Top 3 Take-Aways from AHLA’s Fraud and Compliance Forum Keynote

Believe it or not! I am back in Baltimore to network and learn at the American Health Lawyers Association’s Fraud and Compliance Forum. There are over 50 sessions covering many different topics that are impacting the healthcare industry from a regulatory and compliance perspective. Here are the top 3 take-aways from the keynote address by Joyce Branda, Deputy Assistant Attorney General for the Civil Division of the Department of Justice:

1. Qui Tam (whistleblower) cases will continue to increase. Over the past six years, $2.5 billion have been awarded to whistleblowers. This is a scary trend with staggering financial implications. Healthcare providers should consider beefing up internal reporting mechanisms and reward programs to encourage individuals to raise issues internally rather than bringing complaints directly to the government. When a potential issue is identified internally, it allows the provider to manage the investigation process, which can lead to a reduction in the financial impact and distractions caused by a government investigation.
2. False Claims Act (FCA) cases will increase. There are numerous contributing factors for this trend, the least of which is the use of data analytics to identify possible fraudulent activity. The government is releasing huge data populations to the public, which allows third parties the opportunity to help with the identification process. When possible fraud is identified more frequently, the government will have more cases to pursue. Being constrained by resources, the government will choose not to pursue all of them, which opens up the door for relators who can “stand in the government’s shoes.” Attorneys will ramp up resources to address these types of cases because there are significant rewards if successful.
3. More individuals will be brought to justice. This is a trend that literally “hits home.” In recent years, the government has increased its focus on the individuals, not just the organizations, who commit fraud against the government. Earlier this month, Sally Yates, Deputy Attorney General, issued a memorandum, Individual Accountability for Corporate Wrongdoing. This change “will maximize the [government’s] ability to deter misconduct and to hold those who engage in it accountable.”

Branda covered other healthcare enforcement trends. Some included the government’s enforcement efforts related to hospice care, physician referrals, and improper hospital admissions. She also mentioned there will probably be new types of cases involving insurance exchanges and accountable care organizations.

Stay diligent and be aware that fraudsters are everywhere!