Medicare compliance programs can be helpful for doctors

On Behalf of | Aug 31, 2022 | Health Care Law

Doctors in Texas need to treat patients with all types of insurance. Insurance companies have different types of contracts with doctors and the terms of the contract need to be followed. This is true for Medicare as well, but instead of needing to work with private insurance providers, they are dealing with the government which sets the rules for billing and payments for services.

Sometimes doctors do not follow the rules or bill improperly in attempts to earn more money from the care they provide. If doctors do this, they can create serious problems and potentially face both civil and criminal consequences for Medicare fraud as a result. This can put their professional and personal life at risk. It is important that doctors do not let this occur and it is important that doctors have procedures and policies in place to prevent it from occurring.

Aspects of a Medicare compliance program

Doctors may find having compliance programs in place which double check the areas that could get the doctor in trouble helpful. Good compliance has some of the following aspects:

  • An internal auditing system
  • Creating compliance standards and procedures and ensure all employees know them
  • Having a compliance officer or someone in charge of ensuring all rules and laws are being followed
  • Training employees to know and understand the laws and how to follow them
  • Having procedures in place to correct problems when they do arise
  • Ensuring that communication through the office is open and clear
  • Having appropriate disciplinary actions in place when compliance standards are not followed

Many rules and laws that doctors must follow concern how they care for their patients, but there are also laws regarding keeping their patients’ information private as well as rules for how they bill for their care and procedures. Medicare fraud has serious consequences and it is important that violations do not occur. Experienced attorneys understand how to both comply with the rules and defend against violations. Consulting with one could be beneficial.