Video: Antifraud Compliance Getting More Complex for...(le changes and enforcement initiatives a...),Health

The new information-collection program announced in September imposes stiff penalties ($10,000 per day) for late filings. There will be much more scrutiny on the contractual relationships that physicians have with hospitals, other health systems, imaging centers, durable medical equipment suppliers, and other health professionals. Figuring out whether their physician relationships -- from recruiting through medical directorships -- will take much more careful effort on the part of hospitals and their senior management.

Why Monitoring Hospital-Physician Relationships Is Getting Harder

Two federal laws address hospital-physician relationships: an anti- kickback statute with criminal penalties, and a physician "self-referral" statute (the "Stark Law"), with civil penalties. The Office of the Inspector General (OIG) has been enforcing these statutes aggressively, with more than a dozen settlements with hospitals or health systems in the last three years.

Hospital employees have an incentive to report violations: "Whistleblower" statutes can result in rewards of up to 30 percent of any penalties the government collects. With millions of dollars at stake, these incentives can be very powerful.

According to Jack Gilbertson, senior manager in Deloitte & Touche LLP's Regulatory and Capital Markets practice, "The OIG's 'hot' enforcement areas for 2008 include services provided by non-physicians 'incident to' physician services, business relationships that include imaging services, billing for independent diagnostic and ultrasound services, and fraud related to reassignment of a physician's right to Medicare payments."

If a hospital uncovers a problem and wants to disclose it, the OIG has a "Self-Disclosure Protocol" that can lead to less painful settlements and penalties. This process can also mitigate the pain of ongoing compliance sanctions.

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