Bad News & Good News: More Compliance

The Bad News: A section of the 2010 Patient Protection and Affordable Care Act included a requirement that all providers who provide patient services to Medicare or Medicaid patients initiate a Fraud and Abuse Compliance Program into their practices. CMS was instructed to develop the requirements for physician accordance with a compliance date set at January 1, 2013. The requirements were not released until this summer – over a year later. Despite ranting from the AMA that the requirements were not specific enough, the requirements are now in place. While it is unclear what the “new” compliance date is, we can only assume immediate compliance is expected.

The Fraud and Abuse Compliance Program must include a compliance “manual” stating the practice’s compliance with major fraud and abuse federal statues (five of them); how the practice handles relationships with payers, vendors and other physicians; and how the practice assures patient care is performed and billed in an ethical and legal manner. The program also must include a formal staff training program in all these areas. Much like the HIPAA Security regulations, the Fraud and Abuse Compliance Program allows each physician significant flexibility in developing their own compliance program. The penalties and fines for non-compliance and/or failure to adhere to federal fraud and abuse laws range from $10-$50,000.00 per violation, per statute with a final statute that essentially doubles the fines.

Now, The Good News! Optometric Business Solutions has all of your compliance requirements available in an optometry friendly, easily customizable format. The Fraud and Abuse Compliance Program is available for download at – be sure to use discount code “TSO” for a 20% discount. The program is very complete – customizing the compliance program for your office will require less than thirty minutes of your time. For the braver souls, you can use the following links to read the requirements and design your own program –