Building a Better Compliance Officer

Abstract

The government's conspicuous announcements of recent 6-figure and 7-figure settlement agreements with radiology practices [ 1 United States Attorney's Office, District of OregonEugene, Oregon radiology laboratory settles Medicare and Medicaid Fraud Case for $510,000. http://www.usdoj.gov/usao/or/PressReleases/20061212_Oregon_Imaging.htm Google Scholar , 2 US Department of JusticeSouthwest Florida Radiologists to pay US. $2.5 million for allegedly overcharging Medicare. http://www.usdoj.gov/opa/pr/2004/June/04_civ_429.htm Google Scholar , 3 United States Attorney's Office, Southern District of FloridaBoca Raton radiologist pays US. $7 million to resolve fraud claims. http://www.usdoj.gov/usao/fls/PressReleases/080414-01.html Google Scholar ] serve as compelling reminders of the intense financial scrutiny placed on health care organizations. Meticulous attention to coding and billing and a robust compliance plan are now more important than ever. In encouraging physician practices to develop such programs, the government has set forth a model to help organizations focus on the issues that matter most and, in doing so, hopefully minimize their exposure to charges of fraud and abuse [ 4 Department of Health and Human Services, Office of Inspector GeneralOIG compliance program for individual and small group physician practices. Fed Reg. 2000; 65 (Accessed July 19, 2008)http://oig.hhs.gov/authorities/docs/physician.pdf Google Scholar ].