The report makes clear, he explained, how much coordination and review there is now between the Office of Inspector General at HHS, See more +
The report makes clear, he explained, how much coordination and review there is now between the Office of Inspector General at HHS, the US Department of Justice and also CMS. As a result, a subpoena, or even an investigation, should be taken very seriously. Compliance teams should treat these external actions as if they were a report of non-compliant activity.
The report also reveals that there has been an increase in cases based on the failure of organizations to properly collect payments. Some organizations have undertaken scandalous activity that can be characterized as dereliction of duty. In other cases, the provider has made what it considers a reasonable effort to collect payment—asking at the time of service, sending follow-up letters—others feel more can be done, such as calling patients and creating of a payment plan. Without a clear definition of what is reasonable, the potential for a whistleblowing case is high.
The report also highlights the challenges of the Stark and Antikickback cases. In his view, these cases make it clear that if you look at a situation where on the one hand there is a potential source of business and on the other a potential source of income, and there is a financial relationship between the two, it is better to bring a competent outside counsel to determine whether there may be a violation of these very complex laws.
Bribery cases are very popular with qui tam lawyers, he notes, because of the difficulty of fully defending them.
Looking ahead, Gabe sees a large number of Covid-related fraud cases that will likely take years to develop.
Listen to learn more and be sure to read the report. See less –