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A compliance program has been described as a commitment by an organization's top management to ensure that the organization plays by the rules. Compliance, in its simplest form, is the act of meeting the expectations of others. In health care, it means meeting the expectations of those who regulate our business, pay our claims, and grant us money. Compliance means abiding by applicable legal requirements, including deterring and detecting violations of the law.
For health care organizations, compliance programs focus on compliance with fraud and abuse laws (such as the Civil False Claims Act, the anti-kickback statutes, the Health Insurance Portability and Accountability Act, and the Stark ban on physician self-referrals), Medicare and Medicaid billing requirements, and third party payer regulations. Compliance with legal requirements might not occur if left to chance, particularly in the field of health care, where laws and regulations are extremely complex and are changing rapidly. By instituting a compliance program, a health care organization has taken steps to assure that all employees understand the requirements and their responsibility to adhere to them.
The University of Mississippi Medical Center has a strong and abiding commitment to ensure that its health service affairs are conducted in accordance with applicable laws relating to the practice of medicine and third party reimbursement. UMMC's compliance efforts are designed to establish a culture that promotes prevention, detection, and resolution of instances of conduct that do not conform to federal and state laws, and federal, state, and private payer health care program requirements, as well as UMMC's ethical and business policies.
To underscore and enhance its commitment and to better assist all employees, including faculty physicians, in this area, UMMC has implemented a compliance program to develop effective internal controls that promote adherence to applicable federal and state law, and the program requirements of federal, state, and private health plans. The adoption and implementation of this program has significantly advanced the prevention of fraud, abuse, and waste, while at the same time, furthering the fundamental mission of UMMC to provide quality care to its patients.
Implementing a compliance program provides protection for UMMC and all of us involved in the patient encounter. The benefits of an effective compliance plan include not only damage control, but also other purposes such as demonstrating UMMC's commitment to quality and excellence, protecting and enhancing UMMC's reputation and public image, educating all employees involved in any aspect of the patient encounter, thereby preventing the commission of prohibited acts due to ignorance, detecting violations early and possibly in time to remedy the offense or limit the damage, and reducing UMMC's exposure to civil, criminal and administrative liability.
Please call our office at (601) 815-3944 or you may fax your question to (601) 815-3946. We would be glad to tell you more about the UMMC Complianceprogram.
2500 North State Street
Jackson, MS 39216