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14
COM Outlook . Summer 2012
HEALTH CARE LEGAL EAGLE
Practical Tips for Your Future in Medicine
By Elizabeth P. Perez, Esq.
Health Law Attorney, Broad and Cassel
The act will impose mandatory compliance
programs for all health care providers as a condi-
tion of participation in Medicare or Medicaid.
Before the PPACA, compliance programs were
largely implemented on a voluntary basis. Many
physician group practices are making compliance
programs a priority now, if they had not done
so already before the enactment of the PPACA.
While you may think compliance does not apply
to you because you have no plans to become a
Medicare or Medicaid provider, learning about
the significance of having a compliance program
will be invaluable to your future career. Even if it’s
voluntary, a compliance program is a way to avoid
or mitigate legal problems and minimize potential
liability exposure in the future, particularly as you
enter such a highly regulated industry.
A compliance program is a preventative
measure designed to help health care providers
avoid potential problems and, more important-
ly, to ensure compliance with state and federal
fraud and abuse laws. Currently, physicians na-
tionwide are experiencing an increase in audit
activity and investigations, which can result in
significant Medicare overpayments, false claim
demands, as well as the other collateral conse-
quences. As our forefather, Benjamin Franklin,
once said, “An ounce of prevention is worth
a pound of cure.” It is far more beneficial and
cost-effective for physicians, both financially
and emotionally, to be proactive in developing
an effective compliance program than respond-
ing to government investigations.
Section 6401 of the PPACA requires health care
providers to establish a compliance program as a
condition for participation in Medicare or Medic-
aid. However, as of now, the law does not provide
any specific guidance for physicians other than to
state that it authorizes the government to estab-
lish the core elements for the compliance program
and determine the timeline for its implementa-
tion. Despite the lack of information, we can to
turn to the Department of Health and Human
Services’ (HHS) Office of Inspector General (OIG)
for guidance as to the necessary components to
structure an effective compliance program.
The OIG Web site
(http://oig.hhs.gov/compli-
ance/physician-education/05compliance.asp)
provides a wealth of information concerning
compliance programs, including recommended
components. According to the OIG Web site,
aptly titled A Roadmap for New Physicians,
Compliance Programs for Physicians, it states
that, “Establishing and following a compliance
program will help physicians avoid fraudulent ac-
tivities and ensure that they are submitting true
and accurate claims.”
The following seven components provide a
solid basis upon which a physician practice can
create a voluntary compliance program:
•
conduct internal monitoring and auditing
•
implement compliance/practice standards
•
designate a compliance officer or contact
•
conduct appropriate training and education
•
respond appropriately to detected offenses
and develop corrective action
•
develop open lines of communication
•
enforce disciplinary standards through well-
publicized guidelines
A more comprehensive guidance for physi-
cian practices is found in the OIG Compliance
Program entitled Guidance for Individual and
Small Group Physician Practices that was issued
in October 2000.
1
While the aforementioned OIG
components are meant to be a starting point for
structuring an effective compliance program, a
good compliance program is tailored specifically
to fit the type and size of the physician’s practice.
As medical students, you will have the benefit
of observing and learning how the OIG compli-
ance program mandate will unfold over time.
Perhaps it may even become a topic of interest
in the medical schools. At the very least, un-
derstanding the program will help you become
better prepared as physicians to practice in this
highly regulated world of health care.
(
1
Federal Register. Volume 65, No. 194 (October 5, 2000),
found at http://oig.hhs.gov/authorities/docs/physician.pdf.)
As a health care
attorney, I often hear my
clients say, “They didn’t
teach us that in med
school.” Today’s medical
students are entering
a field that continues
to evolve at a rapid
pace as the health care
industry becomes more
complex and even more
highly regulated by the
government. It is therefore
imperative for you to
stay abreast of relevant
changes in health law
that will inevitably impact
you as future physicians.
The Patient Protection
and Affordable Care Act
of 2010 (PPACA)
is one of
those changes.
An Ounce of Prevention is Worth a Pound of Cure
Elizabeth Perez, Esq., is Of
Counsel in the Fort Lauderdale
office of the statewide law firm
Broad and Cassel. A health law
attorney, she is a member of
the firm’s Commercial Litigation,
Health Law, and White Collar
Criminal and Civil Fraud Defense
Practice Groups.