The Centers for Medicare and Medicaid Services (CMS) requires healthcare organizations to implement an active compliance program to ensure it is following the established fraud, waste, and abuse regulations. Under the Affordable Care Act, healthcare organizations are required to establish compliance programs as a condition of enrollment in the Medicare program. Consequently, many commercial health carriers are now requiring providers to have a compliance plan as a condition of participation. Each year the Office of Inspector General (OIG) is mandated to expand its investigative activities resulting in increasing sanctions to healthcare organizations, providers, and staff.  So, it is critical that all healthcare organizations operate according to federal, state, and local regulations.

The HPS Solution

HPS Solutions facilitates the development, implementation, and monitoring of the healthcare organization’s compliance program. The program includes the development of a Fraud, Waste & Abuse Compliance Manual, employee training, and auditing services to include:

  • Medical record documentation and coding review
  • Annual fraud, waste, and abuse risk analysis
  • Employee sanction screening