Articles Tagged With: fraud
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Risk Managers Valued in Compliance Program Guidance from OIG
The Department of Health and Human Services Office of Inspector General recently issued its new General Compliance Program Guidance, the first of a series of compliance guidelines expected from the OIG, providing guidance, tools, and references addressed to federal healthcare program providers and suppliers. OIG makes clear that risk managers are an integral part of the effort.
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Supreme Court Ruling Helps with Meritless False Claims Act Lawsuits
The U.S. Supreme Court issued an important ruling that will help healthcare organizations and practitioners gain relief from meritless whistleblower lawsuits under the False Claims Act.
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Hospitals Underreport to NPDB, Creating Doubt
The Department of Justice recently announced a large healthcare system in the Northwest agreed to pay more than $22 million to settle allegations that two former spine surgeons falsified or exaggerated patient diagnoses and performed unnecessary surgeries. The case is the latest to show how problematic physicians often are not reported to the National Practitioner Data Bank. -
DOJ Report on FCA Settlements Shows Focus on Healthcare
The U.S. Department of Justice recently announced it recovered more than $5.6 billion under the False Claims Act in fiscal year 2021, more than double the $2.3 billion recovered in fiscal year 2020. Healthcare-related recoveries accounted for almost 90% of the 2021 settlements and judgments. -
Reporting Misdeeds: How and When to Use Disclosure Protocol
Once a risk manager realizes the organization may have violated laws or regulations, the best course of action might be to report the violation instead of hoping no one will discover it. Self-disclosure can offer many advantages that result in lesser penalties and other consequences. But it is important to know when to report and how to do it advantageously. -
2021 Healthcare Takedown Shows DOJ’s Focus on Pandemic
The Department of Justice’s 2021 Healthcare Takedown report indicates government investigators are looking for fraud in some areas related to the pandemic as well as some perennial sources of wrongdoing. -
Billing Records Audits Require Prompt, Thorough Responses
A government billing records audit will make most hospital leaders nervous because of the potential financial — and even criminal — consequences, but understanding the process and best practices can alleviate the stress. -
Whistleblower Exception Allows Reporting HIPAA Violations with PHI
Healthcare professionals can find themselves in a quandary when they want to report fraud or other concerns within their organizations because doing so could require disclosure of protected health information. That could seem like a HIPAA violation; fortunately, there is a whistleblower exception that covers this scenario. -
Biden Administration Expected to Expand Enforcement; Pandemic Grants Targeted
The enforcement of white-collar crime laws in the healthcare sector is likely to expand under the Biden administration, particularly regarding fraud associated with the billions of dollars in grants Congress allocated to hospitals and other health providers for pandemic relief.
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Telemental Health Survey: Increased Risk of Fraud
The expansion of telehealth services brings more risk of fraud and a greater need for internal compliance programs, according to the 2020 Telemental Health Laws survey from Epstein Becker Green in Washington, DC.