The Affordable Care Act (ACA) has mandated physicians and group practices to establish compliance programs if they want to provide services under Medicare, Medicaid and Children?s Health Insurance Program.
Commercial insurers are also requiring medical providers to create a compliance plan as a condition of participation in their pro-gram. Those who do not create a plan are at risk of not being allowed to participate in the healthcare program.
CMS insists that medical providers will be able to protect themselves from improper conduct if they create a compliance program. A functional program ensures that government rules are enforced and that they provide quality care. A good compliance program will help prevent criminal behavior, protect against fraud, improper payments, abuse of the system and other liabilities.