DeKaye Consulting, Inc. - Compliance and Awareness

Where did the industry go wrong?

Instead of headlines lauding our discoveries, scientific and technological advances in patient care and service delivery, they are instead shared with the likes of False Claims, Fraud and Abuse, Up-coding, Patient Dumping and Stark violations.

How is it that Healthcare Fraud and Abuse has become the #2 priority of the United States Justice Department, ahead of the war on drugs and organized crime?

We can trace some of the problem to outright unethical behavior, greed and the "willful and knowing" disregard for the law and regulations.

But slowly evolving technology, weaknesses in operating procedures, lack of staff training and a division of labor that allows task sequences to be finely subdivided so that the sum of the parts do not equal the whole cause missing parts to lead to noncompliance with rules and regulations.

What can be done to improve the situation?

One initiative being implemented around the country is formal corporate responsibility programs. From developing a code of ethics, to establishing a hotline to training staff on the rules and regulations.

But in order to have a lasting effect, providers need to reinforce the messages in their plans. Paper compliance, or the "do as I say, not as I do" attitude is too easy to let happen. Leadership by example from the top down is necessary for a compliance program to take hold and be effective.

How we can help.

Compliance and Awareness. It’s what we believe can help take the potential of your plan and help to make it a reality.

Our program, Safeguarding Healthcare’s Cash Flow Cycle from Fraud and Abuse is designed to explain in terms both front-line and management staff can easily understand and relate to. In addition to covering the national and local issues being faced, we take a very practical hands on approach to illustrating:

	The types of fraud that can be committed
	What to do in the event there is a subpoena, a "knock at the door," or the unlikely event that a "search warrant" is executed on your premises
	How to use your own information to build a data defense to identify problems and exposure issues
	Technical considerations concerning such topics as the 72 Hour Rule, Credit Balances, Medicare Secondary Payer, EMTALA, Medical Necessity and Duplicate Billing, Up-coding and more.

Our services also include contractual reviews to check for possible kickback, Stark, or freedom of choice violations in agreements, and conducting chart-to-bill and 72 Hour audits to ensure billing and coding compliance.

In working with our Strategic Alliance Partners, we combine to bring you the most skilled professionals to help you tackle one of the most significant challenges facing the industry at the turn of the century.

Compliance and Awareness

For more information about our services, or Strategic Alliance Partners, please write to us at: Adkcmpa@aol.com or DKConsult1@aol.com