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CEOs Get a Medicare Compliance Checklist

Dom Nicastro, for HealthLeaders Media, January 29, 2013

Since its inception in March 2007, the Medicare Fraud Strike Force has charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion.

The fraud agents are not done, however, one healthcare leader warns.

"The government Medicare enforcement agents are under added pressure to increase their fraud recoveries," says Roy Snell, CEO of the Health Care Compliance Association in Minneapolis.

"The pressure has increased due to the cost of healthcare reform and concerns about addressing the deficit. The list of Medicare compliance issues you should be concerned about are too long to list, but they are outlined in detail in the Office of Inspector General’s annual Work Plan."

The Medicare Fraud Strike Force was in full force just a short three months ago. A seven-city operation, part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), led to charges against 91 individuals including doctors, nurses and other licensed medical professionals for participating in Medicare fraud schemes involving approximately $429.2 million in false billing.

CEOs can ensure their organizations' compliance programs are functioning as intended by following these guidelines:

1.Hire experienced compliance professionals. "It’s very simple," Snell says of a healthcare CEO’s role in compliance. "Hire an experienced compliance professional to manage a comprehensive compliance program and give him/her the independence and authority to fix the problems he/she finds. Increasing the compliance resources is helpful, but without the freedom to prevent, find and fix fraud, the CEO will always be facing an uphill battle."

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