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Compliance Programs for Physicians

Establishing and following a compliance program will help physicians avoid fraudulent activities and ensure that they are submitting true and accurate claims. The following seven components provide a solid basis upon which a physician practice can create a voluntary compliance program:

For more information on compliance programs for physicians, see OIG's Compliance Program Guidance for Individual and Small Group Physician Practices

  • Conduct internal monitoring and auditing.
  • Implement compliance and practice standards.
  • Designate a compliance officer or contact.
  • Conduct appropriate training and education.
  • Respond appropriately to detected offenses and develop corrective action.
  • Develop open lines of communication with employees.
  • Enforce disciplinary standards through well-publicized guidelines.

With the passage of the Patient Protection and Affordable Care Act of 2010, physicians who treat Medicare and Medicaid beneficiaries will be required to establish a compliance program.