Home Health & Hospice Week

Make sure your compliance plan is resolving complaints before they head to litigation.

Need a good reason to punch up your compliance plan? The feds just gave you more than a billion of them.

For the fiscal year ended on Sept. 30, 2023, False Claims Act settlements for healthcare-related fraud cases surpassed $1.8 billion, the Department of Justice says in a recent release. And the government was party to 348 the healthcare-related whistleblower cases (see more stats in HHHW by AAPC, Vol. XXXIII, No. 8).

“Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases,” stress attorneys Scott Taebel, David Honig, Jessica Biondo, and Jenny Kumosz with law firm Hall Render. “The health care industry continues to be the largest source of FCA settlements and judgments and of increased interest to whistleblowers,” Taebel, Honig, Biondo, and Kumosz maintain in online analysis.

The DOJ also mentions that Carter Healthcare, Stanley Carter, and Bradley Carter paid $22.9 million to resolve allegations that the company improperly paid physicians’ medical directorship fees to induce home health referrals, the DOJ points out in the release. The release fails to mention that the Carters also agreed to pay $7 million for furnishing medically unnecessary therapy in Florida. (More details are in HHHW by AAPC, Vol. XXXI, No. 38.)

Watch out: “The penalties under the FCA, including treble damages and fines up to nearly $28,000 per claim, as well as the tremendous costs of litigation, often lead providers to settle [whistleblower] matters, even if confident in their defenses,” Taebel, Honig, Biondo, and Kumosz warn. “Even low-dollar compliance concerns can cause significant disruption, expense and reputational harm,” they stress.

Providers can help head off whistleblower complaints with a robust compliance plan, the Hall Render lawyers advise. “Areas of compliance focus should include financial arrangements, medical necessity and proper standards of care, … [and] post-public health emergency and the end of Stark waivers and flexibilities,” they offer.

“Proactive compliance programs include internal investigations and making strategic and appropriate self-disclosures to the government to avoid the extensive costs associated with responding to a government investigation,” Taebel, Honig, Biondo, and Kumosz add.

If the feds do come knocking, “health care entities must respond promptly and cooperate fully to mitigate the risk of a prolonged investigative period,” they counsel.