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Compliance - The New Hot Topic

In view of the largest health care fraud take down by the Justice Department recently, I have fielded questions from providers who are asking how they protect themselves from a whistle blower getting them in trouble. Of course, my first answer is – treat your staff with respect and then follow the rules. However, it is probably time for every healthcare business to look at their compliance program and determine if it is effective.

The biggest challenge, especially in smaller practices, is that the compliance plan is a binder that sits somewhere in an office and hasn’t been reviewed in several years. The information in that binder is what can keep you from going to jail or getting a major fine. Even if you are proven not to have committed the offense you were accused of, you can still get a fine for not having an adequate compliance plan.

The best defense for protecting yourself against a whistle blower is to develop a culture of compliance in your office that you work on every day. Every time you start a new procedure or have an opportunity to participate in an ancillary service that can generate additional revenue to the practice; start the discussion with “are we actually providing a needed service, or are we driving revenue by over prescribing the service?”

Since there was a significant focus on over prescribing narcotics such as hydrocodone, look at your policy regarding prescribing in your practice. Do you prescribe narcotics on the first new patient visit? Or, do you evaluate the patient, do labs, and require a second visit to go over labs before actually prescribing a narcotic pain medication? Do you have a contract with the patient that clearly provides rules to be followed by the monthly drug testing and only getting pain medication from your practice? Do you require a visit before re-ordering a prescription, or are you giving multiple refills?

Every healthcare business that writes a prescription for pain medication should have a policy that directs the staff how to manage patients who are getting prescriptions for narcotic pain medication. If you do not have a policy, we can certainly help with that. Now is the time, however, for you to not only review your policy, but to re-educate your staff that policy and the disciplinary process if it is not followed.

There are times when the physician is not aware of the staff actions, but that does not keep you from going to jail. Keep your prescription pads locked up. Maintain a log of every prescription issued and log the tracking number on the script. Never give another staff member your “token” that allows you to prescribe class 2 drugs electronically. If that employee schedules prescriptions without your knowledge, you are still responsible for the actions because you have not secured your pads or “token”.

Develop a culture of compliance in your office and update that compliance plan making it a living document that protects the business you have worked so hard to develop. Also, have your attorney review all the contracts you have with other healthcare businesses to make sure nothing in the contract could be construed as a kick back.

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