Five-Minute Consult

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Brian Roark
Bass, Berry & Sims
Nashville, TN

The Obama administration has taken a long look at healthcare. Not only in the way it's working on healthcare reform but also through the increased focus the administration has taken in ferreting out Medicare fraud. Thanks in part to a new law, at the end of 2009, a batch of 30 alleged fraudsters in Miami, Detroit, and Brooklyn—including doctors and nurses—was indicted on charges they conspired to bilk Medicare out of $61 million by filing false claims. That brings to 500 the number of people charged with Medicare fraud in less than two years. So how does an organization protect itself from becoming a target? Brian Roark has some suggestions:

"The Healthcare Fraud Enforcement Act of 2009 increases criminal penalties and makes it easier for the government to bring false claims lawsuits. Obama has advertised cutting down fraud and waste as a way to control health costs. One takeaway for healthcare providers is that the Medicare Fraud Strike Force, a partnership between the U.S. Department of Justice and the U.S. Department of Health and Human Services, is increasing its use of data analysis techniques to look at areas of the country, particularly healthcare entities that are submitting claims grossly disproportionate to the rest of the country.

That means providers should do that same work proactively themselves as a check on their billing. Are they exceeding national averages? Lots of times there may be good reasons for that. But you should expect [regulators] to come calling if you stand out. The government is going to increase devotion of resources to healthcare fraud. That makes it more important than ever to have good compliance programs to be able to detect fraud on your own. That doesn't necessarily mean increasing manpower, but you need to be doing your own in-house data analysis."

Philip Betbeze

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