Fraud and Abuse Compliance
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The current healthcare environment has significantly increased the need for well-designed and effective compliance programs. The ever-increasing focus on fraud and abuse enforcement makes an organization-wide culture of compliance and defined controls essential. PractiCons’s solutions allow clients to meet these new imperatives with maximum effectiveness and efficiency. PractiCons will give you the confidence in addressing a wide spectrum of compliance needs.

Fraud and Abuse Compliance

Our compliance program review focuses on program design and inputs, assessing the structure, resources, skills, tools, and procedures necessary to meet today’s increasing compliance demands. For both new and existing practices, we work with you to design structure and approaches that are tailored to your practice and meet government requirements and expectations such as those specified in Office of Inspector General (OIG) guidance and the U.S. Federal Sentencing Guidelines. We ensure that you have the right resources in the right places with the necessary tools to implement the compliance program.

Compliance Risk Assessment
First, we provide your with a risk assessment which will allow you to identify, evaluate, and respond to existing and evolving risk areas. This approach considers reputational, financial, and legal risks, facilitates assignment of risk levels and prioritization, and provides a customized roadmap to guide improvements as well as auditing and monitoring activities. This work focuses the compliance program on the most salient risk issues affecting the organization to ensure that the appropriate internal controls exist to mitigate risks.

Program Effectiveness Assessment
Then, we provide you with a detailed evaluation and measurement of the results of the compliance program with recommendations for improvement. The assessment is designed to determine whether the structures, policies, procedures, controls, resources, and tools are actually effective in quickly identifying, deterring, and remediating the noncompliant behavior they were designed to prevent.

Stark Law and Anti-Kickback

The federal Physician Self-Referral Law (Stark law) and Anti-Kickback Statute (AKS) impose liability and financial penalties on providers who fail to properly document and monitor their financial arrangements with physicians and vendors.

Nationally, there is a growing trend of Stark and AKS investigations and settlements. The trend reveals that problems occur at all stages of physician and vendor relationships: failure to properly review and document transactions, failure to monitor compliance with the terms of the relationship post-transaction, and failure to document changes in the relationship that have migrated out of compliance.

We have a comprehensive approach to developing a compliance program for your practice. We ensure that you have the proper policy and organizational structure in place prior to engaging in transactions that trigger these statutory requirements. We also address how well the structure performs in monitoring those transactions once they are in place.

The scope of our solution includes governance and oversight, as well as policies, procedures, and workflow. We encourage collaboration and communication among all personnel, along with processes for tracking and reporting relevant data and transactions.

Independent Review Organization

Stark and AKS settlements often require providers to enter a CIA, mandating training and review by an IRO. PractiCons will guide you through the settlement and CIA process, performing IRO readiness assessments and providing IRO services.

Compliance and Controls
PractiCons’s compliance solutions provide an objective review of program structure and effectiveness, as well as risk analysis, to facilitate compliance in today’s evolving regulatory environment. Our compliance assessment and implementation services result in improved effectiveness, optimal controls and performance, and a greater sense of comfort for the entire institution that the right issues are being addressed by the right people and at the appropriate time.

Throughout the program we offer a hands-on experience with you and your staff.