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Compliance: The Cornerstone of a Healthy Practice
Practice Management
Written by Dr. Eric Kaplan, D.C., F.I.A.M.A.   
Tuesday, 14 September 2004 21:48 Read : 691 times

Today, more than any time in our history, doctors are being watched.  Big Brother is watching!  So many offices are worried about HIPAA. Yes, if you violate HIPAA, you will receive a fine.  However, if you do not follow the rules of the OIG (Office of the Inspector General), you may not only be fined, you may face jail time.

As a consultant who works with integrated practices, it stuns me to see how many offices have integrated by themselves.  They get a legal document from a friend and move forward.  Then they wonder why they are on the cover of Dynamic Chiropractic.  There is no right way to do the wrong thing. Whether you are integrated or not, you must play by the same rules.  These are not separate for MD’s and DC’s; they, like HIPAA, are for all Healthcare.

If you are in practice, know the rules.  If you are integrated, hire an attorney.  While attorneys can help you with the legal documents, most often they are not familiar with billing, coding and compliance.  This is why consultants are so important—not just to provide you with the rules, but to make sure your practice is compliant.  It begins with knowing the rules.  

Code of Conduct

It is the policy of all of my clients’ offices to instruct and understand that all individuals associated with the practice conduct themselves in an ethical manner and in conformance with all federal and state laws and the policies and procedures of the employer. To this end, your office’s Conduct Code and Compliance Program are to be prepared to provide employees, as well as those with whom your office does business and the general public, with a formal statement of commitment to the rules of ethical conduct as spelled out in this Code.

It is imperative that all my clients and personnel comply with the standards contained in the Code, and immediately report any alleged violations thereof to the Compliance Officer.  This is where you begin.  You must designate an employee to hold this title and assist in investigating any allegations of wrongdoing. It is our policy to prevent the occurrence of unethical or unlawful behavior, to halt such behavior as soon as reasonably possible after its discovery, and to discipline personnel who violate the standards contained in the Code and the Compliance Program.

No Code of Conduct can cover all circumstances or anticipate every situation. Therefore, should an employee encounter a situation which is not addressed specifically by this Code, he/she should apply the overall philosophy and concepts of this Code to that particular situation, and observe the ethical standards of honorable people everywhere.

Ethics

It is the responsibility of your office to obey the law. Personnel are encouraged to report all that they are doing to achieve their goals, to record all transactions accurately in their books and records, and to be honest and forthcoming with auditors. We require that all employees conduct themselves in an honest and ethical manner, including honest bookkeeping, honest budget proposals, and honest economic evaluation of projects in all aspects of an employee’s work.

Conflict of Interest

Your office and all employees must avoid situations in which their personal interests could conflict, or reasonably appear to conflict, with the interests of their employer. A conflict of interest could exist in any opportunity for personal gain, apart from the normal compensation provided through employment or payment for services rendered.

Dealing with Suppliers and Patients

Conducting business with suppliers and referring providers may pose ethical or even legal problems. The following guidelines are intended to help all personnel to make the proper “ethical” decisions.

1.  “Kickbacks” and Rebates:  Employees (or their families) may not receive personal kickbacks or rebates in exchange for the purchase or sale of goods or services at any time.  “Kickbacks or rebates” can take many forms and are not limited to direct cash payments or credits. In general, if you or your family stands to gain personally through the transaction, it is prohibited. Such practices are not only unethical but are, in many cases, illegal.

2.  Gifts or Gratuities:  Employees may not, under any circumstances, accept gifts of money, nor may they solicit non-monetary gifts, gratuities, or any other personal benefit of any kind from suppliers or patients. Employees may accept unsolicited, non-monetary gifts from a firm or individual doing, or seeking to do, business with you only if the gift is of nominal value, or the gift is primarily of an advertising/promotional nature.

3.  Entertainment:  Personnel may not encourage or solicit entertainment from any individual with whom your office or employees do business. From time to time, employees may offer or accept entertainment, but only if the entertainment is reasonable, occurs infrequently, and does not involve lavish expenditures.

Overcharging

Insurers and patients shall not be charged for more expensive services or equipment than that actually provided. Examples of overcharging include:

· Billing for more complex or sophisticated (and thus more expensive) services or equipment than actually provided (up-coding);

· Billing two insurers, such as Medicare and a private insurer, for the same services or equipment; and

· Waiving a patient’s co-payment without informing the government so that the government believes that your charges are higher than they actually are.

Books and Records

Falsification of Records:  Federal law requires us to ensure that our books and records accurately reflect the true nature of the transactions represented.  It is against our policy for any employee to cause our books and records to be inaccurate.  This is why we like ink, versus pencil.

Examples of false or artificial record entries include the following:

· Making the records appear as though medical services or equipment were provided to a patient when, in fact, no such equipment or service was ever provided to that patient;

· Making the records appear as though one type of medical service or equipment was provided to a patient when, in fact, a different type of medical service or equipment was provided to the patient;

· Making the records appear as though a medical service or equipment was provided to one person when, in fact, it was provided to another;

· Making the records appear as though a medical service or equipment was provided to a patient on a certain date when, in fact, the service or equipment actually was provided on a later date; and

· The creation of any other records that do not reflect the true nature of the transaction.

Any employee who knows, or should know, that he or she is making false or artificial record entries shall be subject to disciplinary action, including possible termination.

Employee Relations

It is the responsibility of your office to provide equal employment opportunities to individuals who are qualified to perform job requirements, regardless of their race, color, sex, religion, national origin or age. There are laws that prohibit discrimination against minorities, sexual harassment, and similar misconduct. Regardless of any legal prohibition, every u employee has a right to work in an environment free of harassment or discrimination based upon sex, race, creed, physical condition or national origin. All employees shall treat each other with courtesy and fairness and have respect for the dignity of others.

Reports of Wrongdoing

Each employee has a duty to report any suspected violation of your office’s Code of Conduct. If any employee reasonably suspects that any employee, subcontractor or agent is involved in any sort of criminal wrongdoing, or has or is violating the guidelines or policies contained in the Code, that employee should immediately report those suspicions directly to the Compliance Officer. In the event that an employee feels that a report has been given inadequate attention by the Compliance Officer, the employee may report to the Clinic Owner or Administrator.

Remember this rule:  REPORTS OF VIOLATIONS BY EMPLOYEES MAY BE MADE WITHOUT FEAR OF RETALIATION.  This is a mandatory component.  If you would like more information, go online to Office of the Inspector General. 

And, finally, remember that compliance is not an option.  Follow your heart, be true to yourself, and be true to your profession.

The world of healthcare and compliance is based on results.

Dr. Eric S. Kaplan is CEO of Multidisciplinary Business Applications, Inc. (MBA), a comprehensive coaching firm with a successful, documented history of creating profitable multidisciplinary practices nationwide.  For more information, call (561) 626-3004.

Dr. Eric S. Kaplan NOTE:

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