Medicare Compliance & Reimbursement - 2009 Issue 5
COMPLIANCE: 6 Ways to Head Off Compliance Problems --and Lawsuits
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Article Overview
This article discusses hospice compliance concerns in the context of government scrutiny, whistleblower allegations, and False Claims Act exposure. It outlines broad organizational practices for improving compliance programs, addressing internal complaints, reviewing eligibility and admission practices, and conducting self-audits. The piece is aimed at hospice leaders, compliance staff, administrators, and other healthcare professionals responsible for billing and regulatory risk management.
Why This Topic Matters
Hospice providers operate under close regulatory attention, and weak compliance processes can lead to investigations, settlements, and lawsuits. Understanding the article’s scope can help readers assess whether they need guidance on internal compliance programs, employee complaint handling, and hospice admission oversight.
Article Sections
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Settlement Background and Industry Scrutiny
Introduces the compliance concern by describing a hospice settlement and the broader regulatory attention surrounding the industry. It frames the article around risk reduction and legal exposure.
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Steps to Reduce Compliance Problems
Presents a practical overview of internal measures organizations can use to strengthen compliance efforts. The section covers program structure, workplace culture, targeted oversight, and internal monitoring at a high level.
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Eligibility Review and Internal Complaint Response
Focuses on hospice eligibility review, employee concern handling, and the importance of internal escalation before outside action. It also emphasizes self-checks and audits as part of ongoing oversight.
What You Will Learn
- How hospice compliance risk is framed in relation to government scrutiny
- What broad elements are commonly emphasized in a compliance program
- Why internal reporting and response processes matter
- How organizations can think about eligibility review and admission oversight
- Why self-audits and internal checks are part of compliance management
Who Should Read This
- Hospice administrators
- Compliance officers
- Billing and reimbursement staff
- Healthcare managers
- Risk management professionals
- Healthcare attorneys
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