Overpayments: Create culture of compliance

A. In previous columns, I discussed how the 60-day overpayment rule presents a myriad of problems and questions that are sometimes difficult for an HME supplier to identify and address. However, the most effective remedy to overpayment problems is the implementation of and adherence to a robust compliance program. Overpayments will still arise, but the compliance program sets the stage for a corporate culture of compliance.

The Affordable Care Act mandates that suppliers have compliance programs, but CMS has not yet set a deadline for the requirement. The Office of Inspector General stressed the importance of compliance programs and issued guidance on how programs should be structured and implemented. However, the OIG believes that superficial programs that simply have the appearance of compliance without the financial support and resources necessary for ongoing monitoring and fraud prevention are likely ineffective and could expose suppliers to greater liability than no program.

An effective compliance program includes a supplier's written procedures and policies; designation of a compliance officer and compliance committee; conducting effective training and education; developing effective lines of communication between employees and the compliance team; enforcement of disciplinary standards, auditing and monitoring; and response to offenses and corrective actions.

A robust compliance program with effective ongoing monitoring will likely reduce violations of state and federal law amidst heightened enforcement actions against corporations and senior management. 

Now is the time to bolster compliance!

Josh Skora is an attorney with Brown & Fortunato. Reach him at jskora@bf-law.com.