New Focus: Medical Practice Compliance Plans—Physicians Practice

Federal Government, Which Makes an ROI of $7.20 for Every Dollar it Invest in Detection and Enforcement of Fraud, Is Increasingly Monitoring Compliance Plans 

Lucien W. Roberts at Physicians Practice notes that physician practices are increasingly being monitored by federal agencies sensitive to compliance plan violations:

Nearly a decade ago, long before ACO, meaningful use, and PQRS became commonplace terms, HIPAA was a prevalent acronym in medical practices. Practices spent countless hours creating HIPAA privacy manuals. We then spent countless hours training our staffs, educating our patients, and worrying what “Big Brother” would do if we committed a privacy violation.

During this same period, the Office of the Inspector General urged practices to create compliance plans that spelled out what steps they were taking to protect PHI (protected health information) and to monitor internal coding, documentation, and billing practices. Most of these plans included the creation of two or more committees charged with monitoring, education, and reporting responsibilities. In the event a practice or one of its committees found discrepancies, the compliance plan dictated what steps the practice would take. These steps included reporting violations to the government.

We were ready for the inevitable, but nothing happened. Other than a few cases making the evening news, privacy breaches were very rare. Medicare coding audits were just as rare and resulted in little more than a wrist slap and compulsory online coding education for the offender. In many mid-size and smaller practices, the compliance plan committees ceased to meet or function as new priorities arose. Compliance plans gathered dust; but, government oversight gathered momentum.

This generation’s acronyms — RACs, MICs, and ZPICs — are the new sheriffs in town. Unlike their predecessors, they have teeth and have found medical practices to be quite lucrative targets; as I have noted before, the federal government makes an ROI of $7.20 for every dollar it invests in detection and enforcement of fraud, waste, and abuse. Targets include privacy, coding and documentation, and billing — yes, new iterations of yesteryear’s compliance plans. If your practice has ignored its own compliance plan directives, that plan could be your enemy. Many healthcare law gurus feel that not following your compliance plan is worse than having no compliance plan at all. Here are a few steps your practice can take if you have not been following the guidelines you set.

So what are recommendations for professional physician executives who want to stay out of trouble?