Compliance News Roundup - Reputational Risk

1. Former CEO of Hospital Chain to Pay $3.46 Million to Resolve False Billing and Kickback Allegations – “Gary D. Newsome, former CEO of Health Management Associates LLC (HMA), a hospital chain that was headquartered in Naples, Florida, has agreed to pay the United States $3.46 million to settle allegations that he caused HMA to knowingly submit false claims to government health care programs by admitting patients who could have been treated on a less costly, outpatient basis, the Department of Justice announced. The settlement also resolves allegations that Newsome caused HMA to pay remuneration to the Emergency Department (ED) physicians in return for referrals.” Get the full scoop >>

2. Ashland Cardiologist Sentenced to 60 Months for Health Care Fraud and False Statements – “Late yesterday, Ashland cardiologist Dr. Richard E. Paulus was sentenced, by U.S. District Court Judge David L. Bunning, to serve 60 months in federal prison for health care fraud and false statements. In October 2016, a federal jury convicted Paulus, 71, of one count of health care fraud and ten counts of making false statements relating to health care matters, after hearing evidence that Paulus defrauded Medicare, Medicaid, and private insurers, by implanting medically unnecessary stents in his patients and falsifying the degree of stenosis in their medical records. After the trial, the district court granted Paulus’s motion for an acquittal. The Sixth Circuit Court of Appeals later reversed that decision, on June 25, 2018, and reinstated Dr. Paulus’s conviction, resulting in his formal sentencing.” Get the full scoop >>

3. Deeper Than the Headlines: Reputational Risk – “As compliance officers, we assess and discuss risks. We talk about fines and penalties, burdensome integrity agreements or even potential exclusion from government health programs like Medicare or Medicaid. Sometimes we even talk about reputational risk. This is especially important for entities that rely heavily on their reputation or place within the community. Even though we discuss reputational risk, it probably isn’t our number one focus despite the fact that our organizations could benefit from addressing reputational risk. Check out this week’s DTH’s post to find out how. Get the full scoop >>