There is no one-size-fits-all compliance plan as there are many types of care-giving entities. Even so, a good CP has 7 elements:
2. implementing compliance and practice standards
3. designate a compliance officer/contact person
4. conduct appropriate training and education
5. develop corrective actions and use them if offences are detected
6. have open lines of communication
7. enforce disciplinary standards through well-publicized guidelines
The OIG establishes a work plan twice a year with particular areas of improvement. This work plan is very important. If something is on the plan, providers and facilities work hard to achieve it.
It also enforces and investigates fraud and abuse.
Per HIPPA, fraud is intentional attempted/actual obtainment of funds or property of a healthcare benefit program. For example, diagnosing a nonexistent condition to increase medicare payments.
Abuse can be intentional or unintentional. Generally involves improper/incorrect use of services with or without monetary gain.
The easiest way to tell the difference is to ask if the act was intentional and increases payments. Abuse seldom does both, fraud usually does.