Health Care Compliance

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“We hear a great deal about Healthcare Reform�, says Capullo, “and collectively the private, public and governmental sectors strive to increase awareness and integrate checks and balances that are beginning to pay off. But reform without compliance will not work…�

Healthcare is not like purchasing a Home Entertainment System instead of a basic television. The former is more expensive as it takes more intricate circuits, materials and hours to create.

But, healthcare is different, particularly today when nearly every medical condition is “treated” in some fashion. Surprisingly, high-quality healthcare can also be the lowest in cost. The reason? Lower costs arise when the patient stays healthy or recovers more quickly. So, is it simply getting the diagnosis “right”? In part, yes, as huge savings are recognized when unnecessary treatment is avoided.

Is this the only secret to success? Not according to Anthony Capullo, President/CEO of Professional Provider Services, Inc., a Healthcare Consulting firm specializing in the development of corporate compliance programs. “We hear a great deal about Healthcare Reform”, says Capullo, “and collectively the private, public and governmental sectors strive to increase awareness and integrate checks and balances that are beginning to pay off.  But reform without compliance will not work, and compliance programs cannot be manuals that collect dust on the shelf. Rather, compliance starts at the top of an organization and healthcare is no exception. Executives must know and be held accountable for the practices that shape the governance and integrity of the organization.”

“Compliance is also sound business,” says Mike George, Vice President of Operations. “Compliance problems are often caused by broken processes.  If you can fix what is broken you can ultimately save money.” The solutions are not simple, and it appears the work has just begun, but according to experts like Capullo and George, “As long as there are large amounts of money available in government funded healthcare, people will become greedy and try to steal some of it.  Compliance programs help uncover waste that can lead to intentional or unintentional overpayments for healthcare services rendered on behalf of the government.”

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