Ushering in a new era of fraud enforcement, the Department of Health and Human Services (HHS), the Office of Inspector General (OIG) and the Department of Justice (DOJ) have been hosting a series of summits, webcasts and tweets on health care fraud prevention. A national Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training Webcast was held on May 18, 2011. A regional Health Care Fraud Prevention Summit was held on March 15, 2011, in Detroit. The OIG announced it joined Twitter on May 23, 2011.
The May 18th Webcast was open to the public. The main message was to encourage providers to “take the initiative” and adopt a proactive approach to compliance. It was noted, for most of the industry, compliance programs are still voluntary, but specific proposals for mandatory compliance programs are expected soon. The Webcast provided information on establishing, operating and enforcing an effective compliance program. Presenters gave an overview of fraud and abuse laws, creating and maintaining a compliance program, resources for dealing with compliance issues and the consequences of health care fraud. A replay of the Webcast is available here.
The March 15th Summit was part of a series of regional summits hosted by HHS and DOJ where representatives from law enforcement, regulatory agencies, beneficiary groups and industry providers participate on panels discussing the problems caused by Medicare fraud and the ways these groups are coming together to fight against fraud. Participation was by invitation and Hall Render attorneys were in attendance. Keynote speakers were HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder.
The Summit had two main themes: the growing Medicare fraud in various geographic areas and the more resources being devoted to fight fraud, in particular, increased data mining and sharing of data across government agencies. Other fraud enforcement efforts include increased penalties for criminal activity, more stringent Medicare enrollment requirements, expanded overpayment recovery efforts and more government oversight of private insurance fraud. Below is a chart presented at the Summit showing the government’s current and new direction in fighting Medicare fraud and abuse.
CENTER FOR PROGRAM INTEGRITY STRATEGIC DIRECTION
| CURRENT Pay & Chase One Size Fits All Legacy Processes Inward Focused Government Centric Stand Alone PI Program |
→ → → → → → |
NEW DIRECTION Prevention & Detection Risk-Based Innovation Prevention & Detection Public/Private Partners Coordinated & Integrated |
Fraud Prevention Summits were also held in Miami, Los Angeles, Brooklyn and Boston. Summits in other cities may be scheduled in the future. More information can be found here.
On May 23rd, OIG announced that it updated its website featuring a more user-centered design at www.oig.hhs.gov. In addition, OIG announced that it joined Twitter as part of its ongoing efforts to quickly and effectively distribute information here. After the announcement, the first tweet from OIG was, “What does the Office of Inspector General do? Watch the IG here. ”
Should you have any questions about these developments, please contact Elizabeth Callahan-Morris (248.457.7854 or ecallahan@wp.hallrender.com), Gregg Wallander (317.977.1431 or gwally@wp.hallrender.com) or your regular Hall Render attorney.
This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader must consult with legal counsel to determine how laws or decisions discussed herein apply to the reader’s specific circumstances.
