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Feds Use Tougher Tactics To Fight Healthcare Fraud
Date:9/7/2012

ve 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
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SOURCE LeClairRyan
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