We’re back for Episode 5 of Compliance Deconstructed and today, Jessica Zeff, Lorie Davis, and Elvan Baker explore how recent fraud investigations and emergency response funding missteps impact healthcare compliance. They emphasize the importance of understanding fraud, waste, and abuse regulations to reduce risk and protect patient care quality.

Throughout this conversation, the ladies discuss the Department of Justice’s investigation into United Healthcare for alleged upcoding practices to inflate reimbursements. This case highlights the critical need for transparency and the potential consequences of manipulating patient data.

Even smaller providers are subject to the same level of scrutiny from regulatory bodies like the DOJ and OIG. Real-life examples show how individual practitioners have faced prison time for submitting fraudulent claims, reinforcing the importance of personal accountability.

Proactive compliance is a recurring theme, including tips for building a compliance work plan and reviewing the OIG Work Plan regularly. This episode addresses the significance of emergency preparedness, especially when handling federal funds during crises like the COVID-19 pandemic.

Key Takeaways:

• United Healthcare is under DOJ investigation for alleged upcoding and Medicare fraud.
• Fraud, waste, and abuse violations can lead to substantial penalties and reputational harm.
• Small providers and individual clinicians are not exempt from regulatory oversight.
• Proactive auditing and documentation demonstrate compliance intent to regulators.
• Emergency preparedness must include clear protocols for managing relief funds.
• Creating and maintaining a compliance work plan helps identify and mitigate organizational risk.
  
  

Learn more about Healthcare Compliance and discover how Simply Compliance can help your company at simplycomplianceconsulting.com.