Long-Term Care: Training for Fraud, Waste and Abuse

11,343 individuals and entities have been excluded from participation in federal healthcare programs. The federal government has been awarded or negotiated over $6.8 billion in healthcare fraud judgments and settlements.

Tune into our on-demand webinar, Preparing Long Term Care Providers For 2017, to learn how to prevent compliance violations in your organization.

An example, Mark T. Conklin, the former owner, operator and sole shareholder of Recovery Home Care Inc. and Recovery Home Care Services Inc. (collectively RHC), agreed to pay $1.75 million to resolve a lawsuit alleging that he violated the False Claims Act by causing RHC to pay illegal kickbacks to doctors who agreed to refer Medicare patients to RHC for home healthcare services.

Rules are not made to be broken and those who forget history are doomed to repeat it. That’s why a solid compliance program with solid training are key to preventing violations. Part of compliance program training requirement is to train on fraud, waste and abuse.

Compliance programs have been incorporated into the SNF Requirements of Participation. Although not effective until phase 3 of implementation, developing and implementing a compliance program in advance of November 2019 is necessary. Compliance Programs take time and multiple rounds of revision and fine tuning. Additionally, a properly functioning Compliance Program should reduce the SNF’s risk for serious regulatory issues.

Eventually all Medicare providers will need to implement a compliance program. Managed Care organizations are required to obtain satisfactory evidence that their first tier, downstream and related entities have Compliance Programs in place or alternatively conduct Compliance Training based off of the MCO’s standards. Some acute hospitals will even conduct Compliance Program validations of their post-acute partners.

There must be governing body oversight of compliance activities. Governing body members must make reasonable inquiries into the state of compliance to make informed decisions about the state of the company’s compliance. Ignorance is definitely not bliss. Nobody wants to go from living a fantastic life one minute, to owing millions or going to jail the next.