CHA News Article

Health Care Reform Targets Fraud and Abuse; Compliance Manual Addresses Complex Laws
California Hospital Compliance Manual now available

To help pay for the nearly $1 trillion implementation cost of health care reform, President Obama directed federal and state authorities to expand their use of recovery audits to reduce fraudulent, wasteful or abusive practices within Medicare, Medicaid and other government programs. Under this directive, hospitals should expect increased scrutiny of government reimbursement of health care.

To help hospitals understand their obligations and minimize their legal and financial risks, CHA published a new California Hospital Compliance Manual earlier this year.

“The fraud and abuse laws are some of the most complex and, therefore, misunderstood laws that hospitals must abide by,” states Lois Richardson, CHA vice president, legal publications and education. “It took three years and the collective expertise of 25 attorneys to write this manual. The end product is a useful, comprehensive resource that takes both federal and state laws and lays out in detail how these laws impact hospital operations and policies.”

Under the direction of lead authors Lloyd Bookman of Hooper, Lundy & Bookman, Inc., and Richardson, the authors address areas that put hospitals at most risk. Topics include federal and state false claims acts, submission of accurate claims information, proper cost-reporting practices, physician self-referral, anti-kickback laws, repayment and self-disclosure, hospital fair pricing policies, issues for tax-exempt hospitals, and the fundamentals of hospital licensing and certification.

A model compliance plan also is included that hospitals can adapt to fit their operations or use as a baseline to compare to existing plans.

To order the manual, visit www.calhospital.org/Compliance

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