Compliance News Roundup: DOJ Update: “Evaluation of Corporate Compliance Programs”

1. Healthcare Service Provider to Pay $60 Million to Settle Medicare and Medicaid False Claims Act Allegations - A major U.S. hospital service provider, TeamHealth Holdings, as successor in interest to IPC Healthcare Inc., f/k/a IPC The Hospitalists Inc. (IPC), has agreed to resolve allegations that IPC violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed (a practice known as “up-coding”), the Department of Justice announced today. Under the settlement agreement, TeamHealth has agreed to pay $60 million, plus interest. Read more here: https://www.justice.gov/opa/pr/healthcare-service-provider-pay-60-million-settle-medicare-and-medicaid-false-claims-act

2. $5.5 Million HIPAA Settlement Shines Light on the Importance of Audit Controls - Memorial Healthcare System (MHS) has paid the U.S. Department of Health and Human Services (HHS) $5.5 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules and agreed to implement a corrective action plan. MHS is a nonprofit corporation which operates six hospitals, an urgent care center, a nursing home, and a variety of ancillary health care facilities throughout the South Florida area. Read more here: https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/memorial/index.html

3. DOJ publishes compliance document: “Evaluation of Corporate Compliance Programs” - “The DOJ recently published a document which provides some additional insight into their practices of evaluating compliance programs. Recall that back in November of 2015, the DOJ hired a full-time compliance expert, Hui Chen, to “help prosecutors develop appropriate benchmarks for evaluating corporate compliance and remediation measures and communicating with stakeholders in setting those benchmarks.” It seems consistent with the hiring of Chen that the DOJ would publish a document outlining the types of questions they want answers to regarding the effectiveness of an organization’s compliance program. The content of the document is consistent with other foundational documents that conscientious compliance officers have relied upon for years to assess the effectiveness of their compliance programs, including the United States Attorney’s Manual and the United States Sentencing Guidelines.”