Compliance FAQs

What is a Compliance Program?

A compliance program involves a continuous process of adhering to legal, ethical and professional standards applicable to DPH and its staff. It requires constant development of processes, policies and procedures to define appropriate conduct, educate staff and ensure proper application of guidelines. An effective healthcare compliance program can help protect organizations against fraud, abuse, waste and other potential liabilities.

DPH’s Compliance Program – Mission and Goals:

DPH maintains a compliance program in accordance with Federal and State regulations and guidelines to address the complexity of properly and accurately documenting, coding and billing for health care services. All staff, contractors and volunteers who on behalf of DPH furnish or authorize the furnishing of Medicare and Medi-Cal services, bill or code services or monitor the health care provided by the department are expected to ensure and uphold a culture of compliance.

Goals of our Compliance Program are defined as follows:

• To promote an understanding of compliance with Medicare, Medi-Cal and other applicable Federal and State laws and regulations;
• To use education and training to improve compliance with billing and reimbursement rules and regulations; and
• To work with providers, managers, and staff to integrate compliance into the daily operations of DPH.

Benefits of Compliance Program:

Compliance problems can lead to audits, paybacks, investigations or other corrective actions, and expose DPH to increased costs or may harm its reputation as a public institution.
A significant benefit of a compliance program is to identify and prevent possible issues early when the potential harm and the costs to rectify the issues are lower. In addition to avoiding these negative outcomes, an effectively run compliance program can provide guidance to DPH staff about legal and regulatory mandates, as well as empowers them to identify and resolve issues before they escalate, contributing to a culture of compliance.