The “Pith” of Fraud and Abuse Compliance

The “Pith” of Fraud and Abuse Compliance
There has been a great deal of talk about fraud and abuse compliance for many years. Anecdotally, despite all of the discourse, dissertation, exhortation, harangue, and horrifying enforcement actions, there are still a number of providers who just don’t seem to get it! In a speech at the Health Care Compliance Association 2019 Compliance Institute; on April 8, 2019; Joann Chiedi, Principal Deputy Inspector General, provided some pithy statements that may help bring the issues into focus as follows:
• My main message is this: Be bold. Take action. Compliance must have a seat – and a voice – at the innovation.
• We cannot oversee what we do not understand. Effective oversight requires understanding how healthcare is delivered today and how it will be delivered in the future.
• Give Compliance the data. If anyone in your organization has data, Compliance should have access to it, too.
• Compliance and innovation must advance together. Compliance can and will play a big part in getting innovation right in healthcare.
• If you want to predict and manage risks, if you want to delve beyond what happened, to explore why, give Compliance data, give them C-suite support, and freedom to do their jobs.
• Oversight and compliance professionals are working to ensure that the rules of the road are followed, that dollars are well spent, and that patients are protected. Like innovation, compliance never stops, should never become stagnant, and will be essential to the success of the new healthcare ecosystem.
• Businesses that plan to be around for more than fifteen to twenty years will embrace change. They will have their compliance professionals working shoulder to shoulder with their disruptive innovators.
• Create multidisciplinary teams with the flexibility and skills to work in new ways across your organization to identify and gain new insights into program vulnerabilities and how to address them.
• Use your organization’s data to identify compliance soft spots and liabilities before they come to government’s attention and potentially become bigger, more expensive problems.
• Set up a regular process for environmental scanning and prioritization of your compliance activities.
• Compliance leadership is about a clear vision, empowerment, being passionate so others can see that you care, so that they you are sitting at the table, your voice will be heard.
• Compliance and oversight must be forethoughts, not afterthoughts.
• Getting in early and often can avoid costly mistakes and retrofitting down the road.
• Working with mission partners who share your passion for effective oversight makes a huge difference. It is not healthy or sustainable to go it alone.
There it is in a nutshell! Read and follow!

©2019 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

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