--- title: Elements of a Medical Office Compliance Plan description: Medical Billing Company offers insights into creating a compliance policy for a medical office. image: https://www.mbrbilling.com/hs-fs/file-16579818-jpg/images/audit-checklist-resized-600.jpg --- [![](https://www.mbrbilling.com/hs-fs/hubfs/MBR-Images/logo.png?width=340&name=logo.png)](https://www.mbrbilling.com/) - [Home](https://www.mbrbilling.com/) - [Client Login](http://clientlogin.mbrbilling.com/) - [Contact Us](https://www.mbrbilling.com/contact-us) SEARCH # Medical Billing Blog # Elements of a Medical Office Compliance Plan Posted by [Barry Shatzman](https://www.mbrbilling.com/blog/author/barry-shatzman) on Wed, Oct, 26, 2011 @ 14:10 PM - [Tweet](https://twitter.com/share) ![Audit Checklist resized 600](https://www.mbrbilling.com/hs-fs/file-16579818-jpg/images/audit-checklist-resized-600.jpg?width=243&height=162&name=audit-checklist-resized-600.jpg)Let’s face it, no provider really wants to implement and maintain a compliance program in their office, but if nobody bothered then the estimated $60 billion in Medicare fraud would continue to prosper.  Like every other law and regulation our government imposes, medical office compliance programs are intended to better society.  An effectively designed compliance plan should be implemented and enforced with the goals of preventing, detecting, and correcting inappropriate and potentially criminal conduct.  Reducing your exposure to liability is another key reason for implementing a compliance program.  Making reasonable efforts to avoid and detect misbehavior is evidence in itself that a practice does not have intent to commit health care fraud, and thus, may reduce penalties if wrongdoing is found.  The OIG has not issued a model plan for physician practices but they have issued the following elements to be included in all compliance programs. 1. **Code of Conduct:** Ethical standards to which all employees are held accountable. 2. **Compliance Officer:** The practice must appoint a trustworthy person with sufficient authority to influence behavior and organizational practices. 3. **Training and Education Programs:**  The practice must establish an effective and documented education and training program for all personnel, including an overview of health care laws, payor requirements, an overview of the plan itself, and the role each employee has within the plan. 4. **Implementation and Enforcement:**  Appropriate disciplinary action against employees who have violated internal compliance policies, Federal or State regulations, or payor requirements. 5. **“Hotline”:** The creation and maintenance of a process to receive complaints, and procedures to protect the anonymity of complainants and the protection from retaliation. 6. **Disciplinary Guidelines:** The disciplinary process for violations of compliance programs will be administered according to practice protocols (generally oral or written warnings, suspension, or termination) depending upon the seriousness of the violation. 7. **Corrective Action:**  The compliance plan must include a process for responding to complaints, addressing identified offenses, and taking corrective action to prevent further similar offenses. The design and implementation of any compliance plan will vary from one practice to another.  A compliance plan from a high volume practice will differ from a low volume practice.  A specialist’s plan will differ from that of a family practice.  A lab’s will differ from a mobile practice.  To be effective, the plan needs be designed for the services and structure of your practice.  Establishing an active compliance program will require both time and money, but the alternative could be much more expensive in the long run if you are audited. ### Subscribe via Email [![](https://www.mbrbilling.com/hs-fs/file-16642138-png/images/bg/facebook.png)](https://www.facebook.com/MedBillResources) [![](https://www.mbrbilling.com/hs-fs/file-16650079-png/images/bg/twitter.png)](https://twitter.com/#!/MedBillResource) [![](https://www.mbrbilling.com/hs-fs/file-16643229-png/images/bg/linkedin.png)](http://www.linkedin.com/company/medical-billing-resources) [![](https://www.mbrbilling.com/hs-fs/file-16646680-png/images/bg/rss.png)](https://www.mbrbilling.com/CMS/UI/Modules/BizBlogger/rss.aspx?tabid=484940&moduleid=1043750&maxcount=25&u=107101&t=BBE4D262E126601B3B04C3F46C38B13F) [![New Call-to-Action](https://no-cache.hubspot.com/cta/default/119723/112e1d48-db0d-4713-be81-8744e7438136.png)](https://cta-redirect.hubspot.com/cta/redirect/119723/112e1d48-db0d-4713-be81-8744e7438136) [![Click me](https://no-cache.hubspot.com/cta/default/119723/73857c0b-bb42-4989-9f2b-6f01b79dda8d.png)](https://cta-redirect.hubspot.com/cta/redirect/119723/73857c0b-bb42-4989-9f2b-6f01b79dda8d) [![worksheet](https://no-cache.hubspot.com/cta/default/119723/e4db838f-b08e-4fb6-bce4-c965b078dce1.png)](https://cta-redirect.hubspot.com/cta/redirect/119723/e4db838f-b08e-4fb6-bce4-c965b078dce1)     ### Latest Posts ### Browse by Tag - 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