Navigation Links
Feds Use Tougher Tactics To Fight Healthcare Fraud

WASHINGTON, Sept. 7, 2012 /PRNewswire/ -- Describe a federal strike force that relies on informants, undercover officers, asset seizures, secret recordings and other tough tactics, and most Americans would assume the targets were mob bosses or drug cartels. But as two LeClairRyan attorneys noted in an Aug. 22 webinar, various U.S. agencies are doing all of the above as they target, not the mobsters of the world, but major and minor fraudsters in the healthcare business.

In "Healthcare Fraud Enforcement and Compliance Strategies," a one-hour webinar for compliance officers and other executives, LeClairRyan shareholders Michael F. Ruggio and Michael Volkov outlined how the government's ongoing crackdown translates into unprecedented risk of civil and criminal enforcement for a wide variety of healthcare organizations.

"The Justice Department's healthcare fraud initiative, which primarily focuses on Medicare and Medicaid fraud and off-label marketing cases, is one of the highest priorities of the current administration," noted Ruggio, who formerly served as senior trial counsel for the DOJ. "This initiative is itself the product of an unprecedented, coordinated effort involving DOJ, HHS and other agencies, which have teamed up to execute a multipronged strategy aimed at identifying, investigating and prosecuting healthcare fraud."

Given today's aggressive enforcement environment, healthcare providers and other entities must take action to ensure they are in compliance with existing laws on fraud and abuse, as well as those that are soon take effect, added Volkov, a former federal prosecutor. "Healthcare organizations need to dedicate adequate resources to the compliance function, prioritize training programs and encourage the prevention and deterrence of potential violations," he said.

During the webinar, the Washington-based attorneys examined current enforcement trends in the healthcare industry and provided detailed advice on effective approaches to compliance. The risks associated with violations, Ruggio noted, are high. "Today, prosecutors are successfully detaining defendants pending trial without bond or with high bonds," he said. "We have already seen four national 'takedowns' with arrests of more than 100 individuals, including doctors, nurses and other healthcare executives and employees." Last year alone, DOJ recovered more than $5.6 billion in civil and criminal healthcare fraud cases. Approximately $2.8 billion were the result of whistleblower complaints, an increase of $500 million over fiscal 2010. "Meanwhile, Congress has increased funding by nearly $1 billion to combat healthcare fraud and abuse," Ruggio reported. "The government has realized that for each dollar spent on enforcement it saves one-and-a-half times that amount."

Violations of the False Claims Act, in particular, are prime enforcement targets. "These typically involve billing for goods and services not supplied or rendered, and for 'upcoded' or medically unnecessary services and goods," Volkov said. "The government is on the lookout for illegal sales and marketing schemes, kickbacks and false cost reports as never before." And thanks to the Physician Payments Sunshine Act—new legislation that will take effect in January 2013—it will soon be necessary to record and disclose any payments or benefits to physicians, Volkov added. "Congress believes drug and device companies are flouting anti-kickback laws by enriching physicians and creating detrimental conflicts of interest," he explained.

An effective compliance program can reduce the number and extent of possible FCA violations, the attorneys advised. In some cases, these programs can help persuade the government not to intervene. Volkov and Ruggio stressed the need for companies to be proactively committed to a culture of compliance, with clearly defined standards and procedures. "Healthcare organizations need to dedicate adequate resources to the compliance function," Ruggio noted. "The program must have a procedure for ongoing risk assessments, along with elements such as a written code of conduct. Likewise, the pro-compliance 'tone at the top' from senior management must be strong and clear."

The webinar covers topics such as the role of the Chief Compliance Officer, training and communication, internal reporting systems, discipline for violations, proper response as well as various whistleblower-related considerations. "Documentation and systematic measuring of program performance are important, but so, too, is clear-eyed risk-assessment," Volkov said. "When it comes to Medicare, for example, pay attention to the most significant risk centers on billing and coding of services for reimbursement. No one can review every bill or watch over every employee, but basic compliance principles can be adopted to minimize risks."

