Health Care Compliance Officer

Filled under: Healthcare Compliance on June 2010

Under the new Medicaid Integrity Program (MIP) that was included as part of the 2005 Deficit Reduction Act, there has been a new need arise for employees to ensure that MIP protocol is being followed. This means that more and more people are becoming employees who are tasked with the role of ensuring the compliance of the providers they service. In order to fulfill their duties in their role of Medicaid compliance, there is often some additional training that they must complete in order to be successful.

Because of the need for additional training in how to best serve the provider the compliance officer works for, there have been several programs started in various environments. The most popular program is for a compliance officer to work under a chief compliance officer who helps in their training. This also ensures that nothing is missed as most of the work done is checked by the supervisor. Another, and increasingly popular, method to acquire the training needed to be a compliance officer is to get a certificate from an accredited school. These school programs are great for those who live near a school that offers them as they prepare the compliance officer for all aspects of the job and they are generally ready to begin immediately.

The main duty of a compliance officer is to ensure that the company for which they are working acts accordingly and doesn’t abuse the Medicaid system. By doing this, it is supposed to reduce the amount of money that Medicare/Medicaid pays out for unnecessary procedures and tests as well as eliminate the overpayment for treatment that wasn’t performed. Because of the past issues with this in facilities, the compliance officer may be responsible for not only enforcing the regulations of Medicare/Medicaid, but also initiating a plan of action that will plainly outline the purpose of their presence.

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