Compliance | False Claims Act

$2.6 Billion Collected By Feds From Compliance Cheats. ROI Makes Warren Buffet Look Like An Amateur.

Even Warren Buffet can’t get you this return: 420% over three years.

And, it’s 100% leveraged. OPM.

Well, not OPM as in “other people’s money,” but OPM as in “our public money.”

That’s the return on investment that the Feds generated from 2015 to 2017 as a result of coordinated Department of Health and Human Services and Department of Justice healthcare anti-fraud operations.

In total, their efforts returned $2.6 billion.

And, as icing on the compliance cake, the Feds also obtained some non-monetary rewards (especially for those who count convictions as wins): In 2017 alone, the DOJ opened 967 new criminal healthcare fraud investigations, leading to criminal charges against 720 defendants. 639 defendants were convicted of health care fraud-related crimes during the year.

But that’s just the DOJ. The joint DHHS/DOJ Medicare Fraud Strike Force brought charges against an additional 478 defendants, negotiated 290 guilty pleas and obtained convictions against another 40 defendants. 305 individuals went off to prison for an average sentence of more than 50 months behind bars.

If you previously wondered why we have laws such as the federal Anti-Kickback Statute and Stark, and questioned whether they are based on fact or fiction, you might as well give up your queries. After all, it’s a big business. No, that’s incorrect. It’s a big bureaucracy.

In the vernacular, them’s the facts. So, we have to deal with them.

Compliance is not just a punch card list. It’s not just a plan. It’s not just a program. It’s a target, the one that’s painted on your back. There’s hotlines and whistleblowers and strike forces and postal inspectors and Assistant U.S. Attorneys looking to make their stripes. You have to assume that they’re all looking at you.

There’s baseline self-inspections, there are red teams to privately ferret out your weaknesses, there’s active compliance versus passive time wasting. If you need help, get in touch fast.

Get moving. Now.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

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Manage Your Practice

Sexual Harassment is in the News. Make Sure Your Group’s or Facility’s Name Isn’t Included.

From Harvey Weinstein to Al Franken to, now, a well known physician at Fenway Community Health Center, the Boston institution known for its pioneering care for LGBT patients, allegations of sexual harassment and bullying are surfacing on what seems to be a daily basis.

Even if the allegations aren’t aimed at you, they pose significant challenges for your medical group, facility, or organization.

Take the Fenway Community Health Center situation, for example. Last week, the Boston Globe initially reported that the health center’s CEO, Dr. Stephen L. Boswell, resigned, after 20 years in the position, under pressure from the board of directors. Then, the paper reported that Fenway’s board chairman, Robert Hale, was out, too.

The events center around years of sexual harassment allegations against Dr. Harvey J. Makadon. Makadon had allegedly sexually harassed at least three male co-workers and had “yelled at and belittled” male and female staff members. Dr. Makadon denies the allegations. He’s said to have resigned from the facility.

The Globe uncovered the fact that Fenway engaged legal counsel twice over the last four years relating to allegations against Makadon. In connection with the second instance, the CEO apparently ignored the law firm’s advice to terminate Makadon and didn’t report the matter to the board. The Globe also reports that the CEO didn’t tell the board about a $75,000 settlement paid to a former employee in connection with the allegations.

What’s your entity’s policy on harassment? Does it have one?

What action do you take to investigate?

Who conducts the investigation?

What rights do both the accuser and the accused have?

What steps do you take if the allegations are found to be true?

An investigation gone bad, or bad decisions made during and after a proper investigation, have an impact far beyond that on the accuser and the alleged. The easiest way to keep your name and that of your organization out of the press is not to do things that would get it in there in the first place.

For help on policies, investigations, and staying out of the press, comment or contact me if you’d like to discuss this post.

Mark F. Weiss

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