Risk Mitigation Strategies

1. Introduction - With the knowledge of the common areas of fraud, waste, and abuse risk, there are other ways to implement controls to reduce risk of lawsuits and regulatory investigations. Implement a Compliance Program - The primary goal of any compliance program is to provide a tool to strengthen the efforts to prevent and reduce improper conduct.⁶³ However, these programs can also benefit practices by helping to streamline business operations.⁶⁴ Federal guidelines have recommended seven components that provide a solid basis upon which a practice can create a compliance program⁶⁵

a. Oversight - Appointing a Compliance Officer to handle the day-to-day operations of the compliance program;

b. Written Policies and Procedures - Adopting written policies and procedures, so that all practice staff has clear direction on permissible conduct;

c. Training and Education - Utilizing effective training and education to ensure that all practice staff is aware of risk areas and improper conduct, as well as legally mandated obligations⁶⁶

d. Enforcement - Enforcing disciplinary standards through clearly understood guidelines to dis-incentivize improper conduct;

e. Auditing and Monitoring - Conducting internal monitoring and auditing to proactively identify issues and patterns, especially with regard to coding, documentation, and billing issues;

f. Open Lines of Communication - Ensuring open lines of communication, to allow staff to report improper conduct to the Compliance Officer or Leadership confidentially and free from retaliation; and

g. Investigation and Response - Responding appropriately to detected offenses and developing corrective action.

3. Investigate Helpful Insurance Products - Regulatory investigations and lawsuits can occur, even if a dentist’s practice takes proactive approaches to reducing risk. Many insurance companies offer insurance products that may protect a dentist from actions related to fraud, waste, and abuse, such as regulatory riders to malpractice policies. Other policies, such as cyber insurance policies, may insure against enforcement actions under TCPA and CAN-SPAM. Speak to an insurance broker about coverage for regulatory investigations and lawsuits for issues relating to the billing and marketing conduct discussed in this course.