Compliance: Get These 7 Compliance Plan Tips Straight From the OIG's Medical Director

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article summarizes a CMS and OIG webinar on building an effective healthcare compliance program under the Affordable Care Act. It is aimed at providers, practice managers, compliance officers, and billing staff who need a broad understanding of the expected elements, oversight structure, training, communication, auditing, discipline, and corrective action considerations for a practice compliance plan.

Why This Topic Matters

Healthcare organizations need a clear compliance framework to reduce billing errors, support ethical reporting, and prepare for regulatory expectations tied to Medicare and Medicaid participation. The article helps readers understand the major components of a compliant program and why early planning matters.

Article Sections

  1. Background

    Introduces the webinar context and the compliance planning issue discussed by CMS and the OIG. Summarizes why practices are being encouraged to prepare in advance.

  2. Written Policies and Procedures

    Covers the first element of a compliance program and discusses the need for formal written standards, staff review, and internal program documentation.

  3. Compliance Program Oversight

    Describes leadership and oversight responsibilities within a compliance program, including who monitors the program and how oversight is organized.

  4. Training and Education

    Discusses staff education as a core compliance activity, including initial and refresher training approaches.

  5. Open Lines of Communication

    Explains communication channels for reporting concerns and the importance of encouraging staff to raise issues.

  6. Auditing and Monitoring

    Addresses review activities used to assess compliance performance and identify problem areas in practice operations.

  7. Consistent Discipline

    Covers the need for written disciplinary policies and consistent enforcement when noncompliance is identified.

  8. Corrective Action

    Describes follow-through steps for resolving identified compliance issues and reinforcing program effectiveness.

What You Will Learn

  • The main elements of a healthcare compliance program
  • How CMS and the OIG frame compliance planning for providers
  • Why oversight, training, communication, auditing, discipline, and corrective action matter
  • What broad operational areas compliance programs commonly address

Who Should Read This

  • Healthcare providers
  • Practice managers
  • Compliance officers
  • Billing staff
  • Administrative staff

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