What is the purpose of a CMS Compliance Program?

• A. To increase provider billing
• B. To streamline claims processing only
• C. To deter fraud, waste, and abuse
• D. To prevent, detect, and correct noncompliant behavior and to deter fraud, waste, and abuse

Answer: (D)

The main goal of a CMS Compliance Program is to prevent, detect, and correct noncompliant behavior while also deterring fraud, waste, and abuse. It creates a structured system of policies, training, internal controls, and ongoing monitoring so that good practices become the normal way of working. By proactively assessing risks, implementing standards, conducting audits, providing safe channels for reporting concerns, and taking corrective actions when issues arise, organizations reduce the likelihood of improper billing, improper claims, and other CMS rule violations. Deterrence is a key outcome, but it works best when combined with prevention and timely remediation, ensuring ongoing compliance and protecting patients and program integrity. Choices that focus only on increasing billing or solely on streamlining claims processing miss these essential aspects of prevention, detection, and correction.