The False Claims Act, HITECH Act, Stark rule, Red Flags rule, health care reform law and other government actions have ushered in substantially higher levels of regulation for the health care industry.

In the current health care enforcement climate, not only are effective compliance efforts at a great premium, but auditing and monitoring compliance is becoming critical to avoiding problems, says Patrick Coffey, a partner in the Chicago law firm Locke Lord Bissell & Liddell. "More and more, fraud and abuse risk is being driven by the mining of data to reveal problematic conduct," he contends. "Today, there is simply no way of getting around the use of systems to audit and monitor compliance to minimize enforcement risk."

Consequently, information systems--as well as appropriate policies--need to be pervasive in a health care organization, Coffey advises. During an educational session at the Healthcare Financial Management Association's Annual National Institute, June 20-23 in Las Vegas, he will co-present ways to identify enforcement trends that could affect an organization, avoid compliance program shortcomings that increase risk, voluntarily disclose problems to mitigate risk, and respond successfully to claims of fraud and abuse.

There's no question, Coffey notes, that organizations reporting data breaches will be subject to audits from government regulators. "The relatively tame enforcement to date will change." Further, providers could face lawsuits from affected patients. The bottom line: full compliance risk management audits and security systems working together can help an organization achieve the best protection, he says.

The educational session, "Getting Ahead of New Ethics and Compliance Risks," is scheduled for June 21. More information is available at hfma.org.

--Joseph Goedert

 

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