We offer a full range of services to help healthcare providers:

• Understand and interpret healthcare regulations

• Develop and implement compliance programs

• Conduct internal audits to identify potential compliance risks

• Provide guidance on healthcare billing and reimbursement rules

• Train staff on compliance-related matters (e.g., HIPAA training)

• Assist in the preparation for regulatory audits or investigations

• Advise on risk management strategies to minimize legal exposure

Non-compliance can result in serious consequences, including:

• Financial penalties: Large fines from regulatory agencies.

• Loss of licensure: Potential revocation or suspension of healthcare provider licenses.

• Criminal charges: Serious cases of fraud or abuse can lead to criminal prosecution.

• Civil suits: Healthcare organizations can be sued for violations.

• Reputation damage: Loss of patient trust and public credibility.

• Ineligibility for government programs: For example, exclusion from participating in Medicare or Medicaid.

Regular compliance audits are essential to identify potential vulnerabilities and ensure adherence to regulations. We recommend conducting internal audits:

• Annually, to ensure ongoing compliance

• After any significant regulatory change

• In preparation for any external audits

• When establishing new policies, services, or systems

Our team can help develop an audit schedule tailored to your organization’s specific needs and risks.

Some of the key regulations and laws governing healthcare compliance include:

• HIPAA (Health Insurance Portability and Accountability Act): Protects patient data privacy and security.

• The Affordable Care Act (ACA): Sets standards for healthcare coverage and health insurance reforms.

• The Stark Law: Governs physician self-referral for Medicare and Medicaid services.

• The Anti-Kickback Statute: Prohibits payment or acceptance of kickbacks for services or referrals involving federal healthcare programs.

• False Claims Act: Addresses fraud, waste, and abuse in healthcare billing and reimbursement.

• FDA Regulations: Governs the approval, testing, and marketing of medical devices and drugs.

• State-specific healthcare regulations: Varies by jurisdiction and may cover licensure, billing, and other matters.

• CMS (Centers for Medicare & Medicaid Services): Sets guidelines for Medicare and Medicaid programs.