George B. Breen, Member of the Firm, presents “The Enforcers Are Coming: But It’s Not Just About Money Anymore” at Pedorthic Footcare Association’s 53rd Annual Symposium & Exhibition, which runs from November 1 to 3.
Last year the United States Departments of Health and Human Services and Justice reported recoveries of more than $4.1 billion in “fraudulent healthcare payments.” As significant, the Department of Justice reported that it filed criminal charges against 1,430 defendants in fiscal year 2011, the largest number of health care fraud defendants charged in a single fiscal year. DOJ obtained convictions of 743 health care fraud defendants in fiscal year 2011, another record, and reported that there are more than 1,800 health care fraud criminal investigations pending.
It is clear that the government’s interest in pursuing health care fraud is not limited to dollars; the headlines are replete with efforts to pursue individuals criminally. Moreover, the HHS Office of the Inspector General is increasingly looking to exclude individuals from participation in federal health care programs. Significantly, the OIG has almost unfettered discretion to impose exclusion against any officer or managing employee of an entity sanctioned for health care fraud, even without any showing that that individual participated in, had knowledge of or even “should have known” of the misconduct that gave rise to the sanction.
Given this backdrop, it is critical that health care entities doing business with the federal government (and with private insurers), need to have protections and processes in place to ensure that they are conducting business in a compliant fashion. The Patient Protection Affordable Care Act (“PPACA”), passed in 2010, required health care providers to have a compliance program in place in order to participate in federal health care programs. While a deadline for compliance with that provision has not been set, it is critical, given the current enforcement climate, that providers have in place an active and effective compliance program in order to protect themselves and their businesses. Whether you have an existing program, or need to establish one, this presentation will discuss the critical elements of a compliance program as your first layer of defense against the government enforcers.
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