April 20, 2021
Compliance, EMS Compliance News
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The DOJ has released its stats related to False Claims Act (FCA) cases from 2020. While healthcare compliance programs became mandatory after Obamacare for anyone billing Medicare and Medicaid, one of the primary purposes of your compliance program is avoiding prosecution under the FCA, and the massive penalties and/or prison sentences that come along with it.
Significantly, 2020 saw the largest number of new FCA cases initiated in a single year. Strikingly, the number of government-initiated cases against health care entities more than doubled from 2019 to 2020 and was at the highest level ever reported.
Qui Tam (Whistleblower) Cases Continue to be the Driver.
Although we continue to see an increase in investigations based on random Medicare audits and internal Medicare reviews of your billing statistics, Whistleblower cases are still your biggest risk by a significant measure. Remember, the FCA allows one of your employees (or multiple employees) to file an allegation of fraud against your organization. If the government investigates, that individual can receive up to 20% of the total recovery. With most FCA cases having settlements involving millions of dollars, this is obviously a big incentive for disgruntled employees.
To that point, total recoveries from Whistleblower actions generated almost $1.7 billion in 2020. More than $309 million in Whistleblower share awards were paid in FY 2020. The full DOJ report can be found here https://www.justice.gov/opa/pr/justice-department-recovers-over-22-billion-false-claims-act-cases-fiscal-year-2020
One final thought: These eye-popping stats are from the Republican Trump administration. Historically, Republican administrations involve less oversight of businesses. Therefore, we expect these enforcement statistics to only increase in the future under the Biden administration, making the need for a robust healthcare compliance program all that more important.
4.7.2021
