Compliance risk areas in a physician practice

Based on its own specific needs, a medical practice’s Compliance Plan should identify and address risk areas where it may be vulnerable to erroneous. A practice may already have some awareness of these due to its own business operations or consultant recommendations, but areas of legal risk are different because “you don’t know what you don’t know.” Further, due to the truly vast field of healthcare regulation, identifying out legal and compliance risks can be a never ending process. However, in its Compliance Guidance, the HHS OIG suggested that a physician compliance plan at least address these four areas of potential risk:

1. Coding and billing;

2. Reasonable and necessary services;

3. Documentation; and

4. Improper inducements, kickbacks, and self-referrals.

So make sure your compliance plan is addressing these risk areas. The list above is not exhaustive or all-encompassing, but they should be your starting point.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.