AAPC. (n.d.). CERT and OIG work plan as compliance tools. Retrieved from https://www.aapc.com/healthcare-compliance/healthcare-compliance.aspx#CERTandOIGWorkPlanasComplianceTools
Strategic Management Services, LLC. (2017). Compliance programs gap analysis vs. effectiveness evaluation. Retrieved from https://www.compliance.com/resources/compliance-program-gap-analysis-vs-effectiveness-evaluation/
Strategic Management Services, LLC. (2017). Tips for achieving effective compliance program operation. Retrieved from https://www.compliance.com/resources/tips-achieving-effective-compliance-program-operation/
U.S. Department of Health and Human Services, Office of Inspector General. (n.d.). Compliance resources. Retrieved from https://oig.hhs.gov/compliance/
This website provides informative information and resources on healthcare compliance. You will find resources such as fraud alerts, podcasts, videos, brochures and papers that provide additional guidance on Federal healthcare program standards.
The U.S Department of Health and Human Services, Office of Inspector General. (n.d.). Work plan. Retrieved from https://oig.hhs.gov/reports-and-publications/workplan/index.asp
There are many state and federal agencies that are in charge of the oversight of various aspects of health care. Below are some of the agencies and their roles in healthcare compliance (Saffian, 2010). Visit each of these agencies for more information.
This agency supports, collects, and disperses research findings, treatment guidelines, and other qualified data with the intention of contributing to the quality and effectiveness of health care decision-making and services, and is part of the U.S. Public Health Service
This web source is part of the Department of Health and Human Services and provides additional helpful information such as access to healthcare providers & specialties, special topics (i.e., American Indian, end stage renal disease, medicare coverage, office of the Ombusdman, etc.)
The FBI maintains their own initiatives to support health care fraud investigations focused on organizations and individuals suspected of defrauding health care systems, whether public or private.
The OIG to works jointly with state auditors to perform broader coverage of the reviews of Medicare and Medicaid program participants more effectively. The Office of Counsel to the Inspector General (OCIG) represents the OIG in the settlement of cases filed under the False Claims Act, develops compliance program directives, enforces program exclusions, adjudicates civil money penalties to health care providers, and litigates actions within DHHS.
Videos
ProviderTrust. (2015, September 24). Comply with Mike: Healthcare compliance overview [Video file]. Retrieved from https://www.youtube.com/watch?v=sNgb4BfpAak
In this video, “Mike” goes over the basics of healthcare compliance – which includes the definition of compliance, the issues at hand, fraud, and best practices. For more information on healthcare compliance, be sure to watch his other video segments (found in the notes section): Healthcare Fraud, Healthcare Fraud Examples, Best Practices.
American Institute of Healthcare Compliance, Inc. (2021, August 15). 7 steps to an effective compliance program [Video file]. Retrieved from https://www.youtube.com/watch?v=s_WYpNV5aks
This video provided by AIHC goes over 7 tips on to having an effective compliance program. You can find out more information about the American Institute of Healthcare Compliance on their website: www.aihc-assn.org
First Healthcare Compliance. (2019, March 5). Compliance program effectiveness: Auditing and monitoring [Video file]. Retrieved from https://www.youtube.com/watch?v=yEPNFNacUEg
In this video, several compliance hosts provide an interactive discussion on compliance program effectiveness: auditing and monitoring – specifically the differences between the two, review of live case studies and penalties, as well as best practices.
