ACA mandates docs create compliance plans to prevent fraud

A little-known provision of the Affordable Care Act requires medical practices of all sizes to develop their own compliance plans to reduce fraud and abuse, but physicians are still awaiting guidance as to what such programs should look like, MedPage Today reported.

According to Section 6401 of the ACA, new and existing practices will be required to have a formal compliance program in place before enrolling in Medicare and Medicaid, thus shifting the burden of fighting fraud and waste from the government onto doctors.

"If there's a problem with billing or an error or something was miscoded, the federal government can in the future point to these required compliance programs and say 'You didn't follow even your own required compliance program,'" Everette James, director of the Health Policy Institute at the University of Pittsburgh Graduate School of Public Health, told MedPage. "So this does shift the regulatory burden to the practice site from the government."

Although the Department of Health and Human Services Office of Inspector General has yet to publish formal guidelines on how practices should craft their compliance programs, experts recommend using the OIG's 2000 guidance for voluntary programs as a model.

Nonetheless, practices, which have far fewer resources for compliance than hospitals, may find the requirement burdensome. Thus, high-priority items for practices should include training programs, self-audits, and drafting policies and procedures, consultant Julie Sheppard,told MedPage.

To learn more:
- read the article from MedPage Today
- see the OIG's guidance for voluntary compliance programs

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