(April 18, 2012): To be fair, when most dentists and oral surgeons think of an effective Dental Compliance Plan, it wouldn’t be unreasonable for them to think that the primary risks facing a dental practice would be limited to:
Violations of the rules and regulations enforced by the Occupational Safety and Health Administration (OSHA).
Violations and / or breaches of the privacy laws enacted as part of the Health Information Portability and Accountability Act of 1996 (HIPAA).
Suffice to say, the concept of “Dental Compliance” is far broader than merely OSHA and HIPAA Privacy issues. In fact, the Department of Health and Human Services, Office of Inspector General (OIG) has expressly recognized the importance of effective Dental Compliance Plans. As set out in OIG’s Federal Register guidance titled “Office of Inspector General’s Compliance Program Guidance for Individual and Small Group Physician Practices”:
"This compliance program guidance is intended to assist individual and small group physician practices (‘‘physician practices’’) in developing a voluntary compliance program that promotes adherence to statutes and regulations applicable to the Federal health care programs (‘‘Federal health care program requirements’’). The goal of voluntary compliance programs is to provide a tool to strengthen the efforts of health care providers to prevent and reduce improper conduct. These programs can also benefit physician practices by helping to streamline business operations."
65 Fed. Reg. 59435 (Oct. 5, 2000) (emphasis added). As set out in the Federal Register, the definition of ‘‘physician’’ includes: (1) a doctor of medicine or osteopathy; (2) a doctor of dental surgery or of dental medicine; (3) a podiatrist; (4) an optometrist; and (5) a chiropractor. Notably, each of these practitioners must be licensed by their respective State licensing authority. 42 U.S.C. 1395x(r).
As HHS-OIG’s Program Guidance further reflects, the basic framework of an effective compliance plan is comprised of seven fundamental components. These components include:
- Conducting internal monitoring and auditing through the performance of periodic audits;
- Implementing compliance and organizational standards through the development of written standards and procedures;
- Designating a compliance officer or contact(s) to monitor compliance efforts and enforce provider standards;
- Conducting appropriate training and education on provider standards and procedures;
- Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities;
- Developing open lines of communication, such as (1) discussions at staff meetings regarding how to avoid erroneous or fraudulent conduct and (2) community bulletin boards, to keep organization employees updated regarding compliance activities; and
- Enforcing disciplinary standards through well-publicized guidelines.
Importantly, when you (as a dentist or oral surgeon) work to develop an effective dental Compliance Plan, you may find that it is difficult to fully implement each and every aspect of all seven components. However, in most instances, you will be able to implement at least a part of each component in one fashion or another.
The extent of implementation may depend on the size, resources, complexity or identified risks of your particular dental practice. This is often referred to as “scalability.” Smaller dental practices will likely incorporate each component in a manner which best suits the practice. For instance, the Compliance Officer may be an employee (such as a dental technician) who has other functions. By contrast, larger dental organizations may have to incorporate these seven components in a more systematic and comprehensive fashion. Regardless of the size of your dental practice, the annual revenues generated and / or the number of dentists who may be billing for their services, it is imperative that you design and implement an effective Compliance Plan to cover the dental care and treatment you are providing to patients.
Over the next few weeks, we will examine each of the critical seven components of a dental compliance plan outlined above. As we cover each component, we will outline ways that dentists and oral surgeons can better adhere with applicable legal and regulatory requirements. Please stop by in a couple of days as we discuss the importance of: “Conducting internal monitoring and auditing through the performance of periodic audits.” Should you have any questions, give us a call -- we look forward to hearing from you.
Liles Parker is a full-service health law firm focusing on regulatory compliance and provider representation. Our attorneys are highly skilled in designing and implementing effective Compliance Plans for dental practices, physician practices, clinics, home health agencies, DME suppliers and other health care providers. Moreover, our attorneys are experienced in handling an array of complex health law matters, including the appeal of alleged overpayments to Medicare and / or Medicaid. For more information on how we can assist your practice in developing an effective dental compliance plan, call Robert W. Liles, Esq. Robert is Managing Partner at the Firm and can be reached at: 1 (800) 475-1906. Please call him today for a free consultation.