The Office of the Inspector General (OIG) makes it clear:
Federal health care enforcers expect all providers to implement
effective compliance programs and to include in those programs specific
policies, procedures and other mechanisms to prevent and detect illegal activity.
In response to this requirement, MMA has developed a comprehensive Compliance Program, which includes the following elements:
- Model Billing Compliance Plan - available for purchase
- Implementation Plan
- Utilization Profiler
The Model Billing Compliance Plan
provides the practice with a customizable
document designed to meet the OIG's requirements. The Implementation Plan
provides step-by-step instructions and related forms to simplify what can be
a very complex process. The Utilization Profiler
is a web-enabled tool
developed by MMA to benchmark E&M utilization against specialty and
locality specific Medicare norms.
This Compliance Program provides you with internal controls and procedures that
promote adherence to statutes and regulations applicable to Federal health
care programs and private insurance program requirements. It also
has a well-defined self-monitoring and self-reporting policy. Using
this program not only assists you in preventing and detecting
fraudulent activity, it also acts as a legal shield to significantly reduce
the penalties if wrongdoing occurs or if mistakes are made.
