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...
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...
The importance of anti-corruption training is often understated in comparison to other elements of a successful anti-corruption compliance program. Perhaps we should start with the term “training” and broaden the concept to what it really is — “communicating, listening and responding.” For compliance officers and staff, training programs is the one critical opportunity to educate, listen and learn from the audience. It is a two-way communication...
The SEC adopted rules to implement the new whistleblower program authorized by the Dodd-Frank financial reform bill. In a 3-2 vote, following party lines, the SEC adopted the rules over a vigorous defense that the new program will undermine corporate compliance programs by financially rewarding whistleblowers who circumvent existing compliance program reporting requirements. The whistleblower office receives about 1-2 credible reports every day, according to...
As part of my continuing series on building an anti-corruption compliance program from scratch, we need to work on the next step in our continuing series. In yesterday’s post I described the risk assessment process. So, your Bible is now complete. Your risk assessment outlines potential risks and covers the following: geographic areas of operation and levels of corruption in these countries; industry corruption levels and enforcement...
The importance of compliance officers in today’s business is on the rise. This trend reflects the increasing importance of risk management and proactive compliance to minimize those risks. But there is more for a compliance officer to do then simply manage and minimize risks. Indeed, the role of the compliance officer needs to extend into day-to-day business operations; the more this occurs the better off...
