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Medicaid/ OIG Compliance Program Kit for Individual and Small Group Physician Practices

  • 99700

Section 6401 of the Affordable Care Act (“Obamacare”) requires healthcare providers and organizations that receive reimbursement directly or indirectly from Medicare, Medicaid (and other government healthcare programs including Medicare Advantage) to implement and maintain a compliance program that includes the OIG Compliance Guidelines (for Individual and Group Physician Practices and/or for Third-Party Billing Companies) depending on the practice/organization’s type, size and risks.

Section 1557 of the Affordable Care Act required the same providers to comply with non-discrimination laws that protect Limited English Proficiency and hearing-impaired patients and their caregivers.

Review the provider enrollment agreement you/your dentist signed to credential/re-credential with Medicare, Medicaid or other government healthcare programs. You will find you/your dentist attested to the government your practice/organization has an OIG compliance program like the one outlined below. If you don’t have one, it is high time you make it happen before you get busted for falsifying a government document, which is a crime (even if you didn’t realize you did it). The government does not tolerate liars/lying (false attestation).  

The OIG’s Seven Fundamental Elements of an Effective Compliance Program include:

  1. Implementing written policies, procedures and standards of conduct.
  2. Designating a compliance officer and compliance committee.
  3. Conducting effective training and education.
  4. Developing effective lines of communication.
  5. Conducting internal monitoring and auditing.
  6. Enforcing standards through well-publicized disciplinary guidelines.
  7. Responding promptly to detected offenses and undertaking corrective action. 

This kit can be used by participating and non-participating Dentists, Group Dental Practices, Dental Service Organizations and Third-Party Billing Companies who want to develop a strong Compliance Program to prevent the consequences of fraud, waste and abuse and demonstrate organizational integrity.

The kit includes framework to outline help your practice/organization establish written policies, procedures and standards of conduct, designate a compliance officer (and compliance committee, as needed), facilitate effective compliance training and education, establish effective lines of communication (internal reporting process for employee concerns, which lessens the likelihood of whistleblower reports to the government), outlines auditing and monitoring processes, establishes a framework for enforcing your standards, and facilitates your responses and corrective action to detected violations of rules, regulations and your practice/organization’s internal standards.

Specifically, the kit includes:

  1. Customized Compliance Program manual and related forms
  2. Customized Standard Operating Procedures (Policies and Procedures) manual (detailed below)
  3. Internal Audit manuals 
  4. Incident Tracking Log
  5. Limited English Proficiency Plan
  6. Section 1557 Nondiscrimination Notice, Taglines Poster, related forms and employee training on Section 1557 compliance requirements

The Standard Operating Procedures provides written policies and procedures tailored to address risk areas within your practice/ organization such as: Fraud, Waste and Abuse prevention; Anti Kickback Statute; Stark Prohibitions (Improper Provider Referrals); Patient Transportation; Business Promotion; Role and Responsibilities of your Compliance Officer; Patient/Billing Record Retention; Patient Behavior Management/ Patient Safety; and more. In our experience, it is just too risky to tailor your SOPs alone, so our Compliance Specialists will work with you on this process.

 

NOTE: This manual does not address OSHA, HIPAA or Human Resources (employee handbook). 

 We have a version for New York Dental Providers to meet NY OMIG compliance program requirements.

 

This kit pares well with our Record Auditing services to support your Auditing and Monitoring processes, which helps prevent/reduce government audit triggers, recoupments, payment holds, provider corrective action plans, network exclusion, and referrals to OIG/OMIG/MFCU for False Claims Act violations. For more information on our Record Auditing services call us at (817) 755-0035 or email Toothcop@DentalCompliance.com.



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