A compliance program is 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 Act on physician self-referrals), Medicare and Medicaid billing requirements, and third-party payer regulations. 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 often complex and rapidly changing legal requirements, laws and regulations.
UMMC's compliance efforts 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.