False Claims Act

The U.S. Department of Health and Human Services, Office of Inspector General’s (OIG) Compliance Program Guideline’s identify multiple elements that should be included in an effective Compliance Program to reasonably ensure that the claims submitted to CMS and other federal health care programs are valid and accurate. Healthcare providers who cannot prove that they have taken affirmative and consistent action to eliminate billing errors and to avoid other fraud and abuse complications can be found to have engaged in criminal conduct through deliberate ignorance.

  • Solution features that address this area of law:
    • Communication Platform
    • Incident & Investigation Manager
    • Policy & Procedure Library
    • Employee Training Courses
    • Employee Exclusions Tracking
    • Internal Audit Module

The Health Insurance Portability and Accountability Act of 1996 defines required policies, procedures and guidelines for maintaining the privacy and security of individually identifiable health information as well as outlining numerous offenses and criminal penalties for violations. The HITECH provisions of the Economic Stimulus Act of 2009 significantly expanded the scope of HIPAA requirements including additional patient rights, heightened enforcements and increased penalties. Enforcement actions and penalties have been becoming more common and are occurring regardless of the size of the covered entity.

  • Features that address this area of law:
    • Patient Rights and Restrictions
    • Release of Information Workflows
    • Business Associates Agreements with eSignature
    • Incident & Investigation Manager
    • Policy and Procedure Library
    • Employee Training Courses
    • Employee Exclusions Tracking
    • Risk Assessments Tool
Stark and Anti-Kickback

The Stark law is a limitation on certain physician referrals. It prohibits physician referrals of designated health services ("DHS") for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity.

The anti-kickback statute makes it illegal for providers (including physicians) to knowingly and willfully accept bribes or other forms of remuneration in return for generating Medicare, Medicaid or other federal health care program business.

  • Features that address this area of law:
    • Referring Provider Non-Monetary Compensation Tracking
    • Provider Agreement Manager
    • Provider Time & Effort Reporting
    • Incident & Investigation Manager
    • Policy and Procedure Library
    • Employee Training Courses

Payer Audits
Medicare RAC, MAC, MIC, and commercial payer medical claims audits represent significant legal and monetary risk to healthcare providers. These audits typically include very complex appeals processes with stiff penalties such as the automatic recoupment of funds if appeals deadlines are missed, even by as little as one day. It is important to have an electronic way of tracking these audits, associated costs and audit outcomes for sound management and intervention.

  • Features that address this area of law:
    • Payer Audit Manager
    • Outcome Reporting and Dashboards
Social Collaboration

Using the embedded social collaboration platform, your organization can communicate in numerous new ways allowing teams to instantly share data, engage an expert to provide insight, and immediately relay that expert insight to a person or group for decision making.

  • Features:
    • Company wide private social network
    • Private messaging
    • Instant messaging/chat
    • Post files for discussion
    • Poll your users
    • Follow people, files, or records and receive immediate notification of changes
Tools to Track and Simplify

Managing an organization’s compliance program requires tracking information at multiple levels and within various business processes. Compliatric’s suite of utilities allows this tracking to occur in a seamless way across the suite of modules

  • Features:
    • Employee Management
    • Asset Tracking
    • Project Management
    • Contact Management
    • Agenda and Meeting Management
    • Employee Learning Management
    • Agreement Management
    • Assessment and Surveys
    • File Sharing