Healthcare fraud is a serious crime that, if convicted, can come with harsh financial penalties and, in serious cases, potential imprisonment. Healthcare providers are wise to take this issue seriously and take steps to reduce the risk of allegations of wrongdoing.
Proactive steps to achieve this goal can include:
- Develop healthcare fraud and abuse prevention policies. Educate your staff about the rules they must follow to comply with applicable laws. Have clear policies in place and make sure your staff is aware of the expectations.
- Review billing practices. Compare billing data to similar providers. Numbers that are far off from industry standards can signal a problem. If the numbers are different but practices are in line with regulations, make sure to have clear records to support this as the government will likely also take note and may investigate.
- Conduct internal audits. Conducting regular internal audits to check for compliance with applicable rules and regulations on a broad scale can help to reduce the risk of a federal investigation. The cost of these audits is offset by the expense that comes with an investigation — both the financial impact and the potential damage to your organization’s reputation.
Unfortunately, the move to value-based care has put pressure on providers to maximize their revenue. This can lead to unintentional acts that the government may consider acts of healthcare fraud. Examples can include failing to correct a billing error, questionable referral practices or collaborations with other providers that involve financial arrangements the government considers illegal kickbacks. Regular audits can help to bring attention to these errors and provide an opportunity to fix the issue before it rises to the level of healthcare fraud.
Attorney John Rivas is responsible for this communication