Physiatry Practice Management Resources

Taking action to coSrect a fraudulent practice is one of the mostS critical aspects of a compliance program. It is the ultimate test of how effective the program is. Corrective action must not only correct the specific violation that occurred, but also address how to change practices to avoid the problem in the future.

Key Steps

Review Investigation Findings
Complete a thorough investigation before deciding on what action to take. Your response should be based on the specific facts uncovered during the investigation. If any facts are missing, conflicting or unclear, investigate further.

Consult with Compliance Committee and Counsel
Once the facts are known, the compliance offer should consider consulting with the compliance committee or outside counsel. They can assist in developing a corrective action that is appropriate to the violation.

Take Corrective Action Specific to the Situation
The appropriate corrective action always depends on the specific facts and circumstances of the violation; therefore, it is difficult to provide hard and fast rules to follow. Consider the following criteria in deciding which corrective action to take:

• Did someone act knowingly, intentionally or with reckless disregard to the Code of Conduct or applicable laws?
• To what extent does the violation subject the practice to potential civil or criminal liability?
• Was there an overpayment by the government, and if so, how much?
• Did the violation affect the quality of care provided to patients?
• Was this a repeat violation?
• Did the violation result from systemic failure to comply with the Code on the part of an individual or group of individuals?

• Correct the practices that led to the violation. This may include reviewing and amending policies and procedures, replacing defective software, and changing operations.
• Take appropriate disciplinary action against the employee or independent contractor involved. For independent contractors this may include severing the relationship. Employees should be disciplined according to your human resources policies.
• Conduct staff training and education to prevent similar violations in the future.
• If there was an overpayment, calculate the amount and repay the appropriate government entity or insurer.
• If there was actual or potential crime, consult with outside counsel to notify the appropriate government authorities.
• Review the compliance program itself to determine if it needs to be adjusted to prevent future violations.

Document the Corrective Action
As with everything else in compliance, documentation is essential. Document how the corrective action was developed (i.e., minutes from a compliance committee meeting) and corrective action itself. This includes documenting revisions to operational policies and procedures, revisions to the compliance plan, employee discipline, installation of new computer equipment and letters to vendors.

Perform Appropriate Follow-up
This is an often overlooked but essential step. Perform follow-up audits and reviews to determine if the corrective action fixed the problem. For example, if there were billing errors, perform a billing audit to make sure they haven't reoccurred.

Report to the Compliance Committee and Board
Consistent with the compliance plan, the compliance officer should report to the compliance committee and to the board regarding the results of the investigation, the corrective action taken, and the effectiveness of that action.


Key Considerations
Voluntary disclosure, returning overpayments and reporting individuals for criminal prosecution are sometimes necessary. However, doing so carries grave potential consequences for the individuals involved as well as your practice. These disclosures may prompt investigations by outside agencies. Therefore, consider carefully before acting and consult your attorney.

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