It’s Corporate Compliance Week! Today’s Subject – Revenue Cycle Compliance: Fraud and Abuse

November 5, 2015  //  FOUND IN: Updates & Resources

When we think of “compliance”, HIPAA privacy and security often first come to mind. But healthcare compliance actually got its start in the 1990s with Revenue Cycle compliance. Healthcare providers face enormous financial pressures, and UMHS is no exception. However, we must never lose sight of our obligation to accurately document the services we provide and to conduct our financial transactions – including coding, billing, reimbursement, and referrals – in a legal and ethical manner.

Examples of fraud and abuse include incomplete or inaccurate documentation, altering documents to gain higher payment, misrepresenting dates and descriptions of furnished services, and not providing patients with notice about appropriate payment responsibilities or appeal rights.

Violations of state and federal fraud and abuse statutes carry harsh legal consequences, including the potential for heavy fines and exclusion from the Medicare program. There are other serious consequences beyond fines and penalties, though, including reputational harm to the University of Michigan, the Health System, and its providers. More importantly though, compliance directly affects quality of care and patient safety and satisfaction, as incomplete and inaccurate documentation can cause medical errors and misunderstanding of payment obligations, ultimately leading to patient dissatisfaction, concerns about questionable ethical practices, and potential loss of trust.

Remember – compliance, including Revenue Cycle compliance, is above all a quality of care issue.