Compliance & Corporate Integrity for Health Care

Health care is one of the most highly regulated industries in the United States. Thousands of health care entities have been excluded from participating in federal programs, such as Medicare and Medicaid, for violating laws. Government agencies, such as the Federal Bureau of Investigation (FBI), Office of Inspector General (OIG), Department of Justice (DOJ) and Centers for Medicare and Medicaid Services (CMS) target health care fraud and abuse as high-priority areas to conduct inquiries and investigations.

BKD Health Care Group has been assisting health care organizations with corporate compliance services since health care fraud and abuse became a top government priority. Our compliance consultants teach compliance in conferences and seminars, author articles published in national journals and consult with health care organizations across the nation. We have developed innovative compliance tools and approaches to help organizations stay out of hot water. Each service can be customized to meet each organization’s specific needs.

Compliance Program Effectiveness Reviews

We can measure the effectiveness of your organization’s corporate compliance program, conduct risk assessments, facilitate an organizational SWOT analysis and provide your organization with recommendations to improve your compliance program. BKD Health Care Group has developed specific tools to help health care providers evaluate the effectiveness of their compliance programs. These tools consist of questionnaires, checklists, surveys and other forms which are designed to identify gaps and flaws in compliance programs.

Program Review & Design

BKD Health Care Group consultants have developed tools to help health care providers create an effective, customized compliance program. Our approach incorporates the OIG’s model compliance program guidance and regulatory developments. Provider programs developed before the original OIG’s guidance was issued most likely need revision. BKD Health Care Group can review your compliance plan document, recommend enhancements and draft the revised compliance plan to incorporate the OIG’s model compliance guidance and other recommended compliance provisions.

Risk Assessments

We facilitate the process of identifying potential risks to your organization and quantifying the level of risks. We also can assist in developing a work plan to define the scope of compliance work your organization will perform.

Corporate Integrity Agreements

If your organization has committed a compliance violation and is required to enter into a new Corporate Integrity Agreement (CIA), we can assist by designing compliance organizational structures and compliance processes to reduce the risk of violations from recurring and to meet the requirements of the CIA.

Independent Review Organization

If your organization enters into a CIA with the Department of Justice, it typically must contract with an independent review organization (IRO) to provide independent verification that your organization is complying with CIA terms. BKD serves as an IRO to health care organizations by combining our knowledge and expertise of corporate integrity agreements, compliance program operations and coding and billing audits to provide health care organizations with cost-effective and proven results that meet the requirements of the CIA.

Training & Education

BKD can help train your compliance committee, employees, management, board members and physicians on compliance issues. Examples of training include fraud and abuse, current industry developments, compliance program effectiveness, board governance and corporate responsibility and coding and billing issues.

Coding & Billing Audits

BKD’s team of credentialed and certified consultants perform independent and objective reviews to virtually all health care areas including inpatient and outpatient hospital services, skilled nursing services, rehabilitation and psychiatric services, home health and hospice services, community health centers and physician services. Our reviews can be performed using a randomly selected sample or a sample that is statistically valid.

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