Navigating the world of healthcare compliance is never easy. You can study for hours and still not get the answers you need to ensure you’re staying on the right side of the law.

Check out 10 common healthcare compliance questions — along with answers — so you can steer clear of fines, penalties and fraud accusations.

1. What Is Healthcare Compliance?

Healthcare compliance is the practice of following ethical, legal and technical rules that help you stay on the right side of the regulatory laws.

2. Who Is Responsible for Physician Healthcare Compliance at Your Practice?

Your practice should designate a compliance officer who ensures that you’re following the compliance regulations at your practice. But it’s the responsibility of everyone at your office, from the front desk and the doctors to the back-end billing team, to always stay compliant every day.

3. What Should You Do if an Auditor Asks for Records?

Request documentation that the auditor is who they say they are. If they come to your office in person, take them to a private space and contact your practice’s compliance officer and attorney.

4. How Is HIPAA Different From Compliance Rules?

HIPAA is just one of the many compliance regulations that your practice is required to follow. HIPAA protects patients’ confidential health information and provides rules around patients’ access to that information.

5. Is It Non-Compliant to Use Patient Sign-in Sheets?

No. You’re still allowed to use patient sign-in sheets at your practice. But make sure sensitive information doesn’t appear on your sign-in sheet. For instance, there’s no need to ask patients for the “reason for visit” or “insurance ID number” on your sign-in sheet.
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6. What’s the Anti-Kickback Statute (AKS)?

The Anti-Kickback statute restricts practices from exchanging payments or items of value for referrals. You can’t accept or give incentives (cash or other items or services that have value) in exchange for a referral.

7. Is the AKS the Same as the Stark Law?

No. The Stark Law prevents you from referring patients to entities where you or a family member have a financial connection. The AKS, on the other hand, prohibits financial remuneration in exchange for referrals.

8. How Often Should We Perform Compliance Training?

Your practice should provide compliance training to new employees and to all staff members once a year after that. In addition, you’ll want to provide training to existing employees every time regulations change or when new regulations come out.

9. If We Get a Civil Monetary Penalty (CMP), Will We Be Excluded From Medicare?

Not necessarily. Not every CMP requires CMS to exclude you from the Medicare program. Talk to your healthcare attorney if you’re at risk of receiving a CMP to work toward remaining part of Medicare.

10. What Kind of Fines Do Practices Face for HIPAA Violations?

The answer depends on the actual violation. Medicare fraud penalties can range from several thousands of dollars to the millions, depending on how much fraud is discovered. HIPAA violations can top $50,000 per breached record. Some of these penalties can be practice-ending, so your practice should work hard to avoid healthcare compliance violations.