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Fraud & Abuse Update: 2018 National Health Care Fraud Takedown

As a firm that has been serving health care clients and business throughout Texas and the U.S. for over 26 years, our team at Hendershot, Cannon & Hisey, P.C. has seen drastic changes in the regulation of health care fraud and abuse. As the industry and laws surrounding fraud constantly evolve, government agencies expand and improve upon their investigatory and enforcement actions, and penalties are heightened, the need to ensure regulatory compliance has become a more complex and important task.

By staying apprised of the latest developments in health care involving waste, fraud, and abuse, our attorneys are able to provide the insight-driven counsel and representation clients need – both proactively before problems arise, and responsively following high stakes audits, investigations, and allegations.

Though we are well aware of the challenges associated with compliance and defense, as well as the ongoing efforts of regulators and law enforcement, we want to underscore their importance to practitioners, medical groups, and health care business professionals. One way to achieve this is by providing fraud and abuse updates.

2018 National Health Care Fraud Takedown

Earlier this year, state and federal law enforcement, along with Office of Inspector General of the Department of Health and Human Services’ (HHS), participated in an unprecedented fraud enforcement program. The 2018 National Health Care Fraud Takedown, was a large-scale state and federal partnership endeavor which focused on combatting fraud, as well as offenses involving opioids.

True to its aggressive name, the takedown program was the largest multi-agency health care enforcement operation in nation’s history, in terms of both damages sustained by the government and the number of defendants charged for their participation in health care fraud and abuse schemes. A recently released report speaks to the massive scope of the operation.

Here are some key statistics released by the OIG about its 2018 Takedown:

  • Over 600 defendants were charged for health care fraud and abuse offenses, including 165 medical professionals and 32 physicians charged in connection to the prescription and distribution of opioids and other dangerous controlled substances.
  • The takedown involved defendants from nearly 60 federal districts who were allegedly involved in schemes that resulted in more than $2 billion in damages to health care programs.
  • The operation involved over 1,000 law enforcement personnel, including over 350 agents from the OIG, and thirty Medicaid Fraud Control Units.
  • Since the previous takedown operation in June of 2017, the Office of Inspector General issued nearly 590 notices of federal health care program exclusion to entities and individuals involved in opioid-related schemes. That figure included over 400 nurses, 67 physicians, and 40 pharmacy services.

The federal government publishes reports like these not only to educate taxpayers and the public or to justify spending, but to send a severe and strong message that they are heavily focused on fighting health care fraud and abuse, and intent on taking offenders down.

Fraud & Abuse Compliance: More Important Than Ever

Complying with the law has never been unimportant, but amid today’s increasingly aggressive and sophisticated enforcement atmosphere, the stakes are certainly much higher. Because state and federal agencies now share information to enhance their data analysis and better spot fraud and abuse, work collaboratively during investigations, and enjoy more resources, physicians and other health care providers and businesses need to understand the risks of being audited, investigated, and charged are higher today than they have even been – as are the penalties.

For these reasons, it’s important for those in the health care industry, and particularly those who deal with referrals for items and services paid by the federal health care programs, to take actionable steps in ensuring their compliance. A few tips and reminders to keep in mind include:

  • Having a compliance plan doesn’t ensure compliance – providers must conduct internal audits and implement and maintain complete and comprehensive written policies that govern and actively monitor any billing practices, transactions, and contractual relationships.
  • For those who face audits, do not modify or destroy requested records. Enlist the support of experienced professionals who can help you comply with audits while protecting your rights and limiting risks for further enforcement action.
  • Following any notice of an audit or investigation, or when the OIG comes knocking at your door, seek immediate counsel and representation from proven health care fraud attorneys.
  • Compliance needs to be a priority. Fraud and abuse laws like the Anti-Kickback Statute, False Claims Act, and Stark Law, as well as state-based laws against health care fraud, can pose devastating penalties.

Hendershot, Cannon & Hisey, P.C. is a Houston-based law firm with a reputation for our extensive knowledge and experience in matters involving health care regulatory compliance and health care fraud defense. If you would like to discuss our services and how we can assist you with creating a comprehensive compliance plan or implementing a responsive defense strategy, call (713) 909-7323 or complete an online case evaluation form.

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