As Fraud Crackdown Grows, Need for Corporate Compliance Increases

26371785_lWith federal investigators devoting more time and resources toward uncovering fraud schemes involving false claims or kickbacks, corporate compliance programs have never been more important, according to Corporate Compliance Insights.

The article, authored by Anthony C. Vitale, a healthcare fraud defense attorney in Miami, offers pointed compliance suggestions to help healthcare organizations from becoming entangled in a fraud investigation. Given the fact that the government recouped $5.7 billion in false claims settlements and judgments in 2014, and with whistleblowers playing a larger role in uncovering fraud, healthcare organizations have increasingly relied on corporate compliance policies to ensure they are meeting regulations.

Vitale’s recommendations include the following:

  • Develop a written compliance program that accurately explains claims submission and administrative functions.
  • Perform internal records audits of claims submission and internal risk assessments that align with new enforcement areas.
  • Allow employees to report suspicious activity via an anonymous employee hotline and carefully review any complaints of noncompliance.

Additionally, Vitale provided insight into various fraud regulations that organizations should be aware of, including the False Claims Act, the Anti-Kickback Statute and the Physician Self-Referral Law.

“Ignorance is not a defense in the healthcare fraud environment,” Vitale wrote. “Even an honest mistake can cost you time, money and your reputation.”

Corporate compliance officers can be particularly helpful in navigating the changing regulations in the healthcare industry, and surveys show that 30 percent of organizations devote $1 million or more each year to compliance. Although fraud hotlines certainly offer clear benefits, organizations should give careful consideration to who is answering those hotlines in order to ensure anonymity.

Source: http://www.fiercehealthpayer.com/antifraud/story/fraud-crackdown-grows-so-does-need-corporate-compliance/2015-02-17

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