QA & Medicare Compliance, Program for Durable Medical
Equipment Provider, Kentucky (US)
Client Issue: A durable medical equipment provider was being investigated for medicare fraud & abuse by the US Dept of Justice.
The client requested a robust compliance program to be put in place.
Solution: After thorough assessment of the organisation including billing & coding audits, a compliance program & plan was implemented based on national standards for DME providers & accreditation standards for DME organisations. All policies & procedures were defined, compliance plan adopted, organisational wide compliance training, process mapping, HR documents & process. Defining all jobs, communication strategies, contract review with third party payors, external compliance notification.
Outcome: After 2 years the organisation was prepared to pursue national accreditation/certification & successfully positioned for acquisition by new owners.