When a dentist or DSO (or any other healthcare entity) get busted for Fraud, Waste or Abuse (FWA) issues the government may decline criminal prosecution in favor of a civil settlement known as a Corporate Integrity Agreement (CIA). There is much to unpack about CIAs. Here is what I know:
- Corporate Integrity Agreements have become a favorite tool of the federal government.
- You can gain valuable insights on how to protect your practice by reading CIAs (and other government enforcement actions). Every CIA includes requirements that the organization incorporate the OIG’s seven core elements (8 if you're a New Yorker) for compliance programs. The core elements were published as voluntary measures in the late 1990’s and early 2000’s. These same measures (outside of a CIA) are mandatory for healthcare (even dental) providers who bill to or receive money from Medicare, Medicaid, and C.H.I.P. Sadly, few organizations even know about these compliance guidances or their requirements to implement a compliance program.
- The OIGs Core Elements of Compliance Programs include: 1). Conducting internal monitoring and auditing through the performance of periodic audits. 2). Implementing compliance and practice standards through the development of written standards and procedures. 3). Designating a compliance officeror compliance contacts to monitor compliance efforts and enforce practice standards. 4). Conducting appropriate training and education on practice standards and procedures. 5). Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities. 6). Developing open lines of communication to keep practice employees updated regarding compliance activities. 7). Enforcing disciplinary standards through well-publicized guidelines.
- There are few CIAs involving dental organizations (one involves a dental school). I have reviewed each of the dental related CIAs on the OIG’s website. Few organizations had a corporate compliance program in place prior to entering into a CIA.
- Chapter 8 of the Federal Sentencing Guidelines specify due consideration for organizations found guilty of fraud related offenses. That consideration can reduce fines and penalties by up to 90%. Think about that for a moment. What if the government claimed you made $1,000,000 in errors and, because of your compliance efforts, you only have to pay back $100,000? Would you look back on your compliance program and documentation of your efforts and call them a success? Sure you would! This is where compliance efforts really pay off. I see this manifest into real life (it is one of the reasons my business is so busy).
- I know of numerous dental providers who have run into fraud allegations because a government or insurance auditor did not like their clinical notes, found errors in their billing and even inadequate documentation to support ‘medical necessity’ (quite common). In every case they were good people paying for mistakes from 3-5 years ago. This means you can put corrective actions in place today to minimize errors in your documentation and billing and STILL face fines and penalties for fraud related violations. Over the last year good dentists (just like you) have been put on payment holds, probation, and were kicked out of participation with Medicaid, arrested and prosecuted (google dentist arrested) because of auditor’s opinions.
- Compliance has to be a starting point and foundation for everything you do, not an after thought. If you don’t know what you’re doing - get help. If you cannot afford help you have a greater problem because you cannot afford not comply with government regulations – getting caught is getting REALLY, REALLY expensive (I have clients who have paid millions, but could have been forced to pay tens of millions if not for their compliance efforts). The government expects providers to invest a substantial amount of time and capital toward compliance efforts and they don't care about your excuses or that you 'did not know'. The amount Uncle Sam expects you to spend is commensurate with the size of your organization. There is no magic number or dollar amount, but it is not zero.
- I have helped build and refine compliance programs for dentists and DSOs (large and small) with great success (their's and mine). It takes a lot of work and there is no finish line, but it is worth it. I love the people I get to work with. If you need help lets connect and see if we're a good fit.
Make today your greatest ever!
Dental Compliance Specialists helps make dental offices safer for patients, dentists and their employees. We help our clients develop and maintain their compliance programs including OSHA/Infection Control, HIPAA, DEA regulations and prescribing practices, Radiation Safety, OIG/Medicaid Compliance, Record Auditing, and more by providing actionable systems, easy-to-use tools, robust training, and accountability. Most of our clients have never been in trouble and want to keep it that way. Sometimes, though, dentists call when they are in trouble. In either case, we are there to make a meaningful difference. If you need help call us at 817-755-0035.