June 1, 2011
Health care is on the forefront of national and local attention. The targeting of laboratories and other health care providers is driven by the perception that fraud is rampant in the health care system and must be eradicated.
The Patient Protection Affordable Care Act (PPACA), signed into law by President Obama March 2010, mandates that all healthcare providers to have a compliance program and raises the government’s financial commitment to fighting health care fraud in 2011 to $1.7 billion.
PPACA also toughens sentencing for criminal activity, enhances Medicare screening and enrollment requirements, encourages increased sharing of data across government, expands overpayment recovery efforts, and provides greater oversight of private insurance abuses.
For the period of October 2010 through March 2011, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently reported that it is expecting $3.4 billion in new recoveries.
PPACA comes on the heels of the Fraud Enforcement and Recovery Act (“FERA”), as well as the formation of Health Care Fraud Prevention and Enforcement Action Team (HEAT), an aggressive interagency task force created in May of 2009 by Attorney General Eric H. Holder Jr. and HHS Secretary Kathleen Sebelius, to combat Medicare and Medicaid fraud. Reports on the recent efforts of the HEAT team are provided in the HHS OIG’s Semiannual Report to Congress for Spring 2011(http://oig.hhs.gov/reports-and-publications/semiannual/index.asp).
According to lab industry attorney David Gee of Garvey Schubert Barer, “Health care providers must meet the current environment of heightened scrutiny and new laws by carefully assessing their compliance risks and then implementing strategies to control those risks.”
David Gee goes on to say, “Indeed, PPACA now mandates that providers implement and maintain a compliance program. Labs can no longer view a compliance plan as something that only the big labs do, or that can be postponed until they have the time and money. We strongly advise providers not only to satisfy the new legal requirements, but also to assure that their plans, policies and procedures actually enable them to manage the risks of regulatory compliance.”
Lessons Learned
- Compliance programs are now mandatory for laboratories that file claims with Medicare and other government payors.
- The government, under FERA and HEAT, is aggressively looking for fraud recovery opportunities from laboratories and other healthcare providers.
- Having an “effective” compliance program, focused on assessing compliance risks and implementing strategies to control those risks, can prepare laboratory providers to deal with the new laws and the current environment of heightened scrutiny.
LabPath professionals have a wealth of experience in assisting laboratories in implementing effective compliance programs and conducting audit assessments to identify and eliminate risks.
For questions concerning this LabPath News Alert and or the services available to assist laboratories in implementing and maintaining an “effective” compliance program, please email us at vasb@ynocngupbafhygvat.pbz or call us at 727-244-1150.