Has your practice adopted a corporate compliance program? If not, now is the time to call your healthcare lawyer. That’s because if a proposed federal rule goes into effect a lot more money could be made available to catch those involved in fraud and abuse.
Health and Human Services Secretary Kathleen Sebelius just announced a proposal that would increase rewards for reporting fraud to $9.9 million. While that may sound like a lot, during the last three years the Obama administration has recovered nearly $15 billion in fraud, a big chunk of which came from individual whistleblowers.
Under the proposed changes, a person who provides specific information that leads to the recovery of money may be eligible to receive a reward of 15 percent of the amount recovered, up to nearly $10 million. HHS currently offers a reward of 10 percent up to $1,000 under the current reward program.
With that kind of money on the line, it could become more worthwhile and draw more potential whistleblowers from the woodwork.
Because of that Medicare providers and suppliers should adopt a strict corporate compliance program establishing a culture of compliance or risk the possibility of becoming the target of someone seeking a reward.
Current, future, and former employees, competitors, customers/patients, and vendors not only are potential but the most likely whistleblowers. And it’s not hard. It does not require that a whistleblower case be filed in federal court. They only need to provide useful information and then apply for the reward.
In addition to increasing reward compensation, the proposed rule would also strengthen certain provider enrollment provisions including allowing HHS to deny enrollment of providers who are affiliated with an entity that has unpaid Medicare debt, deny or revoke billing privileges for individuals with felony convictions, and revoke privileges for providers and suppliers who are abusing their billing privileges.
Providers and suppliers who receive reimbursement from Medicare should contact their legal counsel to review their current or proposed business arrangements and discuss the creation and implementation of a formal compliance plan. It could help them avoid becoming a target.
HHS issued a fact sheet on the proposed rule that further outlines the reward program proposals.