Healthcare Compliance – Reducing Fraud Risk

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The main reason for implementing healthcare compliance is reducing fraud risks and abuse. The most important best practice is complying with laws and regulations which are imperative for risk management. There are recommended initiatives and programs which one can employ to achieve best practices in healthcare.

Healthcare professionals are constantly on their feet helping citizens with treatments for one ailment or the other, accidents and giving birth. However, there are some risk management laws they need to abide by to ensure the best practice in their profession. Therefore there are healthcare compliance issues with could have negative consequences on healthcare providers if there is no compliance.

Throughout the Unites States there are healthcare compliance guidelines. These help healthcare providers with guidance on a framework for handling appointments, surgeries, billing, coding of treatments, referring, and managing health insurances. The database of the people entitled to receive healthcare is too large and people tend to take advantage of this. There have been various fraud cases at different levels due to failure to comply with best practices. Most lapses leading to fraud in healthcare are poor management of records, incorrect billing, missed entries and miscommunication.

Professionals in healthcare are also expected to comply with best practices in order to maintain adequate risk assessment, ethics of practice, referral laws and patient rights. Professionals in healthcare must be able to manage their patients in compliance with these regulations to maintain high standards and patient satisfaction. There must be proper documentation of the bills which must be accessible during audits. Additionally, healthcare compliance reduces the risk of maltreatment, malpractice and abuse of patient rights.

Measures taken to Reduce Fraud Risk:

In order to reduce the risk of fraud, certain healthcare reforms have been implemented in the United States. These include:

There is a SRDP (Self Referral Disclosure Protocol) allowing providers and suppliers to disclose actual or potential violations of the stark law. Upon self disclosure the penalty will be reduced.

Further reading: Corporate Governance | Audit | Performance Improvement

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