As if corporate healthcare businesses needed an enforcement reminder, DOJ recently announced a settlement with Cigna Group for $172 million to resolve claims that Cigna exaggerated patient illnesses to extract more money from the Medicare Advantage Program. Under the Medicare Advantage (MA) Program, also known as Medicare Part C, Medicare beneficiaries have the option of obtaining their Medicare-covered benefits through private insurance plans called MA...

Looking back in time, the compliance field owes a lot to the healthcare industry.  In the 1990s, there was a dramatic explosion in the industry in response to aggressive federal enforcement programs and increasing regulation.  All of a sudden, compliance officers who sat in the backrooms of legal departments were “volunteered” to address proactive compliance.  Federal regulators pushed the compliance function to assume a much...

Corporate compliance programs in the healthcare industry include many of the same elements that we are all familiar with – risk assessments, code of ethics, written policies and procedures, comprehensive training requirements, confidential reporting and investigation systems to address employee concerns, gifts, meals, grants, and medical education programs, and audit and review processes to maintain a continuous improvement program. Aside from this standard list of...

If you are a compliance officer for a healthcare provider (e.g. hospital, HMO, skilled nursing facility, hospice center), you must sometimes feel that no one understands or feels your pain.  When you consider the number and extent of risks, it can be mind-boggling.  I am sure there are times that compliance officers in the healthcare industry look wistfully or even with envy at a compliance...

The Supreme Court , in a unanimous decision, rejected a challenge by corporate pharmacy defendants, to the intent requirement in a Medicaid and Medicare over-billing False Claims Act case.  Justice Clarence Thomas, who has established himself as the lead justice concerning False Claims Act cases, wrote the unanimous opinion. The defendants, SuperValu and Safeway, claimed that thier alleged overbilling did not meet the intent requirements...

We always focus on foreign bribery — the FCPA and corporate bribery of foreign officials.  It is certainly a problem that undermines economic development and human rights. However, bribery and corruption is real and significant in the United States, from local to state to federal government officials, the news is filled with instances of bribery and corruption.  Wherever there is money flowing, there is sure...