decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
False Claims Act / Compliance tips and tools / Half-hearted compliance efforts can lead to more penalties
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Article Overview
This premium article focuses on compliance-response practices in the context of False Claims Act risk. It discusses how government investigators may review internal compliance materials, and it outlines general management areas such as assigning responsibilities, documenting corrective actions, following up on audits, addressing billing issues, considering refunds or self-disclosure, and maintaining records. The content is aimed at providers, compliance staff, and billing leaders who need to understand how compliance efforts can affect enforcement outcomes.
Why This Topic Matters
Organizations that identify billing or compliance problems need to respond carefully and consistently. This article helps readers understand why the quality of a response can matter during government review and what broad categories of follow-up are commonly emphasized in compliance programs.
What You Will Learn
- Why a partial response to a compliance issue can create additional enforcement risk
- How organizations can structure a response when an internal problem is identified
- What broad follow-up activities are commonly associated with audits and corrective action plans
- Why documentation and record retention matter in a compliance investigation
- How self-disclosure, refunds, training, and disciplinary actions fit into a compliance response
Who Should Read This
- Health care providers
- Compliance officers
- Billing managers
- Audit and internal investigation staff
- Practice administrators
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