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By Wayne van Halem, President, The van Halem Group

Why have a proactive compliance program? I mean it’s strongly suggested, but to date, there has been no real enforcement or penalties assessed to companies without one unless there have been significant compliance issues that have come to light. There are enough requirements that are enforced, why spend the time and resources on something that doesn’t really matter?

It matters if you’d like to keep your company out of the headlines. Recently a news story broke about an orthotics provider that was subject to millions in extrapolated overpayments. A co-worker at the office could be heard gasping “how could this happen” while reading the article. Lack of a compliance program that includes proactive claims audits is how this could happen. The government expects providers to be conducting proactive claims audits quarterly and applying the necessary education and process improvements based on findings. If you’re not conducting chart reviews with qualified individuals, you are leaving your business at risk for potential errors going undetected, for years.

In our practice, we have seen companies forced to do look-back audits and refund money, undergo extrapolated audits with significant overpayments, or even payment suspensions and revocations all for reasons that could have easily been avoided.

It matters because buyers are looking. The van Halem Group is contacted several times a month by attorneys, M&A firms and VC groups looking to engage us in due diligence audits. As you can imagine, this practice is good business, a buyer wants to know what they are getting before they sign on the dotted line. Our team is not just looking at claims audits. Did you know that in virtually every situation our team is asked to review a sellers compliance program? In fact, we’re asked to review both reimbursement and HIPPA compliance programs. Buyers see the risk in purchasing a company that has not taken steps to create a proactive compliance plan and to make a culture of compliance a priority.

We often talk about proactive compliance being a bit like an insurance policy and it’s true. Compliance is not just about the immediate benefit, it’s about protecting your business for the long run and it’s about the impact that protection can have to the value of your business.

Did you know that The van Halem Group offers a full line of proactive services, including Monthly Compliance Packages?

Our monthly compliance packages are designed to augment or enhance your existing compliance program so that it meets the OIG requirements for a compliance program. These services are designed to assist your compliance officer in integrating each of the required elements of an effective compliance program. We have developed four package levels, bronze to platinum, providing you the option to choose the one that best fits your needs. Each monthly package includes the following:

  • User licenses for custom online compliance training with management reporting and tracking
  • Quarterly random sample generation
  • Technical and Clinical review to ensure compliance in coding, billing and medical necessity
  • Quarterly Audit Reports per location with benchmarking  
  • Compliance consultations, corrective action plans, and quarterly education following audits
  • Anonymous Compliance Hotline (Telephone and Web-based) for all employees
  • Compliance literature for all locations
  • Quarterly compliance newsletter
  • Discounted rates on reactive services

If you would like more information about our monthly packages, or other proactive compliance offerings, contact us today!