The recently-released Health Care Fraud and Abuse Control Program FY 2021 report contains a treasure trove of information for healthcare compliance teams. To gain a better understanding of lessons to be learned from this document we sat down with SCCE & HCCA board member Gabe Imperato, Partner at Nelson Mullins.
The report makes clear, he explained, how much coordination and review there is now among the Office of Inspector General at HHS, the US Department of Justice and also CMS. As a result, a subpoena, or even an inquiry needs to be taken very seriously. Compliance teams need to treat these external actions as if they are a report of non-compliant activity.
The report also reveals that there has been an increase in cases based on failures of organizations to appropriately collect copays. Some organizations have taken egregious activity that could be characterized as ignoring the obligation. In other cases the provider has made what it considers to be a reasonable effort to collect the payment – asking at time of service, sending follow up letters – others think that more could be done such as calling patients and setting up a payment plan. With no clear definition of what’s reasonable, the potential for a whistleblower case is high.
The report also illuminates the challenges of Stark and Antikickback cases. In his opinion these cases makes it clear that if you are looking at a circumstances where on the one hand there is a potential source of business and on the other hand a potential source of revenue, and there is a financial relations between the two, it is best to bring in competent outside counsel to determine if there may be a violation of these highly complex laws.
Kickback cases are very popular with qui tam attorneys, he notes, because of the difficulty in defending them completely.
Looking to the future, Gabe sees a large number of Covid-related fraud cases that will likely take years to play out.
Listen in to learn more, and be sure to read the report.