Fraud is still a very real issue across the relationships
between physicians and hospitals
Is it possible to align physician satisfaction and compliance? According to Gail Peace, President of Ludi Inc., “Regardless of the physician being independent or employed by a hospital, there are a myriad of regulations to navigate in these relationships.” She goes on to explain how the dynamic between physician groups and hospitals can be tense and complicated. And yet, fraud continues to be a very real issue for them both. In fact, she says, while fraud overall is down in other industries, it’s not the case in health care. In a recent post, from Insights from Ludi, Gail emphasizes out how devastating financial settlements can be. Health care fraud cases make up 90% of the OIG settlements. Kickbacks, it turns out, are the leading cause of hospital violations.
Further, as the number of regulations continues to rise, these tensions and complexities can become even greater between hospitals and physician groups. The Office of Inspector General (OIG) has offered good guidance for physicians. And so, with these factors in play, it’s worth reviewing the OIG’s 7 components for physician groups:
7 Components for Creating a Voluntary Compliance Program
Establishing and following a program like this, the OIG says, will help physicians a lot. In fact, the OIG says hat a well-designed compliance program can:
- Speed and optimize proper payment of claims
- Minimize billing mistakes
- Reduce the chances that an audit will be conducted by HCFA or the OIG; and
- Avoid conflicts with the self-referral and anti-kickback statutes
Here are the OIG’s seven components to create a voluntary compliance program:
- Conduct internal monitoring and auditing.
- Implement compliance and practice standards.
- Designate a compliance officer or contact.
- Conduct appropriate training and education.
- Respond appropriately to detected offenses and develop corrective action.
- Develop open lines of communication with employees.
- Enforce disciplinary standards through well-publicized guidelines.
Surely, we all agree these are important components. But what else can physician groups and hospitals be doing?
Can’t We All Just Get Along?
Gail and co-leaders, Kelly Walenda, Sr VP Legal Services and Chief Privacy Officer, Jefferson Health; and Eugene McMahon, Senior VP and Chief Medical Officer, Capital Health System, are leading an intriguing session at HCCA’s Compliance Institute. They plan to get to the heart of this issue. The premise is simple: compliance can feel big brother to physicians. On Tuesday, April 9, we’ll be looking forward to hearing more in the session: Can’t We All Just Get Along? Physician Satisfaction and Compliance Are Not Mutually Exclusive In Physician Arrangements. They will be presenting case studies, strategies and best practices to manage arrangements that align priorities. They will also share their paths for engaging physicians and how to dialog with physicians about work performed to drive clinical agenda. We look forward to hearing these ideas and we’ll be sure to share our impressions, too.
Likewise, it will be good to discuss how youCompli’s distinctive features and benefits may prove quite helpful. At its core, youCompli ensures compliance and increases efficiency. These are the priorities we all share.
We are looking forward discussing this and more at HCCA CI. Not going to CI? Let’s meet virtually – just request your 10-minute demo.
#chaostoconfidence #stopreadingregs #patientcare