ACA requires that practitioners maintain diligence to stay compliant

LITTLE ROCK, Ark. – With the initiation of the Patient Protection and Affordable Care Act, the US government is taking greater steps to investigate and protect against fraud. George Breen, Esq., a partner at Epstein, Becker and Green in Washington, DC, spoke about ways a practitioner can increase compliance and avoid potential fraud at the Pedorthic Footcare Association Annual Symposium and Exhibition, here.

Breen emphasized that although fraud is primarily investigated within federally-funded programs such as Medicare and Medicaid, the private insurance industry is also a target for investigation.

“It is no longer just a situation where it’s just federal dollars involved. Its payments made to both federal and private insurers, and that’s something that I don’t think a lot of people recognize,” Breen said. “The key here is the definition of a healthcare benefit program. It is not limited to federal dollars. It is any public or private plan.”

Breen also emphasized that under the Affordable Care Act (ACA), the necessity of intent in order to be convicted for fraud is removed.

“No longer do you have to show that a person had a specific intent or actual knowledge in order to convict,” Breen said. “So that means, if you did it, whether or not you intended to, the potential exists to be convicted.”

In order to protect themselves from potential fraud, practitioners should take steps to ensure that they are complying with all regulations. To do this, facilities can create written standards and procedures, designate a compliance officer within the workplace to enforce the rules, educate and train employees at least once a year and outline disciplinary guidelines for any employee that might breech a rule. Practitioners should also create open and effective lines of communication between the practitioner and the employees, as well as between the facility and its customers and beneficiaries. Finally, facilities should keep detailed records of all practices and policies to prove that they are taking the necessary steps to ensure compliance.

“How do you represent yourself and therefore your business in these kinds of issues? What do you do to make it known that you think compliance is important?” Breen said. “It’s critical that whatever you do with compliance starts at the top. The business owner has to be the person that enforces this program. If it doesn’t work at the top, it will not work at all.”

For more information:

Breen, G. The enforcers are coming: but it’s not just about money anymore. Presented at the Pedorthic Footcare Association Annual Symposium 2012. Nov. 1-3, Little Rock, Ark.

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