decisionhealth Newsletters, Part B News - 2021 Issue 5 (May)
Here’s what the DOJ wants in an effective compliance program
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Article Overview
This article is a high-level review of compliance program expectations for physicians and other providers. It discusses the HHS Office of Inspector General’s core compliance elements, the Affordable Care Act’s compliance-program requirement context, and the Department of Justice’s framework for evaluating whether a program is effectively designed, implemented, and operating in practice. It is most relevant to compliance officers, practice managers, physician administrators, and coding/billing professionals who support organizational compliance efforts.
Why This Topic Matters
Compliance programs affect how organizations prepare for audits, reduce risk, and respond to detected problems. Understanding the broad federal framework helps healthcare practices align internal policies, training, reporting, and oversight with current expectations.
Article Sections
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Compliance
Introduces the core compliance-program concepts discussed in the article and frames the federal guidance used to evaluate program effectiveness.
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Department of Justice evaluation framework
Summarizes the DOJ’s general approach to assessing whether a compliance program is effective, including the major areas of review and oversight.
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Resources
Lists external reference materials from HHS OIG and the Department of Justice that support the article’s compliance-program discussion.
What You Will Learn
- How federal agencies frame compliance-program expectations for physician practices
- What broad areas are considered when evaluating whether a compliance program is effective
- Which types of organizational controls and oversight are emphasized in compliance guidance
- Where to find the referenced HHS OIG and DOJ resources
Who Should Read This
- Physicians
- Practice administrators
- Compliance officers
- Medical billing and coding professionals
- Healthcare compliance staff
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