Healthcare compliance is required by law throughout the United States.  This regulates billing and coding compliance for treatments, risk assessment, practice ethics, referral laws, and patient rights legislation.  The proper billing for services rendered needs to be accurate to ensure that problems with the government do not arise.  Proper documentation and itemization of charges for treatments and services are important to provide proof of service during an audit or adjustment by integrity contractors.  The compliance of healthcare providers also prevents improper treatments, lawsuits and various problems which occur between patients and insurance claims.

Mandatory Medicaid Compliance
Of particular importance are laws and regulations concerning compliance programs applicable to providers participating in Medicaid and Medicare programs. For instance, New York Office of the Medicaid Inspector General requires all providers who order, provide, bill, or claim at least $500,000 in a 12-month period (directly or indirectly, including through third-party HMOs) to Medicaid to have a written compliance program in place.  Similar requirements apply to certain providers in New Jersey and elsewhere throughout the United States.

We have the knowledge and experience to draft and implement effective compliance programs.  We will review your operations and offer an economical solution to bring your practice in line with the current legal and regulatory requirements.  In most cases, we will be able to do it at a flat fee.

If you are a New York pharmacy requiring a Medicaid compliance plan, we encourage you to use our E-Compliance service where you can submit your information online and receive your customized compliance plan in days for a low flat fee.