Respond appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities. The development of a compliance program may take weeks, if not months, depending on the complexity of the physician practice and its ability to dedicate limited resources to the process. Physician practices should begin the process of instituting a compliance program today. Finalization of the program, particularly certain organizational aspects, should await the final issuance of the Guidance. Physician practices should consider engaging a billing and coding consultant to perform billing record audits, clinicians to participate in the auditing and chart reviews, and an experienced health care attorney who can help the practice evaluate and develop the appropriate policies and procedures needed, as well as tailor the policies to specific practice activities and special areas of risk.
Myriad laws establish criminal and civil penalties for billing improperly for health care services.
Violation of the criminal statutes may result in imprisonment ranging from one to ten years. In addition, the provider can be excluded from participation in Federal health care programs. Violation of the civil statutes prohibiting certain activity with respect to Federal health care programs may result in substantial fines and penalties and exclusion from participation in the programs. The Federal Government has been actively enforcing these laws.