliance officer or contact.
4. Conduct appropriate training and education.
5. Respond appropriately to detected offenses and develop corrective action.
6. Develop open lines of communication with employees.
7. Enforce disciplinary standards through well-publicized guidelines.
A compliance program helps create a safe harbor and defense of any allegations of criminal fraud. It shows a commitment to proper billing and is used to show lack of criminal intent if and when billing mistakes are made. It also helps avoid lawsuits by whistleblowers when there is an internal program for handling these complaints internally.