Compliance News Roundup: Diving Into A CIA Part 2: Written Standards And Training

1. Justice Department Recovers Over $4.7 Billion From False Claims Act Cases in Fiscal Year 2016 - “The Department of Justice obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016 ending Sept. 30, Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division, announced today. This is the third highest annual recovery in False Claims Act history, bringing the fiscal year average to nearly $4 billion since fiscal year 2009, and the total recovery during that period to $31.3 billion.” Read more here: https://www.justice.gov/opa/pr/justice-department-recovers-over-47-billion-false-claims-act-cases-fiscal-year-2016

2. Administrator of Miami-Area Home Health Agency Convicted of Conspiracy to Commit $2.5 Million Medicare Fraud Scheme - “The administrator of a Miami-area home health agency was convicted today for his role in a $2.5 million Medicare fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Division and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.” Read more here: https://www.justice.gov/opa/pr/administrator-miami-area-home-health-agency-convicted-conspiracy-commit-25-million-medicare

3. DEEPER THAN THE HEADLINES: DIVING INTO A CIA PART 2: WRITTEN STANDARDS AND TRAINING - “The radiology practice was given 90 days after the effective date of the CIA to develop and implement written policies and procedures regarding the operation of its compliance program. It’s one thing to write policies and another to implement them. I’ve reviewed many organizations’ compliance policies and they read beautifully. But have those policies been disseminated, digested and put into practice by the frontline employee who is ultimately the individual involved in the activity the policy is trying to address?

“For example, your organization has a policy that it will follow all Medicare payment and reimbursement policies such as Local Coverage Determinations (LCDs) published by the Medicare Administrative Contractor (MAC). That sounds great in the policy but are those involved in the operations reading and following those LCDs? Your policy said you would. This means the clinicians who order, provide and document clinical services are aware of the LCD and understand it. It also means the coders and billers are aware of the LCD requirements and not just trying to get claims paid, but rather trying to get them paid in compliance with the written requirements of the LCD? Just because something was paid, doesn’t mean it should have been paid.” Read more here: Deeper Than the Headlines: Diving Into a CIA Part 2: Written Standards and Training