Discuss compliance programs in health care, including the purpose of such programs, their benefits, and relevant laws and regulations

Answer 1

Compliance programs assist an organization in creating policies, standards, and training programs to guard against fraud and abuse.
All health care providers who receive payments under Medicare or Medicaid are expected to have compliance programs to guard against fraud and abuse. Guidance documents for the development of compliance programs for various types of providers have been available from the OIG since 1998 and can be found at the OIG website. Compliance programs were voluntary until mandated by the Patient Protection and Affordable Care Act in 2010. Although the details of the OIG's guidance varies somewhat for each type of provider, common components of compliance programs include internal monitoring and auditing, development of compliance standards or policies, designation of a compliance officer or contact, appropriate training and education of the workforce, an appropriate response or investigation when offenses are detected, as well as other elements (OIG, n.d.). A small provider may not have the resources to fully implement its own compliance program and may contract with a consultant for services to meet some of the requirements.

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