Healthcare Compliance Programs

  • Roz Cordini, JD, MSN, RN, CHC, CHPC

    Roz Cordini, JD, MSN, RN, CHC, CHPC

    Senior Vice President


Healthcare Compliance Programs: Ensuring Integrity and Adherence to Guidelines

Healthcare organizations, their senior executives, and governing bodies face escalating scrutiny to establish robust compliance programs. The Federal Sentencing Guidelines for Organizations advocate the necessity of a comprehensive compliance program, defining it as a strategy designed to prevent and detect criminal conduct.

Key Elements of an Effective Compliance Program:

  • Operational Compliance: Operate and comply in accord with legal and regulatory requirements.
  • Proactive Fraud Prevention: Prevent fraud, abuse, and waste through proactive measures.
  • Prompt Issue Identification: Identify and detect compliance issues promptly.
  • Swift Resolution: Stop noncompliant behavior promptly and correct identified concerns.
  • Recurring Activity Prevention: Establish controls to prevent the recurrence of noncompliant activity.
  • Cultural Emphasis on Integrity: Promote an organizational culture of honesty and integrity.

OIG Fraud Risk Indicator:

In 2018, the Office of Inspector General (OIG) introduced the “Fraud Risk Indicator” to assess the risk level of organizations refusing to enter into a Corporate Integrity Agreement (CIA). While the presence of a compliance program doesn’t affect the assigned risk level, the absence designates the organization as “higher risk”.

Cost of Noncompliance:

Noncompliance in healthcare carries substantial costs, including recoupment of overpayments, fines, penalties, reputational harm, negative publicity, and exclusion from Medicare/Medicaid. Individual liability is also a potential consequence.

Coker’s Compliance Program Support

Coker offers comprehensive support for developing, evaluating, and improving compliance programs. Services include:

  • Program Development: Tailored assistance in creating a meaningful compliance program.
  • Evaluation: Assessment of existing programs against OIG’s seven required elements.
  • Recommendations: Offering practical recommendations for program enhancement.
  • Implementation Support: Tools and resources for implementing proposed improvements.
  • Ongoing Advisory Services: Continuous support for execution, advice, and compliance guidance.

Cultivate Compliance with Confidence

In a landscape where compliance is mandatory for healthcare entities, Coker provides the expertise to navigate the complexities. Whether establishing a new program or enhancing an existing one, our services ensure adherence to guidelines, mitigate risks, and safeguard your organization’s reputation.

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    Contact us today for more information about our healthcare consulting services and learn how we can help your organization.

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