Question

What elements should be incorporated into a coding compliance plan? How does a coding compliance plan address fraud and abuse?

Answer 1

The elements that should be incorporated into a coding compliance plan are as follows:

• There should be written procedures and policies with the standard of conduct needs to be established.
• Now, make an appropriate committee and give designation to chief compliance officer with their roles and responsibilities.
• To provide better understanding of the work, some educational programs and effective trainings should be given to these officers.
• There is a need for developing an effective process through which reporting a compliance becomes easy.
• Draft disciplinary guidelines and enforce them through a program.
• To know whether the program is effective or not, monitor and audit it at regular intervals of time.
• Take corrective action against allegations.

Coding compliance plan address fraud and abuse by approaching the issue according to the clauses comes under Federal Civil False Claims Act. This law provides framework for abuse and fraud and also states about investigations and penalties regarding different issues.