Is FCA Healthcare Fraud Enforcement on the Rise?

It appears so. While the number of False Claims Act (“FCA”) recoveries declined last year, there were many of FCA cases opened last year by the Department of Justice (“DOJ”).

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Per the DOJ, last year was the highest on record with a 13% increase in new health care cases opened and a 205% increase in new health care cases opened that were not brought forward by a whistleblower.

The FCA is used to establish liability for knowingly presenting a false or fraudulent claim for payment to the United States government. It is often used to combat fraudulent healthcare billing, specifically for Medicare and Medicaid billing.

The DOJ has indicated that they are cracking down on health care fraud and more broadly, on all white collar crime.

What does this mean for healthcare practices?

Expect more audits and a higher level of scrutiny.

Also, the DOJ stated that personal liability of individuals is at the forefront of enforcement. Identification of all involved individuals is required for a cooperation credit.

How do you protect your practice?

Audit and monitor your billing to ensure compliance. We recommend working with a healthcare attorney to perform an audit that is protected by attorney-client privilege.

Look closely for:

  • Billing for services not rendered
  • Upcoding
  • Inaccurate claims
  • False certifications

And any other inaccuracies or issues.

Training of staff goes hand in hand with audits. Make sure to continuously train your staff.

Staff should be advised of the personal liability and individuals being named in complaints by the DOJ.

The DOJ is using personal responsibility to deter fraud and employees should be made aware of this practice.

If you need help with your audits, training or compliance in general, contact us today.

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