Provider Compliance Program Guidance

Introduction

Effective compliance programs are essential to any provider navigating the complex world of government benefit programs. The Department of Health Care Finance (DHCF) believes the utilization of compliance programs by providers serves as a positive step towards ensuring adherence to applicable statutes, regulations, and program requirements. In addition, an effective compliance program assists providers in preventing the submission of erroneous claims or engaging in unlawful conduct involving health care programs.

There is no “one-size fits all” approach to compliance. Effective compliance programs must be tailored to suit your organization’s needs. This guide covers the following topics:

• Implementing a Compliance Program
• Seven Core Elements of an Effective Compliance Program
• Compliance Program Do’s and Don’ts
• Additional Compliance Program Resources

For questions or comments on this guidance, please contact the Division of Program Integrity at the address below:

Department of Health Care Finance 
Division of Program Integrity 
441 4th Street NW 
Washington, DC, 20001
(202) 698-2000