A Simple Ten Point List of Things to Revise in Upgrading a Compliance Program

It should go without saying in this day and age, that any entity which bills federal payers without having in place a robust compliance program is simply playing with fire. Too many physician practices and other entities adopt a plan and then simply let it languish. We have had to update our Compliance Plan Development Protocol multiple times to be sure we have captured developing risk areas. Likely we will have to do it again soon. However, if anyone had doubts about the need to review their compliance plan, update it and then comply with its direction, in April 2019 the US Department of Justice Criminal Division (!) published a document on how they think prosecutors should conduct Evaluation of Corporate Compliance Programs. Whether a program is truly effective is directly relevant to whether there might be mitigating or aggravating factors to lower or raise the criminal penalties associated with violating behavior. But the real import of the guidance is that all entities subject to federal law ought to take this opportunity to revamp and amp up their compliance programs. In our AGG Note, we have taken the DOJ generic guidance and recast it in the context of the clients we represent – physician practices, IDTFs, health systems, pharmacies, DME providers, practice managers, billing companies and the like. We have identified a simple ten point list of things to revise in upgrading a compliance program. We also advise our readers that the point of a good compliance program is not to offer defenses or mitigation to prosecutors; the point is to prevent problems in the first place.