In the year since the Patient Protection and Affordable Care Act (PPACA) has been enacted, the industry has been wrestling with new mandates, incentives and compliance issues. Of course, there is a lot at stake – Medicare reimbursements in the billions of dollars. In many areas, health care organizations have to determine how they can collaborate with other institutions to reduce costs and gain efficiencies...

In the year since the Patient Protection and Affordable Care Act (PPACA) has been enacted, the industry has been wrestling with new mandates, incentives and compliance issues. Of course, there is a lot at stake – Medicare reimbursements in the billions of dollars. In many areas, health care organizations have to determine how they can collaborate with other institutions to reduce costs and gain efficiencies...

The government’s health care reform effort is replete with inconsistencies — on the one hand, the government has given industry some real and meaningful benefits, and on the other, the government has imposed additional burdens on the healthcare industry. Let me give just one example.  The government amended the False Claims Act (FCA) to extend liability to identified overpayments which must be reported and repaid...

The government’s health care reform effort is replete with inconsistencies — on the one hand, the government has given industry some real and meaningful benefits, and on the other, the government has imposed additional burdens on the healthcare industry. Let me give just one example.  The government amended the False Claims Act (FCA) to extend liability to identified overpayments which must be reported and repaid...

With all of the dangers surrounding healthcare companies, it is worthwhile to develop a targeted compliance plan focused on your significant risks. It is critical to avoid False Claim Act liability. The government’s HEAT strike force effort has been successful in ferreting out fraud and extracting large recoveries for false claims. But the strike force is using sophisticated data mining and data analysis to identify...

The government’s primary weapon to combat health care fraud is the False Claims Act. With recent amendments to the FCA, the government’s weapon has become even more powerful. The FCA is used for a range of schemes, including billing for services not rendered or goods not supplied, “upcoded” services, medically unnecessary services, kickbacks, false cost reports, and illegal sales and marketing schemes. The potential recoveries...

You are now in charge of putting in place a compliance program for your healthcare company. You start from the beginning. You have just left a company where you designed and implemented an FCPA compliance program. Can you transfer any of those components or skills? You will quickly learn that the compliance principles share a striking resemblance to each other. For starters, the US Sentencing...

While I devote much of my blog to anti-corruption issues, I wanted to take a few posts to examine significant health care fraud and compliance issues. What is interesting is the overlap in many compliance issues. Like the anti-corruption area, the Justice Department and HHS have aggressively enforced health care fraud laws. Over the past two years, the Justice Department has expanded its prosecution of...

While I devote much of my blog to anti-corruption issues, I wanted to take a few posts to examine significant health care fraud and compliance issues. What is interesting is the overlap in many compliance issues. Like the anti-corruption area, the Justice Department and HHS have aggressively enforced health care fraud laws. Over the past two years, the Justice Department has expanded its prosecution of...

With all the hoopla these days about the FCPA, UK Bribery Act and other anti-corruption law enforcement, you would expect that every company has initiated some compliance actions.  With guidance provided by Justice Department filings and settlements, the U.S. Sentencing Guidelines, the OECD, and the UK Ministry of Justice, companies have certainly available resources to assist them in the compliance arena. A 2011 KPMG survey, however, paints a...