Medicare Compliance & Reimbursement

Hint: Educate staff on compliance to circumvent fraud.

Being at the center of a qui tam suit can cost your Medicare practice more than lost income. Consider this advice to ward off whistleblower woes.

1. Institute a compliance program. If your Medicare practice lacks a comprehensive compliance plan, create one ASAP, legal experts urge. “Prevention is the best cure,” counsels attorney John E. Morrone, partner with Frier Levitt LLC in New York City. Compliance preparation helps you avoid a wealth of issues, including those that lead to denials, audits, indictments — and whistleblowers.

2. Keep the lines of communication open. It’s critical that your employees feel safe to report workplace violations and fraud. As part of your compliance planning, you should implement an effective reporting mechanism, including an option for staff to relate concerns anonymously.

Why? If staff don’t feel comfortable about airing grievances inside the organization, they’re more likely to seek an outside outlet such as a qui tam attorney.

3. Be proactive about complaints. It’s important that staff feel their complaints are heard. Most whistleblowers say they’ve been telling their bosses repeatedly about what they’re doing wrong, but the executives don’t listen. Then the whistleblower feels like the inability to change is putting them personally at risk, leading to concerns about their own livelihoods and culpability.

Tip: If your employee registers a legitimate complaint, investigate the issue immediately. If your inquiry reveals the employee was mistaken, discuss your findings with them; however, never discount staff worries without looking into the matter, experts warn.

4. Manage your compliance risks with self-audits and training. As enforcement scrutiny increases, it’s wise to revisit your policies, checking for inconsistencies, eradicating problems, and updating when necessary. Plus, it’s crucial you keep your employees in the compliance loop by offering training and promoting transparency. That way they feel invested and will be more likely to come to you instead of an outside source if trouble arises.