The full webinar is available as streaming audio at:

About LeClairRyan
As a trusted advisor, LeClairRyan provides business counsel and client representation in corporate law and litigation. In this role, the firm applies its knowledge, insight and skill to help clients achieve their business objectives while managing and minimizing their legal risks, difficulties and expenses.  With offices in California, Connecticut, Massachusetts, Michigan, New Jersey, New York, Pennsylvania, Virginia and Washington, D.C., the firm has approximately 350 attorneys representing a wide variety of clients throughout the nation.  For more information about LeClairRyan, visit


SOURCE LeClairRyan
Copyright©2012 PR Newswire.
All rights reserved

Related medicine technology :

1. Tougher Times May be Ahead for Biotechs: 1H12 Fundraising Slows
2. Polymedco Aligns with MedPrimex to Fight Colorectal Cancer in Mexico
3. Pharmacists United for Truth and Transparency Marks One Year Anniversary of Fighting Abuses by Pharmacy Benefits Managers
4. Back to School Ideas: Vaccines for Kids Could Hurt Rather Than Help Fight Disease
5. Global pharmaceutical industry calls for broad-based cooperation to fight online sales of counterfeit medicines around the world
6. Makers Of Over-the-Counter Inhaler Leading Fight To Have Product Back On Market After Removal Due To Environmental Treaty
7. Jazz Pharmaceuticals Announces Participation At The 2012 Morgan Stanley Global Healthcare Conference In New York On September 11
8. CVS Caremark to Present at Morgan Stanley Global Healthcare Conference
9. Boston Scientific to Participate in the 2012 Morgan Stanley Global Healthcare Conference
10. Frost & Sullivan Acknowledges the Value Dell Healthcare and Life Sciences Brings to the Enterprise Imaging Informatics Marketplace
11. Depomed To Present At Morgan Stanley 2012 Healthcare Conference
Post Your Comments:
(Date:11/26/2015)... Nov. 26, 2015 Research and Markets ... the "2016 Future Horizons and Growth Strategies ... Supplier Shares, Country Segment Forecasts, Competitive Intelligence, Emerging ... --> --> This ... the Italian therapeutic drug monitoring market, including emerging ...
(Date:11/26/2015)... DUBLIN , November 26, 2015 ... has announced the addition of the  ... in the European Cell Surface Marker ... Emerging Opportunities"  report to their offering.  ... announced the addition of the  "2016 ...
(Date:11/25/2015)... -- The total global healthcare industry is expected to grow at ... America has the highest projected growth at 12.7%, ... ), is second with growth projected at 11.5%. ... expenditure. In 2013-2014, total government funded healthcare was nearly 68%. ... 41.2% in 2013-2014. In real terms, out of pocket expenditure ...
Breaking Medicine Technology:
(Date:11/27/2015)... ... 2015 , ... The print component of “Supporting Our Caregivers” ... New York, Minneapolis, South Florida, with a circulation of approximately 250,000 copies and ... vast social media strategy and across a network of top news sites and ...
(Date:11/27/2015)... ... 2015 , ... A simply groundbreaking television series, "Voices in America", which is ... an array of issues that are presently affecting Americans. Dedicated to providing the world ... is changing the subjects consumers focus on, one episode at a time. , ...
(Date:11/27/2015)... Rosa, CA (PRWEB) , ... November 27, 2015 , ... ... Northern California Medical Associates, Inc. and Dr. Tucker Bierbaum with Emergency Medicine at ... meeting. They observed that both STEMI and Sepsis conditions present in similar ways and ...
(Date:11/26/2015)... ON (PRWEB) , ... November 26, 2015 , ... ... of a real-time eReferral system for diagnostic imaging in the Waterloo region. Using ... BMD and Nuclear Medicine tests directly from their electronic medical record (EMR) without ...
(Date:11/26/2015)... ... November 26, 2015 , ... ... process, participated in the 61st annual Employee Benefits Conference. The Employee Benefits Conference ... Sunday, November 8th through Wednesday, November 11th, 2015. The conference was held at ...
Breaking Medicine News(10 mins):