Those of you who have been following my work on the Healthicity blog, my webinars and/or speaking engagements know that one of my topics of choice is the government's increased efforts to hold individuals, not just organizations, accountable for suspected non-compliance.
Generally speaking, financial settlements with organizations tend to be announced first and announcements against individuals announced later. This same pattern seems to hold true in the Tenet/Clinica de la Mama settlement announced last year in October of 2016, which I blogged about then.
In that settlement, the dollar amount agreed upon exceeded $510 million and was the result of a whistleblower lawsuit. In his complaint, the whistleblower alleged that the hospital was paying kickbacks to Clinica de la Mama which was a clinic catering to undocumented Hispanic women for maternity care services. Clinica would steer patients for delivery services to the hospitals that paid them kickbacks. The Chief Operating Officer of Clinica pleaded guilty. Clinica told patients they would need to deliver their babies in the hospitals identified by Clinica. If patients questioned being required to deliver at the named hospital, Clinica told them that their Medicaid applications were more likely to be accepted if they delivered at the hospital recommended by Clinica. To disguise the kickbacks, the payments were hidden in a contract for Spanish interpreters and patient Medicaid eligibility determination services. These allegations were the main impetus behind the settlement.
A year later, in addition to previous actions taken against some of the individuals allegedly involved, it was just announced that more indictments were returned on Sept. 26, 2017 against a former executive of a Tenet hospital along with a clinic owner and operator. Bill Moore, 61 of John’s Creek, Georgia and Edmundo Cota, 64, of Dunwoody, Georgia are being charged with conspiracy to defraud the United States and pay and receive health care bribes, falsifying corporate books and records, and receiving health care bribes among others.
In January of 2017, charges were brought against John Holland, 60, of Dallas, Texas. He had served as a senior vice president of operations for Tenet Healthcare Corporation’s Southern States Region and as chief executive officer of North Fulton Medical Center, Inc., in Roswell, Georgia. This newly announced indictment brought new charges against Holland as well.
The Department of Justice appears to be holding true to their promises of going after individuals they feel are the bad actors of corporate or organizational wrong-doing. They announced this intention with the Yates Memo back in Sept. of 2015 and as we predicted the DOJ under the new administration would continue that emphasis.
Effective compliance programs can help avoid both the organizational settlements as well as the individual wrong-doing. No compliance program is perfect, there are bound to be missteps, even in organizations with the best compliance programs, but one way to demonstrate that your organization and individuals are committed to proper conduct is to financially support and implement an effective compliance program.