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Compliance Concerns

Compliance Concerns
By Don M. Cross, D.C.

Practice Compliance

It’s all about the numbers.


ObamaCare is here, and it is affecting all chiropractic offices-large and small, insurance and cash. Most chiropractic practices have less than 50 employees, so we’re not required to offer our employees health insurance, BUT (and this is a huge but) other sections of ObamaCare (P.P.A.C.A. of 2010) will have a significant impact.

Effective September 23, 2013, all offices were required to have developed and be implementing a written set of policies and procedures beyond the bare minimum of a HIPAA manual, according to Section 6401. These new requirements revolve around having a fraud and abuse compliance plan in place. Being the owner of a small practice, I hoped that my research into the new requirements would reveal a “minimum number” somewhere that would allow me to be exempt.

These types of numbers are contained in the Family Medical Leave Act, the EEOC regulations, the American Disabilities Act, and certain OSHA requirements. Fifteen seems to be the magic number; fewer than 15 employees and we are exempt from many aspects of these laws and regulations. Unfortunately for all of us, what I found from my research into ObamaCare was that if I had an NPI, and I had one employee or one patient, I had to comply with the new regulations. As I said earlier, this story doesn’t have a happy ending.

Another major change that went into effect this year was a huge increase in the fines levied for information breaches, plus fines for violations are dramatically higher if there isn’t a compliance program in place. Many of these fines increased from $25,000 each to $1.5 Million! Why? To help pay for ObamaCare, which includes recoupment as part of the budget for the new program. In 2008, the OIG reported recouping $3.8 BILLION, and as ObamaCare is just beginning to ramp up it nearly doubled to $6.9 Billion last year.

There’s also been a policy shift in Washington focusing on cooperation amongst the various enforcement agencies, who now coordinate closely to maximize recoupment. For example the FBI has $130 million in its budget for investigation of health care fraud alone. The trend is that one complaint will multiply into several agencies being involved. And there is a huge amount of complaints being filed; the OIG has been receiving over 48,000 per month!

And another danger is the various “whistle blower” programs, which rewards the person filing the complaint with 25 to 30% of what is recouped. This could be a disgruntled employee or patient! Another change allows an investigation or audit to be initiated without a complaint. If they find any evidence of fraud, the case is turned over to the OIG who has the authority to review claims clear back to the day the practice was opened.

I explored many different ideas trying to find a way to be legally exempt, but with no success. Last year alone, 3131 individuals were added to the Federal Exclusion List due to non-compliance of some type. To practice chiropractic in any kind of practice, you must be compliant. This is the new reality for American health care.

This is the first in a series of articles I’ll be sharing with you as I discuss what we must do to “be compliant” in our small offices, with under 15 employees.

I recommend our OCCM Compliance Manual and Form Set to get your small office compliance ready.

For larger offices, my advice is to hire a compliance specialist to come in and develop your program.

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