Compliance Program Development and Audit Services

Developed to assist Client in establishing effective internal controls that promote adherence to applicable Federal laws and regulations and, if applicable, the program requirements of private health plans.

The scope of the engagement includes a combination of an off-site review and on-site review with technical assistance. The program includes, but is not limited to:

• Development: HMI first identifies areas of existing potential compliance risks through questionnaires completed by the designated Client staff, staff interviews and medical record and bill audits
• Implementation: HMI will provide education/training to Client staff to promote a good understanding of the compliance program responsibilities, 
• Auditing: HMI will provide assistance in this area as required by the Client. Initially, the audit would entail a review of the staffs' success in implementing the compliance program, and
• Maintenance: Through the joint efforts of HMI and the Client staff, HMI will make recommendations for revising the compliance program on an as needed basis.

Why establish a compliance program?

The Office of Inspector General (OIG) created a sample compliance program for hospitals several years ago as a result of its auditing activities related to Medicare fraud and abuse. The OIG's suggested program gave hospitals a ground level approach to laying out an effective compliance program. HMI simplifies the necessary steps to putting in place an effective tool by first determining the hospital's risk areas and defining the actions to be taken to resolve non-compliant activities.