Having a compliance plan is important for many reasons but the most important is that it is required by law. It is the best way of preventing erroneous billing and fraudulent claims. It will also help you in the case of a potential audit and help prevent enormous legal expenses. The Federal Sentencing Guidelines explicitly reward the adoption of an effective compliance program by reducing the imposed sanctions. For years the Office of Inspector General (OIG) has encouraged providers to implement compliance programs. They have also indicated providers who lack programs risk more severe sanctions if penalties are given.
Since 1976, the Department of Health and Human Services Office of inspector General (HHS-OIG) has been working to prevent fraud, waste and abuse in federally funded healthcare programs. These include Medicare, Medicaid and the Children?s Health Insurance Program (CHIP). HHS- OIG’s focus is to protect the integrity of HHS programs as well as the health and welfare of program beneficiaries.